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Archive for the ‘Trauma’ Category

Massive Transfusion

As promised, see the attached Massive Transfusion Protocol Final.

Some important points are highlighted. The guideline for when a patient might need the MTP is:
· one blood volume transfusion over 24 hours,

· 50% blood volume in 3 hours

· ongoing blood loss >150 ml/min

· expected >10 pRBC units in 24 hours

Most of all, please remember, there are TWO ways to get emergent blood and they are both done by a PHONE CALL to the blood bank:
· Emergent release of blood

o This could be o-neg or type specific uncrossed blood.

o Be aware you might get O-pos blood for men and women over child-bearing years.

o Use this for unstable bleeding patients who need blood ASAP, but don’t meet the above MTP criteria

· Massive Transfusion

o Use this for patients meeting the above criteria.

o The blood bank will put an order into Epic saying which products were sent.

Pleased send a reply to me indicating that you have read and understand the policy.

Peter Shearer, MD FACEP

Written by phil

March 17th, 2014 at 3:11 pm

PCC Study Synopsis

Written by phil

August 16th, 2010 at 7:48 pm

Sinai Trauma Policy

Goal: To expedite treatment of unstable trauma victims in the ED.

Management:

At the discretion of the ED attending, the admitting surgical resident can be summoned to the ED by page and, if necessary, by overhead, as well as any surgical specialties that may be required.
If there is need for a rapid institutional response, telecommunications/(the page operator) can be notified for a “Trauma Team”. This will not be an overhead page. Rather, telecommunications will then notify the surgical resident on call as well as the Anesthesia, Cardiothoracic surgery on call, Neurosurgery, and Orthopedics.
Any procedures in the ED will be under the supervision of the ED attending. Once the patient is admitted, management may be taken over by the surgical attending if present.
Disposition:
Patients will be admitted by the ED attending to the most appropriate service in consultation with the attending of that service. If the patient has multi-system/service trauma, he/she will be admitted to the General Surgery admitting team for 24 hours if necessary. The patient may then be transferred to the service caring for the most severe injury if all other injuries are stable after 24 hours.

Written by phil

May 7th, 2009 at 5:44 am

Posted in ED Guidelines,Trauma

Chest Tube Drain Tutorial

Written by reuben

December 4th, 2008 at 5:38 am

Posted in Trauma

Spinal Cord Injury Protocol

We are the spinal injury receiving center for the Jets and the protocol has them coming thru the ED. I have attached a brief synopsis. Talk to Amish or Sigrid about this weekend experience and see Amish on You Tube towards the end of the recording.

Jets Spinal Injury Protocol.

MSH has a new protocol with the jets medical team through Dr Andrew Hecht of orthopedics (spine) to handle all Jets home game player spine injuries. Below is a summary.

On-Field Medical team:
Emergency Physician
Team doctor
Paramedics
Trainer

On Field Capabilities:
RSI Intubation
ACLS
Immobilization
Plain film imaging
Clear spinal injuries will have no imaging before transport

Transport by on-field medical team by ground:
BP control to prevent hypotension
High dose steroids (emcrit)
Hypothermia not part of protocol at this point.

Notification to MSH Upon transport from stadium:
MSH ED: ED Director, A Jagoda, and North attending
Dr. Andrew Hecht of spine ortho or designee
Neurosurgery
Radiology

Arrival at Mount Sinai ED
To be overseen by ED attending on duty
Will be a coordinated multidisciplinary attending driven effort.
There may be public and media attention
Jets PR people will handle all media relations

Written by phil

September 29th, 2008 at 8:33 pm

Posted in ED Guidelines,Trauma

Trauma Policy

Written by reuben

September 11th, 2008 at 9:20 pm

Posted in ED Guidelines,Trauma