How does your trauma/resu Bay look like?

[krumel]

What are your resus/Trauma bays in the hospitals in your area equipped with?

What do they look like?

How does the communication between the prehospital and hospital stuff work?

To answer my own questions:

Here its the new "trend" to equip the so called "Schockraum" with an multislice CT.

As an standard the "Schockräume" are equipped with:

- Anaesthesia machine/ICU respirator (normally an anaesthesia machine)

- Multiparameter monitoring (ECG,SpO2, invasive Pressures, CO2, NIBP, etc.)

- Conventional C-Bow X-Ray

- Defibrillator/pacer

- Ultrasound

- Fiberoptic airway solution

- Masses of surgical and emergency medicine equipment (etc. for foleys, arterial BP, chest decompression, surgical airways, etc.)

Example photo:

(Muncipal Hospital Munich - Schwabing- Level 1 Trauma Center Adults & Pediatrics)

[VentMedic]

Here its the new "trend" to equip the so called "Schockraum" with an multislice CT.

Are you saying every trauma room has its own MSCT?

Does it also double as a stretcher for other procedures?

[WolfmanHarris]

Good timing. I had a field trip to Sunnybrook Health Sciences Centre in Toronto a couple weeks ago and snapped some shots of their brand new trauma room.

The trauma room is across the hall from the dedicated ED x-ray and CT suite which is cleared when a trauma alert comes in.

When EMS arrives they report to the trauma team leader and one of the charting RN's and then hang around in case on of the specalists wants the info again (ortho, etc.). Plus being a slack jawed lollygagger is fun apparently.

Photos aren't the greatest as my camera sucks.

[chbare]

Heheh!

Our flight/response bags & medication bags are on a shelf to the right and a tank of oxygen sits on the left of the bed.

Major Items:

-Philips MRX monitor

-Heart Start 4000 backup

-Suction with foot powered backup

-Glucometer

-Urine test strips/HCG test strips

-All the typical ALS equipment in our response bags

-Oxylog 2000 ventilator

-Most of the typical ALS meds to include assorted primary care meds and antimicrobials

Take care,

chbare.

[krumel]

Yes, own CT...Becomes a Standard here...

Normally there is no need to change the stretcher. The Patient lays on a "trauma matress" or is still (as its very usual in the German speaking countries) in an vacuum matress.

I know two hospitals that have CT stretchers that can be modified like an normal trauma OR table.

But one thing for information: Even Level 1 Trauma Centers normally have only one (maximum two) "Trauma room" /Schockraum due to the fact that we have a lot of trauma centers here (5 level 1, 4 Level 2, 4 Level 3)

Also its not common to threat more than one severe injuried patient in one trauma room.

(and federal law would not allow us to had equipment lay open... They are very strict...Everything has to be stored in an closed cabinets. No discussion)

@chbare:

Harhar, but: I know a small hospital around here with even less equipment in its "resus bay"

Greetings,

Phil

[VentMedic]

Yes, own CT...Becomes a Standard here...

I can not imagine effectively working a patient on a CT scanner sled. We turn our patients to do a full assessment and will do many procedures in the ED since not all trauma patients require an OR. We also see alot of head trauma which have the tendency to be combative, as do some of our locals, and restraining to the sled is difficult without losing access to parts of the body. However, the MSCT is available in many hospitals throughout the U.S.

We're quick and it doesn't take long to get diagnostics and pocedures done. Central lines, A-lines, LPs and chest tubes are done in the trauma room.

In the U.S., our trauma centers are rated with levels also with consistenvy of available equipment and services for each. Even the local little generals must meet certain criteria to maintain ED accreditatoin. We also have a level which is a shock trauma hospital or medical center and has the qualifications to be a free standing hospital with all services dedicated to trauma.

Our trauma rooms each have access to:

Intervential radiology and C-Arms

Portable ultrasound

STAT lab POC machines for electrolytes and ABGs

Monitor: SpO2, ECG, ETCO2, NIBP and invasive pressures - venuous and arterial

Portable and ICU ventilators with various gas mixtures (HeliOx, Nitric Oxide)

Various ETTs and intubation devices include fiberoptic

Fiberoptic scopes of various types for airways and GI - Endoscopy (Video and portable)

Acute Hemodialysis Capability

OR suites

Lab and Radiology services dedicated to trauma

Helipad with elevator straight to trauma area

The hospital also a full service pedi and burn center as well as the hospital having a high risk maternal unit and Level 3 NICU. We also have a cath lab available with a thoracic surgical team (the team also does chest trauma).

Everything is also stored in cabinets or in sealed sterile packages.

[fireflymedic]

Wow - that is quite the set up. Here things are a bit different depending upon where we go, but I'll focus on university as I have worked there and am most familiar with it and take patients there the most.

6 Trauma rooms (we are only trauma center in this region of the state plus take alot of referring stuff from neighboring states) - 2 are "CODE RED" traumas requiring major resuscitation (typically if you come in via flight and are intubated with significant blood loss this is where you will go - or if ground designates you a code red, then you'll go there as well - all burn patients fit this criteria unless minor burns). We have 4 critical areas which each have their own supply cabinets fully stocked at all times and are curtain partitions. The two code red rooms are sliding glass door style and can be adjusted to whatever the needs of the patient. Typical equipment in code red rooms which may be borrowed out to the other areas as needed

Ultrasound

Vent (respiratory automatically responds to any code red or intubated trauma)

mobile X ray (they are automatic response as well)

Vitals monitors

Crash cart

It's own fully stocked pyxis with swipe card access

Fiberoptic/difficult airway equipment (anesthesia's usually along for the ride as well)

ability to accomodate stretcher/hospital bed to a traction set up if needed

then dedicated CT scanner and MRI for just trauma/stroke patients

dedicated transport team within hospital for transfers between areas

plenty of residents, interns, med students, paramedics, rn's and even a really grouchy attending depending on the night !

We do pretty well here

[krumel]

@Vent:

I had the same thoughts before but I had to learn that is works very well when the teams are trained to work on the CT Stretcher.

I'm trying to make a better picture of one of the university hospital trauma rooms tomorrow (the picture I posted is the oldest one and one of the baddest... Its one of the muncipials...They are...well...old fashioned).

The thing I was afraid of most is that there would be not enough room between the head section and the CT for the airway crew to work. But as the trauma CTs are build with enough room between the Scanner and the head compartment.

The last patient we brought in had an "cannot intubate, cannot ventilate properly, cannot use alternative airway" situation and it was no problem trying the fiberoptic (failed) and putting the surgical airway in. (We (including an field physican which was an anaesthesist) didn't get it in... Men hit in the neck with a chainsaw).

The restraining problem is infact an interesting question and I will ask the ER staff tomorrow, but I don't think that this is such an big issue here due to the fact that most of our patients which go to the trauma rooms get intubated onscene. (we work with anaesthesist as field physicans, remember;)..)

The "Trauma Center" System is also known here although not really used. We had something called "care classes". They are called "house of maxmimum care" (comparable to the Level 1 Trauma Centers), "House of central threatment" (Something between Class 2 and 3, I guess), "House of regular threatment" (Level 3) and "House of Ground threatment" (Level 4)

But, to be true: This is not as specified as the "Trauma Level" System is. It mostly depends on which departments a hospital has, how they big they are, etc." but not on the equipment, not the building cirumstances, etc.

Theoretically you can be a "maximum care" hospital without having an MR or CT as long as you have all the required departments....

Our equipment (excluding the hemodiaysis...this is normally performed in the ICU...But, if needed, you can also admit a patient directly there - common procedure etc. for post arrest patients, etc.-) is very similar, although "big" lab(everything which is not BGA) is normally performed by the hospitals central lab..But they are pretty fast and normally very close to the E.R.

BTW: Remember: I'm talking about central europe.. I guess all Trauma Centers within the city get as much traumas a week you get within a day.

So long: More pics anyone?

[Arizonaffcep]

@ UMC in Tucson, there are 4 rooms, rooms 3 & 4 can be split to have 2 pts a piece. In Trauma Bay 1 & 2, there are 2 FAST machines, a Pyxis, a Level 1 machine (there is an overhead X-ray machine, but it is very cumbersome, so X-ray techs prefer the portable X-rays). There are several traction splints, difficult airway cart, Central line cart, medication refrigerators, boom which contains a Philips Monitor and on top of the ACLS cart a Philips MRX monitor for defib, internal defib paddles, ED thorocotamy trays (x 2), and the Hot Add-Mix warmer (250ml NS bags warmed to 150 degrees F, which when combined with blood products-the blood product MUST be hung like normal and the NS MUST be forced up into the blood, creating a swirling action and warming it to body temp, allowing for RAPID infusion), along with LR and NS warmers. All suites contain the Philips monitors and ACLS carts, chest tube set ups x2, etc. Basic layout is simple: square room with stretcher in middle and boom with monitor off to one side.

Now, in June/July of this year, UMC will be opening their new ED/Trauma area, which makes the trauma area 4 beds (for immediate resuscitation) and an 8 bed holding area (post resus). It will also have a dedicated X-ray and CT scanner. Right now, we have to take Pts to CT which is not far, and all in very close proximity to the OR suites (less than 200 feet). I'm not sure if there will be a dedicated OR suite there, or if we will have to walk the Pts down the hall, but we will see.

[krumel]

That extremly cool in one of the University hospitals here: When you go in by the "ambulance entrance" the first room you see is the trauma room (with CT). directly (and directly means: directly) attached to the trauma Room is the special O.R-Area. Directly over the O.R. is the SICU. Has its own elevator to that O.R. Area...Very cool thing, you have a total transport distance of 20m at all.