Non-Operative Trauma/Major Organ Trauma and Resuscitation Review Committee for Surgery

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Non-Operative Trauma/Major Organ Trauma and Resuscitation Review Committee for Surgery Major Organ Trauma, No Operation Required (MOTNOR) The CPT code for recording non-operative trauma is 99199. Guidelines include: • The category “major organ trauma, no operation required” is defined as patients with major organ trauma who were admitted to a specialty care unit in the hospital, i.e., SICU, CCU, Burn Unit, etc. • The most senior resident on the trauma service should claim credit for the MOTNOR case. • If the patient subsequently requires a general surgery operative procedure that may be claimed in the defined category. Non-Operative Trauma-Team Leader Resuscitation The CPT code for recording Team Leader Resuscitation under Non-Operative Trauma is 92950. Guidelines include: • The subcategory of Team Leader Resuscitation is defined as the team leader directing the management of a patient who has sustained trauma and is critically-ill from injury. • Critical illness includes a range of conditions, including shock due to hemorrhage with resulting hypovolemia/fluid loss, organ injury, obstructive physiology due to pneumothorax, cardiac tamponade, etc. • Because no current CPT code exists to report Non-Operative Trauma-Team Leader Resuscitation, the Case Log System uses CPT code 92950 (Cardiac Arrest with Cardiopulmonary Resuscitation) to aid in the search function when logging this procedure. Cardiac arrest and/or CPR is NOT required for the resident to log Non- Operative Trauma-Team Leader Resuscitation. 06/2019 ©2019 Accreditation Council for Graduate Medical Education (ACGME) .

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Title: ED Trauma: Trauma Nurse Clinical Resuscitation

Title: ED Trauma: Trauma Nurse Clinical Resuscitation Document Category: Clinical Document Type: Policy Department/Committee Owner: Practice Council Original Date: Approved By (last review): Director of Emergency Services, Approval Date: 07/28/2014 Trauma Medical Director, Medical Director Emergency (Complete history at end of document.) Services POLICY: To provide immediate, effective and efficient patient care to the trauma patient, designated nursing staff will respond to the trauma room when a trauma page is received. TRAUMA CONTROL NURSE: 1) Role: a) The trauma control nurse (TCN) is a registered nurse (RN) with specialized training in the care of the traumatized patient, and who will function as the trauma team’s lead nurse. b) The TCN shall have successfully completed the Trauma Nurse Core Course (TNCC), Advanced Cardiac Life Support (ACLS), Emergency Nurse Pediatric Course (ENPC) or Pediatric Advanced Life Support (PALS), and role orientation with trauma services. c) Full-time employee or regularly scheduled part-time Emergency Department (ED) nurse. d) RN must have 6 months of LMH ED experience. 2) Trauma Control Duties: a) Inspects and stocks trauma room at beginning of each shift and after each trauma patient is discharged from the ED. b) Attempts to maintain trauma room temperature at 80-82 degrees Fahrenheit. c) Communicates with pre-hospital personnel to obtain patient information and prior field treatment and response. d) Makes determination that a patient meets Type I or Type II criteria and immediately notifies LMH’s Call System to initiate the Trauma Activation System. e) Assists physician with orders as directed. f) Acts as liaison with patient’s family/law enforcement/emergency medical services (EMS)/flight crews.
Management of Acute Liver Failure In

Management of Acute Liver Failure in ICU Philip Berry MRCP, Clinical Research Fellow, Institute of Liver Studies, Kings College Hospital, London, UK Email: [email protected] Self assessment questions Scenario: A twenty-year-old female is brought into the Emergency Department having been found unconscious in her bedsit. There is no other recent history. She did not respond to a bolus of 50% dextrose in the ambulance, despite having an unrecordable blood glucose when tested by the paramedics. While she is being intubated on account of reduced level of consciousness, an arterial blood gas sample reveals profound lactic acidosis (pH 7.05, pCO2 2.5 kPa, base deficit – 10, lactate 13 mg/L). Blood pressure is 95/50 mmHg. 1. What are the possible explanations for her presentation? Laboratory tests demonstrate hepatocellular necrosis (AST 21,000 U/L) and coagulopathy (INR 9.1) with thrombocytopenia (platelet count 26 x 109/L). Acute liver failure appears the most likely diagnosis. 2. What are the most likely causes of acute liver failure (ALF) in this previously well patient? Her mean arterial blood pressure remains low (50mmHg) after 3 litres of colloid and crystalloid. The casualty nurse, who is doing half-hourly neurological observations, reports reduced pupillary response to light. 3. What severe complications of ALF may result in death within hours, and what are the immediate management priorities for this patient? Introduction Successful management of this rare but potentially devastating disorder relies on early recognition. The hallmark of acute liver failure (ALF) is encephalopathy (ranging from a subtle alterations in consciousness level to coma) in the context of an acute, severe liver injury.
Guidelines for Trauma Team Activation (TTA)

Guidelines for Trauma Team Activation (TTA) ONE of the following criteria must be present with associated traumatic mechanism L e v e Measure Vital Signs and level of consciousness l Trauma Team Activation ALL TTA 1 & 2's MUST BE TRANSPORTED TO RGH Rural Travel time greater than 1 hour, failed airway · Glasgow Coma Scale less than 13 or immediate life threat divert to local facility and · Systolic Blood Pressure less than 90mmHg arrange STAT transport to RGH Trauma Center · Respiratory Rate less than 10 or greater then 29 breaths Prehospital per minute (less than 20 in infant), or advanced airway · Assess patient and determine TTA Level 1 support required · Early activation to receiving facility with: TTA Level, MIVT Report, ETA · STARS Activation or ALS (ACP) intercept NO · Update facility as needed Yes · Transport to Trauma Center Assess anatomy of injury Triage Nurse · Alert TTL Physician with TTA level, MIVT Report, ETA · TTL has a 20min response time · All penetrating injuries to head, neck, torso, and · Alert switchboard to overhead page: extremities proximal to elbow or knee Trauma Level ‘#’ ETA · Chest wall instability or deformity (e.g. flail chest) Trauma Team Lead · Two or more proximal long-bone fractures · Update ER on incoming Rural Trauma patients · Crushed, degloved, mangled, pulseless or amputation · Assume lead role and MRP status of an extremity proximal to wrist or ankle · Prepare resuscitation team · Pelvic fractures (high impact) · Assess, Treat and Stabilize patient 2 · Major facial or head trauma including depressed/open
Validation of Lactate Clearance at 6 H for Mortality Prediction in Critically Ill Children

570 Research Article Validation of lactate clearance at 6 h for mortality prediction in critically ill children Rajeev Kumar, Nirmal Kumar Background and Aims: To validate the lactate clearance (LC) at 6 h for mortality Access this article online prediction in Pediatric Intensive Care Unit (PICU)-admitted patients and its comparison Website: www.ijccm.org with a pediatric index of mortality 2 (PIM 2) score. Design: A prospective, observational DOI: 10.4103/0972-5229.192040 study in a tertiary care center. Materials and Methods: Children <13 years of age, Quick Response Code: Abstract admitted to PICU were included in the study. Lactate levels were measured at 0 and 6 h of admission for clearance. LC and delayed or nonclearance group compared for in-hospital mortality and compared with PIM 2 score for mortality prediction. Results: Of the 140 children (mean age 33.42 months) who were admitted to PICU, 23 (16.42%) patients died. For LC cut-off (16.435%) at 6 h, 92 patients qualified for clearance and 48 for delayed or non-LC group. High mortality was observed (39.6%) in delayed or non-LC group as compared to clearance group (4.3%) (P = 0.000). LC cut-off of 16.435% at 6 h (sensitivity 82.6%, specificity 75.2%, positive predictive value 39.6%, and negative predictive value 95.7%) correlates with mortality. Area under receiver operating characteristic (ROC) for LC at 6 h for mortality prediction was 0.823 (P = 0.000). The area under ROC curve for expected mortality prediction by PIM 2 score at admission was 0.906 and at 12.3% cut-off of PIM 2 Score was related with mortality.
Package for Emergency Resuscitation and Intensive Care Unit

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Anytown Trauma Center Trauma Protocols

ANYTOWN TRAUMA CENTER TRAUMA PROTOCOLS TITLE: TRAUMA TEAM ACTIVATION PROTOCOL PURPOSE: The purpose of the protocol is to establish guidelines for trauma team activation and define the members of the responding trauma team to facilitate the resuscitation and management of critical or seriously injured patients who require rapid, organized resuscitation, evaluation and stabilization to promote optimal outcomes. It also serves to provide triage guidelines for adult and pediatric patients. PROCESS: 1. TRAUMA TEAM ACTIVATION PROTCOL A. The criteria for activation of the trauma team is clearly defined and posted at the Emergency Department triage desk, by the EMS communication station and in the resuscitation rooms. B. The trauma team may be activated prior to arrival based on the EMS communication and their assessment. C. The trauma surgeon, emergency medicine physician, emergency department charge nurse/ house supervisor, emergency department nurses and the Trauma Program Manager may activate the trauma team. D. The person calling the trauma activation will initiate the trauma page to group page the trauma team and will specify the MOI, BP, HR, ETA and level of activation required and age if available. E. If the trauma team members are present in the emergency department and alert is still communicated to ensure everyone is notified. F. Trauma team member notification and arrival times will be documented on the trauma flow sheet (paper or electronic). G. Trauma team members will sign-in when they arrive. H. Trauma team members will be activated for all patients who meet the following criteria: 1. Level 1 trauma activation (major): life threatening injuries and/or unstable vital signs, limb-threating or disability threatening injury 2.
Central Venous Catheter (CVC) Placement

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Chapter 1 - Trauma Team from Prehospital Through the Emergency Department Test Questions

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Mass Casualty Incident (MCI) Response Module 1

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Basic Trauma Overview - ABC

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Trauma Resuscitation and the Damage Control Approach

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Early Acute Management in Adults with Spinal Cord Injury: a Clinical Practice Guideline for Health-Care Professionals

SPINAL CORD MEDICINE EARLY ACUTE EARLY MANAGEMENT Early Acute Management in Adults with Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals Administrative and financial support provided by Paralyzed Veterans of America CLINICAL PRACTICE GUIDELINE: Consortium for Spinal Cord Medicine Member Organizations American Academy of Orthopaedic Surgeons American Academy of Physical Medicine and Rehabilitation American Association of Neurological Surgeons American Association of Spinal Cord Injury Nurses American Association of Spinal Cord Injury Psychologists and Social Workers American College of Emergency Physicians American Congress of Rehabilitation Medicine American Occupational Therapy Association American Paraplegia Society American Physical Therapy Association American Psychological Association American Spinal Injury Association Association of Academic Physiatrists Association of Rehabilitation Nurses Christopher and Dana Reeve Foundation Congress of Neurological Surgeons Insurance Rehabilitation Study Group International Spinal Cord Society Paralyzed Veterans of America Society of Critical Care Medicine U. S. Department of Veterans Affairs United Spinal Association CLINICAL PRACTICE GUIDELINE Spinal Cord Medicine Early Acute Management in Adults with Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Providers Consortium for Spinal Cord Medicine Administrative and financial support provided by Paralyzed Veterans of America © Copyright 2008, Paralyzed Veterans of America No copyright ownership