Trauma Team

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  • Sorry if I got some incorrect ^^; I'm not particularly active in some of these communities but I see posts about 'em here and there!

anonymous asked:

What's the most commonly accepted verbal exchange between paramedics and ER staff during handover? TV usually begins it with 'RTC, patient is 23, diabetic... BP etc.' What would you consider the most realistic dialogue in a script?

Hey there nonny! Good question. I have absolutely no idea what “RTC” means and have never heard it in the field (or in the TV shows I’ve seen). 

This depends on the handover. If the patient is in for something routine, like a cough or a broken leg, and they can wait, the first thing that happens is that EMS will bring the information to registration and give things like name, date of birth, etc. to the clerk. 

Next they’ll wait to be triaged by the nurse. They’ll already have the demographics in the computer, so they’ll ask more pertinent questions: “What happened?” “Any history?” “Allergies?” “Medications?” EMS will answer, but actually if you tell a triage nurse “This is a 23 year old male, history of diabetes, ….” you’ll get looked at funny. The nurse needs specific answers for the computer question, not the patient’s life story.

That’s for routine cases. 

Critical cases come straight into the resus room, and the character might have two life-saving procedures before they get registered. So in that case, handoff is a whole different story. 

This is where your medic will give the shortest and best version of the story they can. Here’s an example, one that I might give on handoff: 

“Hi everybody. This is Billy, he’s a 53 year old male status-post pedestrian struck at unknown speed, he went up and over the windshield with spider-cracking and landed behind the vehicle. He’s got a depressed fracture of the left parietal skull and trauma to the left leg. Positive LOC on scene, awake, now unconscious again, GCS 3T. He was intubated in the field for airway protection with roc and etomidate, with midazolam for sedation. He’s got an 18 in the left AC, and the tube is a 7.5, 23 at the lip.

Last set of vitals was 170 over 70, pulse 60 and NSR, GCS of 8 prior to intubation. He was intubated with roc and etomidate and he’s gotten 4 of midazolam IV so far. The period of lucidity makes me think epidural but I can’t be a hundred percent. ” 

History is diabetes, hypertension and one MI in 2006, per the wife, she’s in the waiting room. NKDA, insulin-dependent. He’s all yours.” 

Every single piece of that handoff is important. The name isn’t always given, but I always do (it’s a reminder that this is a person.) The age isn’t exactly crucial unless you’re fine-cutting kids by their ages, but what the hell, it’s tradition. The injury – pedestrian struck (the car is implied) – predicts injury patterns, as does the more specific “up and over” trajectory, and  the fact that the windshield spider-cracked implies that that much force was also applied to the body. The skull fracture and leg trauma – vagueness is fine here, it’s secondary – give the specific injuries, but the mechanisms tell the staff what else to predict.

LOC means loss of consciousness and is important. The fact that the character lost consciousness, regained it, and lost it again, is pretty much pathognomonic – a sure sign – of an epidural bleed. (I qualify this later to make room for diagnostic errors and “edge cases,” but this pattern is well-known.) 

Next is what I did for him: I intubated poor Billy (placed a breathing tube), and say why – there are lots of reasons to tube a patient (respiratory failure being chief among them, but in this case it was to keep him from vomiting). The pharmacological agents are important – the rocuronium is a long-acting paralytic, where another (succinylcholine, or “sux”) might be short-acting (60 vs 5 minutes). 

Last is his history – which is mostly (not entirely) irrelevant – and where to get more info, finished off with a “good luck with that” and a swift exit from the trauma room. 

One thing to realize is how much slang is in here: we have a mechanism (”pedestrian struck”), medication names (”roc”) and doses (”4″, the milligrams is implied), mental status (”GCS”, for Glasgow Coma Score), tube size and placement (”7.5″ would me 7.5mm internal diameter and “23 at the lip” means the tube is 23 cm deep, measured at the lip line), heart rhythm (”NSR”), suspected condition (”epidural”, the “hemorrhage” is implied), history (”MI” means “heart attack”), allergies (”NKDA” is short for “No known drug allergies”). It’s a specialty with its own lingo, and this handoff isn’t even lingo-heavy. It’s all shorthand for getting t he most information across in as little time as possible, but damn if it isn’t hard to learn at first. 

However, that’s my personal style. Afterwards there will be questions – was he a difficult tube? Did he get any other meds in the field? How long ago did this happen? 

One format is called MIST. A nurse or doc will call an “EMS Time-Out,” and then EMS will proceed with their report like so: 

That’s…. roughly what that might look like. 

If you are willing to PM me your case and the situation I’ll reblog this with a customized handoff for your situation, and will keep your anonymity. 

xoxo, Aunt Scripty


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