Assessing TBI in the Field: NorthBay Healthcare Level II Trauma - - PowerPoint PPT Presentation

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Assessing TBI in the Field: NorthBay Healthcare Level II Trauma - - PowerPoint PPT Presentation

Mar 31, 2024 409 likes •818 views

Assessing TBI in the Field: NorthBay Healthcare Level II Trauma Center Hospital to Home NorthBay Ambulance Bay NorthBay Ambulance Bay Pre-hospital Delivery Pre-hospital report - Basic trauma information - Vital signs

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SLIDE 1

Assessing TBI in the Field:

NorthBay Healthcare Level II Trauma Center “Hospital to Home”

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SLIDE 2

NorthBay Ambulance Bay

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SLIDE 3

NorthBay Ambulance Bay Pre-hospital Delivery

  • Pre-hospital report
  • Basic trauma information
  • Vital signs
  • Transportation code (2 or 3)
  • ETA
  • 5-minute “Ring Down”
  • Patient unloading
  • Nursing Care
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SLIDE 4

Emergency Department Entrance

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SLIDE 5

Emergency Department Entrance

Patient Arrival

  • Trauma level
  • Full vs Limited
  • Announcement
  • Trauma Bay selection
  • Crowd control
  • Security
  • Resource response
  • Lab / Radiology / Personnel
  • Nursing Care
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SLIDE 6

NorthBay Trauma Bay

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SLIDE 7

NorthBay Trauma Bay Initial Patient Contact

  • Pre-hospital report
  • Detailed trauma information
  • Initial evaluation
  • Primary & Secondary surveys
  • Vital signs
  • Oxygen
  • Warming
  • Lab / Imaging
  • FAST exam
  • Nursing Care
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SLIDE 8

Trauma Bay Transfusion Equipment

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SLIDE 9

Trauma Bay Transfusion Equipment

Resuscitation

  • Multiple large gauge IV’s
  • Rapid fluid infusers
  • Fluid warmers
  • Blood Refrigerator (O-)
  • MTP
  • Massive transfusion protocol
  • TXA
  • Tranexamic acid
  • “Stop the Bleed”
  • Nursing Care
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SLIDE 10

Trauma Bay Supply Carts

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SLIDE 11

Trauma Bay Supply Carts Procedures

  • Endotracheal tube
  • Nasogastric/Orogastric tube
  • Central venous catheter
  • Intraosseous catheters (IO)
  • Foley catheter
  • Chest tube(s)
  • Thoracotomy tray
  • Minor surgical tray
  • Splints / Immobilizers
  • Nursing Care
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SLIDE 12

Trauma Surgeon Computer

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SLIDE 13

Trauma Surgeon Computer

  • Antibiotics
  • Pain medications
  • Tetanus
  • Wound care / dressings
  • Trauma admission order set
  • Level of care
  • Nursing care
  • Medications
  • Consultations

Patient Care

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SLIDE 14

CT Scanner

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SLIDE 15

CT Scanner Diagnostic Tests

  • CT scans +/- contrast
  • Head / Maxillofacial
  • Cervical
  • Chest
  • Abdomen / Pelvis
  • Extremities
  • CT Angiograms
  • Ultrasound
  • MRI
  • Nursing Care
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SLIDE 16

Surgical Operating Suite

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SLIDE 17

Surgical Operating Suite Surgical Intervention

  • Trauma
  • Cardiothoracic
  • Abdominal / Pelvic
  • Vascular
  • Neurosurgery
  • Orthopedic
  • Maxillofacial / Plastics
  • ENT
  • Urology
  • Nursing Care
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SLIDE 18

Intensive Care Unit Room

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SLIDE 19

Intensive Care Unit Room Inpatient Care

  • Physicians / Consultants
  • Multidisciplinary teams
  • Physical therapy (PT/OT)
  • Respiratory therapy
  • Dietary
  • Social services
  • Case management
  • Nursing care
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SLIDE 20

Discharge Transportation

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SLIDE 21

Discharge Transportation Disposition

  • Home
  • Skilled Nursing Facility
  • Acute Rehab Facility
  • Transitional Housing
  • Other Healthcare Facilities
  • Tertiary Centers
  • Pre-paid Health Plan
  • Long Term Neuro Care
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SLIDE 22

CASE PRESENTATION

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SLIDE 23

NorthBay Ambulance Bay Pre-hospital Delivery

  • Pre-hospital report
  • 31 y/o M: GSW to head and

left forearm

  • Vitals: P=160, BP=140/p,

R=30, GCS=10

  • Transportation: Code 3
  • ETA: 20 minutes
  • 16 minute “Ring Down”
  • No change in condition
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SLIDE 24

Emergency Department Entrance

Patient Arrival

  • Trauma level: Full
  • Trauma surgeon, emergency

physician, anesthesia, ED/OR personnel

  • Overhead announcement
  • Trauma Bay #3
  • Security: lock down / “RENO”
  • Resource response
  • Lab / Radiology / Personnel
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SLIDE 25

NorthBay Trauma Bay Initial Patient Contact

  • Pre-hospital report
  • + right sided weakness
  • Initial evaluation
  • Open wound to head + blood
  • Vitals: P=112, BP=134/99,

R=21, GCS=8

  • Oxygen
  • Warming
  • Lab / Imaging
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SLIDE 26

Trauma Bay Transfusion Equipment

Resuscitation

  • Multiple large gauge IV’s
  • IV Fluid: NS 1 liter
  • No MTP
  • TXA given
  • “Stop the Bleed”
  • Pressure dressings applied

to head and arm wounds

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SLIDE 27

Trauma Bay Supply Carts Procedures

  • Endotracheal tube
  • Ventilator
  • Orogastric tube
  • Foley catheter
  • Cervical collar
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SLIDE 28

Trauma Surgeon Computer Patient Care

  • Antibiotic: Ancef
  • Pain medication: Fentanyl
  • Tetanus
  • Wound care / dressings
  • Trauma admission order set
  • Level of care: ICU
  • Medication: Mannitol
  • Consultations:

Neurosurgery / Intensivist

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SLIDE 29

CT Scanner Diagnostic Tests

  • CT scans w/o contrast
  • Head
  • Cervical
  • Chest X-Ray
  • Left Forearm X-Ray
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SLIDE 30
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SLIDE 31
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SLIDE 32

Surgical Operating Suite Surgical Intervention

  • Neurosurgery
  • 5/28: right partial

craniectomy, evacuation of SDH and duraplasty, ICP monitor placed

  • 5/29: left partial

craniectomy, evacuation of SDH and duraplasty

  • 6/3: tracheostomy + PEG
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SLIDE 33
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SLIDE 34
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SLIDE 35
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SLIDE 36
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SLIDE 37
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SLIDE 38

Intensive Care Unit Room Inpatient Care

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SLIDE 39

Discharge Transportation Disposition

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SLIDE 40