I recently received a reader request regarding trauma bay design. Today, I’ll rerun my article on trauma bay size. Tomorrow, I’ll describe my system for quantifying the space in your trauma bay. Finally, next week I will address equipment layout in the resuscitation room.
Trauma resuscitation rooms vary tremendously. They can range from very spacious…
to very tight…
Most trauma bays that I have visited were somewhere between 225 and 300 square feet (21-28 sq meters), although some were quite large (Rashid Hospital in Dubai at nearly 50 sq meters!).
Interestingly, I did manage to find a set of published guidelines on this topic. The Facility Guidelines Institute (FGI) develops detailed recommendations for the design of a variety of healthcare facilities. Here are their guidelines for adult trauma bays:
Single patient room: The clear floor area should be 250 sq ft (23 sq m), with a minimum clearance of 5 feet on all sides of the patient stretcher.
Multiple patient room: The clear floor area should be 200 sq ft (18.5 sq m) with curtains separating patient areas. Minimum clearance of 5 feet on all sides of the patient stretcher should be maintained.
The FGI “clear floor area” corresponds to my “Trauma Bay Working Area”, which is the area that excludes all the carts, cabinets, and countertops scattered about the usual trauma room. California’s guideline of 280 sq feet seems pretty reasonable as the “Trauma Bay Total Area”, if you can keep your wasted space down to about 30 sq feet.
Bottom line: Once again, don’t try to figure out everything from scratch. Somebody has probably already done it (designed a trauma bay, developed a practice guideline, etc). But remember, a generic guideline or even one developed for a specific institution may not completely fit your situation. In this case, the FGI guidelines say nothing about the trauma team size, which is a critical factor in space planning. Use the work of others as a springboard to jump start your own efforts at solving the problem.
To all of you who have already taken the survey on ED thoracotomy, thank you! There’s been a great response rate over the past 24 hours.
And to those of you who have missed it so far, please take 2 minutes to fill it out. I am trying to determine who could and who actually does perform ED thoracotomy across the various trauma hospitals around the world.
I’ll be publishing the results here once the responses start to taper off. Please participate!
Hello all! I’d like to invite you to participate in a brief survey regarding ED thoracotomy at your hospital. I’m curious about who can and does perform the procedure. The survey is very short and should only take a minute or two to complete.
Please take a moment to participate by clicking here to take the survey.Although entering your center name is optional, I do require the city, state/province, and country so I can eliminate duplicates.
The survey will officially close in 2 weeks, so please fill it in soon! I’ll publish the results in a post shortly afterwards.
Yesterday, I described how the typical automated oscillometric blood pressure cuff works. We rely on this workhorse piece of equipment for nearly all pressure determinations outside of the intensive care unit. So the obvious question is, “is it accurate?”
Interestingly, there are not very many good papers that have ever looked at this! However, this simple question was addressed by a group at Harvard back in 2013. This study utilized an extensive ICU database from 7 ICUs at the Beth Israel Deaconess Medical Center. Seven years of data were analyzed, including minute by minute blood pressure readings in patients with both automated cuffs and indwelling arterial lines. Arterial line pressures were considered to be the “gold standard.”
Here are the factoids:
Over 27,000 pairs of simultaneously recorded cuff and arterial line measurements from 852 patients were analyzed
The cuff underestimated art line SBP for pressures at or above 95 torr
The cuff overestimated SBO for pressures below 95 torr (!)
Patients in profound shock (SBP < 60) had a cuff reading 10 torr higher
Mean arterial pressure was reasonably accurate in hypotensive patients
Bottom line: The good, old-fashioned automated blood pressure cuff is fine for patients with normal pressures or better. In fact, it tends to understimate the SBP the higher it is, which is fine. However, it overestimates the SBP in hypotensive patients. This can be dangerous!
You may look at that SBP of 90 and say to yourself, “that’s not too bad.” But really it might be 80. Would that change your mind? Don’t get suckered into thinking that this mainstay of medical care is perfect! And consider peeking at the mean arterial pressure from time to time. That may give you a more accurate picture of where the patient really is from a pressure standpoint.
The blood pressure cuff is one of those devices trauma professionals don’t give a second thought to. Old timers like me remember using the cuff with a sphygmomanometer and stethoscope to get manual blood pressures. I’ve had to do this twice in recent months on airplanes, and I had forgotten how much work this is.
But technology makes things easier for us. Now you just slap a cuff on the arm (or wrist), push a button, and voila! You’ve got the pressure.
But have you stopped to think about how this actually works? Why don’t we need the stethoscope any more? Here’s the scoop:
When you take a manual blood pressure, the cuff is inflated until a pulse can no longer be auscultated with the stethoscope. The pressure is slowly released using a little thumb wheel while listening for the pulse again. The pressure at which it is first audible is the systolic, and the pressure at which it softens and fades away is the diastolic.
The automatic blood pressure device consists of a cuff, tubing that connects it to the monitor, a pressure transducer in line with the tubing, a mini air pump, and a small computer. The transducer replaces the analog pressure gauge, and the pump and computer replace the human.
The transducer can “see” through the tubing and into the cuff. It is very sensitive to pressure and pressure changes. The computer directs the pump to inflate to about 20 torr above the point where pulsations in the air column cease. It then releases the pressure at about 4 torr per second, “feeling” for air column vibrations to start. Using a manufacturer specific computer algorithm, the mean arterial pressure is measured. A little more proprietary calculation results in an estimated systolic and diastolic pressure.
Piece of cake! But here’s the question: is it accurate? Tomorrow, I’ll write about how the automated cuff compares to an indwelling arterial line.