UPMC Trauma Service
Orientation Packet
NEED TO KNOW…………………………………
RESPONSIBILITIES – ALL
Receive trauma pagers from the person you replaced. If there is a problem contact one of the
Trauma Nurse Coordinators – pager numbers on front of list.
With some exceptions, AM rounds start at 6:30a, Monday through Friday, in the Renal
Conference Room on the 11th Floor. The following will be covered:
ICU Admissions and ICU update
Deaths
Admissions
Potential Discharges for day
Consults
OR Schedule
Trauma Clinic Assignments
Complications and System Issues
Saturday and Sunday rounds begin at 7a
Afternoon walk rounds are made daily and are generally rum by the on-call chief resident.
The time of the afternoon rounds will vary depending on the conference schedule, operative
cases, and ED admissions. Please page the Advance Practice Nurse (Lisa, Amy, Anne-Marie,
Dee or Deb), to let them know you are beginning to round.
Documentation is essential to good patient care on a busy service, and it is everyone’s
responsibility. This includes a complete H & P (signed), daily note, plan of care and signing
of verbal orders. All orders must be clear, concise, and legible. Only used approved UPMC
abbreviations. Always date, time, and sign orders as well as placing your pager number
down. Medical students MUST have their progress notes and orders signed by in-house staff.
EVERY PATIENT ON THE TRAUMA SERVICE MUST HAVE A DAILY PROGRESS
NOTE BY THE HOUSESTAFF AND A DICTATED DISCHARGED SUMMARY.
THERE ARE NO EXCEPTIONS.
At no time are supplies to be taken from the Emergency Department to care for patients on
the floor. Supplies are to be obtained through the central supply distribution center facilitated
by the unit. Use dressing supply carts when available.
Communicate with PNCC daily with regard to plan of care and discharge plan. Attempt to be
consistent with discharge expectations that are expressed with patient and with case manager
or primary nurse.
For all deaths, contact Coroner, ensure that CORE has been notified and document in chart
the time of death, time Coroner was notified, and name of person you spoke to at the
Coroner’s office. All patients must have a hand written death pronouncement and a dictated
death summary by the pronouncing physician.
Cervical spine clearance as per protocol. A note should be written in the progress note
section of the chart when the spine is cleared and an order written discontinuing C-spine
precautions. Clearance of the TLS spine, and its documentation should be performed in a
similar fashion.
In addition to cervical spine clearance, other guidelines include cardiac contusion, blunt
spleen injury, and blunt liver injury. See attached.
If your patient requires a long-term Miami-J collar, or the fit is not standard sizing, please
consult Hangar Brace Company for proper fitting.
Rehab consults are to be written STAT for any patient with a head injury or spinal cord
injury, and the Spinal cord pager should be notified. Pager 958-5243.
All Patients should have ETOH Levels obtained in the ED.
ETOH with positive drug levels or ETOH level > 50 must have a chemical dependency
consult ordered for social services to evaluate. No patient is to be discharged with positive
drug or alcohol level without a social worker consult. ED social worker covers from Friday
night to Monday morning.
Lovenox is generally preferred for patient with lower extremity fractures if deemed safe.
Hold morning dose on day of OR. DVT prophalaxis (SCDs and/or Lovenox) should be
included in the admission orders on all trauma patients.
In the presence of blunt or penetrating trauma, when the patient presents in asystole with no
cardiac activity after standard ACLS interventions, blood products are to be withheld. In the
event that cardiac activity is obtained and sustained, blood products are to be administered in
the customary fashion.
Please report any and all incidents to the Hotline 647-5481. These include but are not
limited to complications, difficulty in obtaining studies, when final and preliminary reports
differ.
MED ALERT: Low Molecular Weight Heparins
Low molecular weight heparins (LMWH) are used for a myriad of
indications, including DVT/PE treatment and prophylaxis. UPMCHS is
implementing guidelines for LMWH use that involve patient safety
checks and preferred formulary agent selection.
Safe Use of LMWH
LMWH should not be used concurrently with spinal or epidural
anesthesia or analgesia, due to increased risk of neuraxial
bleeding, spinal hematoma, and hemorrhagic complications.
LMWH should not be used in patients with creatinine clearances
5 years since vaccine),
UA, plan.
6. You CAN read off your daily progress note and off the daily sheet that the chiefs give
out, especially labs/I&Os/vitals.
7. You should try to get patients in the high numbered rooms on 10G (example 10G-26)
because we present them first in the morning (you are often at lecture when we do off-
service patients) and this will give you an opportunity to present.
8. Sample morning note:
11/3/98 5:00am Trauma Surg HD#3 POD #2 MSIII note
S: patient has no abd pain/n/v, tolerating normal diet, no other complaints (often write +BM or
flatus)
O: P: 110 RR:28T: 36.7 Tmax=38.5 at 2am BP: 110/70 O2 Sat-98% R/A
I/O’s: 24 hours: 3500/2500 urine-150/100/250=500 colostomy=200/400/600
Peripheral JP of L leg=250/250/200
Lungs: CTA B, dyspneic
Heart: tachy, nl rhythm nl sls2 no m
Abd: +BS, soft, NT/ND, abd wound clean and dry, colostomy no erythema/draining, G-tube to
gravity
Ext: no c/c/e, moves right toes/ nl sens/nl cap refill, L leg TED/SCD, calves NT
Labs: H&H 10.2/30.0 (down from 13.7/39.0 11/2)
A/P: 22yo s/p MVA x-lap, colon resection, colostomy (POD#3) and R open tibial fx s/p ORIF
(POD#2).
1. ex-lap/colostomy – tol reg diet, abd healing-possible closure/reanastomosis this
week
2. R tib fx-OR yest for ORIF revision-ortho following-PT today-no restrictions
except non-wt bearing-R leg-Day number 3 of timentin for open fx
3. New dyspnea-get CXR consider PE if neg (LE dopplers/V/Q or spiral CT)
4. Diet-reg diet
5. IVF-D/C’d
6. DVT proph-lovenox 30 mg SQ BID, L leg SCD/TED
7. Pain management: PCA morphine change to po percocet
8. Dispo: rehab facility next week.
9. You should arrange between yourselves who will be present on the weekends—you only
need to be there if you are on-call or post-call. You cover the other medical student’s
patients when they are off (ask the interns if you have too many patients).
10. When you are on-call you have priority for doing procedures in the trauma bay from 7
AM until 7 AM the next day. All students should go to traumas when not in lecture and
not in surgery. Extra students should write the H&P for the trauma. The medical
students switch on and off with the intern. We will orient you to the trauma bay your
first day. If an off-service medical student is also on with you—you should show them
how to do things and give them first crack at doing things after they have seen one
trauma since they may not see another trauma (since they only do two days). If no one is
on-call that day, the person who gets there first has priority.
11. If you know your patients well and nothing is going on with them, go to the library you
should leave to go home after evening rounds once your work is done (get sleep while
you can). When on call, if noting is going on, study or sleep (late evening naps help you
survive up-all-night traumas).
12. Notice the surgery schedule at the end of the chief’s list handed out each morning. You
need to go down to the holding area for patients prior to surgery. Have them page you
when the patient gets there (they don’t always do it-hang out in the library and check
every once in a while around the time that your surgery is scheduled). Talk to the surgery
residents more about this.
Cervical Injury excluded by clinical
evaluation*
Yes No
Clinical
3-View Cervical
clearance
spine series
without X-rays
Adequate & Normal
Inadequate or
Abnormal
Clinical exam: cervical pain
cervical tenderness
Abnormal neuro exam Yes CT scan of Cervical Spine
Obtunded
No Normal Abnormal
Clinical Continue collar
clearance Neurologic Exam Consult spine
service
Normal Abnormal Obtunded
Cervical pain Consider MRI#
No or vs
Clinical
tenderness MRI Miami J til F/U
clearance
Consult
spine
Yes
Flexion-
Adequate & Normal Inadequate or Abnormal
extension
films
Miami J
Remove
Consult
collar
spine
*Inappropriate or Low Risk Mechanism
Absence of Head/Neck trauma
Reliable exam (absence of intoxication, etc)
Lack of distracting injury
#
Performed as soon as possible (preferably before day 7)
Approved, Trauma MAC Committee Dec. 2002
Revised August, 2005