… A patient has clinical evidence of a new onset stroke and the stroke team needs to be mobilized… … A patient has clinical evidence of a new onset stroke and the stroke team needs to be mobilized… Code Stroke Code Stroke When patient is potential candidate ( < 8 hours) Stroke Yellow Stroke Yellow Evidence of acute stroke greater than 8 hours
Code Stroke Stroke Team Stroke Team N N N NIS/on-call neurologist C C C CT tech M M M MRI tech E E E ED Director, CTU Manager Clinical Leaders, and charge nurse
Code Stroke Soooo…. Why not call from the field??? - Needs to be called by RN or MD as witnessed - Resource allocation - Chain of events
… A trauma patient arriving at the ED will be classified into one of three different categories… IIIIII
Trauma Alert Category I Category I Has two types of criteria Severe Mechanism Severe Mechanism Severe Instability (majority reason) Severe Instability (majority reason) Response Paged out / Overhead Paged out / Overhead Trauma Surgeon in 30 minutes Trauma Surgeon in 30 minutes Who else? Who else?
Trauma Alert Category I Criteria Category I Criteria Sustained hypotension: Systolic blood pressure ≤ 90 (≤ 80 in pediatric patients) All penetrating injuries to head, neck, torso to include buttocks, groin, shoulder Respiratory rate 29 Intubation/advanced airway intervention in the field in the presence of significant trauma GCS≤ 10 Traumatic Arrest-Penetrating
Trauma Alert Category II Category II Varying criteria Response Response Paged / No overhead Trauma Doc consult Has to respond within 12 hours Has to respond within 12 hours Who else?
Trauma Alert Category II Criteria Category II Criteria GCS 11-14 Ejection from vehicle Motor vehicle crash with a fatality in the same passenger compartment Falls: Adults >20 feet (one story =10 feet); Pediatric >10 feet or 2-3 times the height of the child Motor vehicle rollover (>180 degrees)
Trauma Alert Category II Criteria Category II Criteria Motor vehicle crash with intrusion >12 inches and/ or auto deformity >18 inches Motorcycle crash >20 m.p.h or separation of rider and motorcycle Pedestrian/ Bicyclist struck, thrown or run over Combination trauma with ≥ 10% TBSA burn (proximal to wrist/ ankle) Amputation proximal to wrist or ankle
Trauma Alert Category II Criteria Category II Criteria Limb injury with sensory or motor deficit proximal to wrist or ankle (crushed, degloved or mangled extremity) Sensory or motor deficit or paralysis (suspected spinal cord injury) Two or more long-bone fractures Traumatic Arrest-Blunt EMS provider judgment
Trauma Alert Category III Category III “This group of patients has sustained injury, but does not meet Category I or Category II criteria based on the initial assessment by the Emergency Department physician or designee. The initial assessment will occur within 10 minutes of arrival to the Emergency department.”
Remember!!! …Because these functions occur as a chain reaction throughout the hospital, when you call for an alert, it may not happen due to the criteria and circumstances that must be adhered to. Do not get discouraged for next time!!! If you feel an alert is warranted, please exercise due diligence in the best interests of the patient each and every time and recommend the alert. It only harms the patient in the long run if we don’t… If you feel an alert is warranted, please exercise due diligence in the best interests of the patient each and every time and recommend the alert. It only harms the patient in the long run if we don’t…
Thoughts? Questions? Complaints? Feel free to contact us in the EMS office… Feel free to contact us in the EMS office… Shannon Morris 630-527-3332 630-527-3332 firstname.lastname@example.org email@example.com Stephanie Klavohn 630-527-3341 630-527-3341 Stephanie.Klavohn@edward.org Stephanie.Klavohn@edward.org Dan Donahoe 630-527-3112 630-527-3112 Daniel.Donahoe@edward.org Daniel.Donahoe@edward.org