Emergency Department (ED) Clinical Pathway for Patient Meeting Trauma Activation Criteria

Prior to Patient Arrival
Pre-Notification
Via Emergency Medical Services (EMS)
ED Medical Command Physician (MCP) notifies transport of level
Transferred from Outside Hospital
Transport center calls ED MCP and trauma fellow who determine activation level
No Notification
Via EMS or private vehicle
ED clinician notifies Transfer Center with activation level
Special Considerations for Transfer
Assign

Trauma Resuscitation Team Roles

Implement Crowd Control
Patient arrival to ED
0 min
Primary Survey: Organized Evaluation to identify life threats and Intervene
Life-threatening Injury
Respiratory
  • Altered mental status due to neurologic/circulatory etiologies
  • Airway Obstruction
  • Direct Airway Trauma
  • Tension Pneumothorax
  • Suspected Pneumothorax
  • Pulmonary Contusion
  • Smoke Inhalation
Circulatory
  • Hemorrhagic Shock
    • Blunt Trauma
    • Penetrating Trauma
    • Pelvic Fracture
    • Long Bone Fracture
    • Vascular Injury
  • Massive Hemothorax
  • Cardiac Tamponade
Neurologic
  • Head/Intracranial Injury
  • Spinal Cord Trauma
  • Spinal Shock
 C Catastrophic Hemorrhage Interventions
Identify and control active exsanguination
A Airway, C-Spine
B Breathing
  • Assess Indications for Intubation
    • Medications, Procedure
  • Ventilation, Monitoring
C Circulation
D Disability, Dextrose
E Exposure
Log Roll: Immediately after primary survey completion
Secondary Survey: Organized Evaluation to identify all injuries
Imaging Considerations Per Trauma Attending/Fellow, ED Attending/Fellow - Prioritize triaging imaging
Plain films X-ray C-Spine, chest, pelvis, injured extremities
Computerized tomography (CT) Non-contrast Head CT (consider C1-C2)
abdominal CT IV contrast, chest CT IV contrast
Considerations for Pediatric eFAST
Nasogastric/orogastric tube, foley
Ongoing Care: Stabilization and Considerations for Disposition
  • Consults
  • Neurosurgery, Orthopedics, Plastics, Oral and Maxillofacial Surgery, ENT, Vascular, Urology, Social Work
  • As clinically indicated, Contact Numbers
  • Other Considerations
  • Continued attention to ABCDs
  • Analgesia, temperature, antibiotics, tetanus
  • Review laboratory/radiology results
  • Communication
20 min
Medical Examiner
PICU
OR
Med/Surg
ED Exam Room
Discharge Home
Posted: January 2020
Revised: April 2020
Reviewed by Children's Hospital of Philadelphia Trauma Committee: November 2019
Authors: H. McCorkle, CRNP; D. Perks, CRNP; S. Chaudhary, MD; S. Meyers, MD; G. Nace, MD; M. Abbadessa, RN; J. Connelly, CRNP; S. Gaines, RN; J. Lavelle, MD