All posts by The Trauma Pro

The Electronic Trauma Flow Sheet: Why Hospitals Want You To Switch

Today, I’ll kick off my series on use of the electronic trauma flow sheet (eTFS) with a list of the typical reasons used to justify it. 

Typically, hospital administrators pressure trauma programs to adopt an eTFS at some point after implementation of an electronic health record (EHR). For the most part, they give two reasons:

  1. We need to go paperless! The assumption is that all of the rest of the charting will be electronic, so the trauma flow sheet should be moved to this format as well.
    The reality is that there will always be some good, old-fashioned paper parts to the patient’s chart. Every hospital ward has a little cubby with some old-timey three ring binders for putting the scraps of paper that accumulate. These may be records from an outside referring hospital, a pre-hospital run sheet, blood bank tags from units of blood products, and other stuff. What typically happens to it? It gets scanned into the chart at some point. 
    So there is no reason that a paper trauma flow sheet can’t be scanned as well. The key move is that it should be scanned early so that it is available in the EHR as soon as it is complete.
  2. We need to see patient flow, vitals, meds, etc from the time they hit the door. We don’t want to miss the activity that occurs in the trauma bay, right?
    The care typically received in the trauma bay is what I would consider a singularity. It is like nothing else in the hospital stay in terms of pace, intensity, and level of activity. Being able to trend medication or blood administration from arrival through discharge is not that important. Vital signs during resuscitation may be nothing like those of the rest of the hospital stay. It’s just not that helpful to be able to connect that phase of care with the rest of it.
    But having said that, it may be helpful to be able to see all of the medications given during a hospital stay. Ideally, someone should go back and reconcile the medications after the fact. A pharmacist, perhaps?

Neither of these excuses really hold any water, so don’t get talked into trying out an eTFS because of them.

Tomorrow, I’ll write about why the eTFS doesn’t work during the trauma resuscitation phase of care.

Next Week: The Electronic Trauma Flow Sheet

It’s been a while since I visited the topic of the electronic trauma flow sheet (eTFS) for trauma activations. A few years have passed, the software engineers have gotten smarter (hopefully), so let’s look at it again.

Next week, I’ll be covering the eTFS in detail again. Here is what I will touch on:

  • eTFS: Why Hospitals Want To Switch
  • What Does(n’t) Work
  • Oops! Now What Are My Options?

I’d also like to spend a day on Q&A. To that end, please start emailing, commenting, or tweeting your questions so I can answer them in detail at the end of the week. Let the games begin!

Nursing Tips for Managing Pediatric Orthopedic Trauma

Nurses have a complementary role with physicians in caring for children with orthopedic injuries. Typically, the child will have been evaluated and had some sort of fracture management implemented. In children, nursing management is easer than in adults since a child is less likely to need an invasive surgical procedure. Many fractures can be dealt with using casts and splints alone.

Here are a few tips for providing the best care for your pediatric patients:

  • Ensure adequate splinting / casting. You will have an opportunity to see the child at their usual level of activity. If it appears likely that their activity may defeat the purpose of the cast or splint, inform the surgeon or extender so they can apply a better one.
  • Focus on pain control. Nothing aggravates parents more than seeing their child in pain! Make sure acetominophen or ibuprofen is available prn if pain is very mild, or scheduled if more significant. Ensure that mild narcotics are available if pain levels are higher. Remember, stool softeners are mandatory if narcotics are given.
  • Monitor compartments frequently. If a cast is used, check the distal part of the extremity for pain, unwillingness to move, numbness or swelling. If any are present, call the physician or extender and expect prompt attention to the problem.
  • Always think about the possibility of abuse. Fractures are rarely seen in children under 3, and almost never if less than 1 year old. If you have concerns about the physical findings or parent interactions, let the physician and social workers know immediately.

In The Next Trauma MedEd Newsletter: Massive Transfusion

The next Trauma MedEd newsletter will be released later this month. In this issue, I will cover the good old Massive Transfusion Protocol (MTP) in detail.

Topics will include:

  • How to build a good MTP for your hospital
  • Analysis of the various parts of the MTP
  • How to accurately trigger your MTP
  • What’s the right “ratio” of products to give?
  • How does TEG fit into the MTP
  • and more!

As always, this issue will go to all of my subscribers first. If you are not yet one of them, click this link to sign up now and/or download back issues.

Unfortunately, non-subscribers will have to wait until I release the issue on this blog, about 10 days later. So sign up now!