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Trauma Resuscitation — Circulation: Vascular Access, Escalation — Clinical Pathway: Emergency

Trauma Resuscitation Clinical Pathway — Emergency Department

Circulation: Vascular Access, Escalation

Goals

  • IV access within 5 minutes of arrival (ideally x 2, with largest bore possible).
  • Consider escalation to IO, EJ, Femoral line, Saphenous Cut-Down early to optimize volume resuscitation.

Resuscitation Room Vascular Access Algorithm

Patient arrival
Immediate IO access
No
Pulse?
Yes
Veins visible or palpable?
No
Attempt USGPIV
3 minutes elapse
OR
2 attempts
unsuccessful
Consider IO
or
advanced therapies
Attempt unsuccessful
Attempt 2nd IO access and initiate peripheral attempts
Attempt unsuccessful
Attempt 3rd IO access and initiate advanced therapies
Attempt successful
Yes
Bedside RN/Tech simultaneous TIV attempts
Attempt successful
Additional access needed?
Yes
2 minutes elapse
OR
2 attempts unsuccessful
No
Stop additional access attempts
Attempt successful
Basic Principles of Access
Trauma
Large Bore AC
No T-Connector
Medical
Consider large bore if need for fluid resuscitation
(sepsis dehydration, hemorrhage)
Advanced Therapies
Based on patient presentation and subspecialty availability consider:
  • EJ Catheter
  • Femoral Line
  • Saphenous Cut-Down

 

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