THE TRAUMA CAPTAIN CAN HAVE A BIG IMPACT!
-Good trauma rescucitation can have large impact on outcomes
-Good rescuc should be organized, quiet, and rapid
-Simulation important, ATLS compliance increased 56% to 83%, procedure completion time reduced
-Review and understand the established protocols for trauma
Before a CODE
-Check code criteria and establish if appropriate personnel present
-Assign roles: airway, procedures, ultrasound.
-Anticipate possible procedures and prepare drugs/equipment
-Set expectations prior to arrival of pt - expected time to completion of code/rescucitation
-Be Loud and Calm
At the CODE
-Establish your leadership - "Everybody listen up"
-Move patient after medic report
-ABCs, primary and secondary survey, monitoring, lab studies
-Continually articulate the plan and ultimate disposition. "Why are we still here?"
-Feel them feet
-Where's the blood? External, chest, abdomen, thighs, retroperitoneum
-Pain control: Caution if shock, AMS, elderly
-No drama, quiet, can betray how sick they are
-Low reserve, normal VS until crash
-Get a lactate, liberal CT scanning
-Admit these patients
Pre-CT check list
-CT is a dark place where trauma patients go to die
-Before CT, do you Need ET tube? Chest tube? Pelvic binder? Tourniquet? Splints?
-Do they really need CT, or do they need OR, angiography, or transfer?