INTRODUCTION:
The Blue Surgery
(Trauma/Emergency) rotation is sponsored by the Division of General Surgery,
Section of Trauma and Critical Care. The length of the rotation depends on the
year of post- graduate training. The rotation is designed specifically to
provide all residents with experience and didactic knowledge in comprehensive
care of the injured adult (≥ 15 years of age) and adults with trauma or
requiring emergent general surgical intervention.
ROTATION
OBJECTIVES:
1. Provide clinical
experience, instruction, and knowledge in the initial assessment/evaluation,
resuscitation, surgical intervention, and management of all injured adults.
2. Provide clinical
experience, instruction, and knowledge in the initial assessment/evaluation,
resuscitation, surgical intervention, and management of adults with emergent
general surgical illness and/or requiring emergent surgical intervention.
3. Provide clinical
experience, instruction, and knowledge in the management of critically ill
patients.
ROTATION
REQUIREMENTS:
I. Patient
Care Responsibilities
A. Trauma
Patients*
The majority of
trauma patients are admitted via the Emergency Department (ED). There will be
direct inter-facility transfer of injured patients from the referring hospital
to the ICU or floor. Occasionally, direct admits to the OR will bypass ED
evaluation. Trauma patients can present as a referral from another hospital and
physician, direct from the accident scene via helicopter (scene call), or
unannounced by ground ambulance from Fayette County or the surrounding county
EMS. *Refer to attached "Trauma Admission Guideline"
Trauma
Expect: Patients referred and accepted by the trauma service from
another hospital (ground or air transport) are considered trauma expects.
Trauma expects are often referred for EM evaluation. Unless referred for EM
evaluation, the Trauma/emergency surgery residents will, in those cases, be
consulted by the EM residents/faculty. Emergency general surgery referrals are
more likely to require early assessment by the Trauma/Emergency Surgery
residents and conveying this necessity to the EM residents/faculty is helpful
to accelerate care.
Local EMS
Transports: Patients transported by local EMS
providers become the responsibility of the Trauma/emergency surgery residents
by one of two mechanisms:
1. Trauma consult called by the ED
2. Trauma Alert RED* called by ED.
*The Trauma Alert system is
discussed below under a separate heading.
Initial assessment
and evaluation of the multiply injured patient should proceed according to ATLS
protocol. A review of your ATLS provider manual is highly recommended. Resident
roles and responsibilities during the initial evaluation are outlined in the
attached documents. Role assignment is pre-designated depending upon
experience, skill proficiency, and resident knowledge base. The chief surgical
resident in house (PGY4 or PGY5) assumes responsibility for the timely
evaluation, management, and disposition of the trauma patient. This
responsibility also includes the timely notification of the attending
physician. Patient disposition should be determined within 60 minutes of ED
admission. The entire diagnostic evaluation/disposition should not exceed 120
minutes. Should it become obvious at any point during the initial evaluation
that the patient will require surgical intervention, it is imperative that the
OR be contacted immediately. A surgical resident will accompany hemodynamically
unstable patients outside the ED for all diagnostic procedures (i.e., CT scan,
angiography, etc.). Physicians are not required to accompany "stable
patients". It is the responsibility of the ED nursing staff to insure that
all trauma patients will be accompanied by an RN during procedures done outside
the ED. There is a policy that governs the RN responsibilities for transport.
1. Trauma Alert
System
The trauma alert notification system was designed to provide rapid
and efficient mobilization of personnel and resources essential for
resuscitation, evaluation, diagnosis and treatment of the multiply injured
patient. The trauma alert system is divided into two levels in order to
maximize the efficiency resource allocation.
Trauma Alert
A trauma alert will
be called based on the outlined mandatory and/or potential criteria (http://uktraumaprotocol.blogspot.com/2013/11/trauma-activation-criteria.html).
Patients receiving a trauma alert may be arriving via ground ambulance, air
medical transport, or could be present in the ED and experience an acute
deterioration in condition.
Trauma Alert
Red
A second level of
trauma alert called 'Trauma Alert Red' is present in order to provide immediate
OR access for patients that have a high likelihood of requiring emergent
life-saving surgical intervention. 'Trauma Alert Red' is reserved for injured
patients with reported or measured hypotension (within the 1st hour
after arrival) following blunt injury and for patients who have sustained
penetrating injury to the neck, thorax and/or abdomen. An operating room will
be held for 30 minutes after the trauma alert red has been called. The chief
surgical resident is responsible for the decision to release the OR suite as
soon as possible after patient arrival.
Trauma Alert
Rotation
Responsibility for directing trauma alert resuscitations is the
purview of the EM residents and faculty.
Trauma alert red supervision is the responsibility of the
Trauma/Emergency Surgery residents and faculty.
2. Trauma Labs
There is guideline
outlining laboratory tests that will be ordered (http://uktraumaprotocol.blogspot.com/2014/08/trauma-labs.html).
The labs ordered are based on the severity of the injuries. Blood Alcohol and
urine drug screens are mandatory for ALL trauma activations. Any questions
regarding the necessity values should be clarified with the chief surgical
resident and communicated to the nurse.
3.
Documentation
Trauma Admission
H&P
The trauma H&P is
to be completed IN FULL on ALL injured patients admitted to the trauma service
or receiving consultation from the trauma service. This includes ALL ED and
OPERATING ROOM MORTALITIES. Critical errors and frequently missing data are as
follows:
1. Injury time.
2. Thorough HPI
3. Loss of consciousness
4. Medications
5. Family history
6. Complete ROS
7.
Laboratory results including ETOH and
urine drug screen results.
8. Procedures.
9. Primary diagnoses in detail (MVC is not considered an adequate medical
diagnosis and will not be accepted).
10.
Referring physician and referring
hospital.
11. For aeromedical scene work, the county where the scene work
occurred.
The trauma admission
H&P becomes the patient's medical record. It is used for clinical care,
quality reporting, credentialing and verification and verification of the
trauma center, billing, criminal prosecution, malpractice defense and other
purposes. Any missing trauma H&P’s are the responsibility of the chief
surgical resident on-call that day. Any trauma admission form submitted
incomplete will be returned to the chief or junior resident for completion
within 24 hours. Missing data elements will be noted for completion. Documentation
of all injuries AND medical diagnoses must be accomplished under the SCM
problem list. This list should be updated as new injuries and diagnoses are
identified.
Documentation should
not stop with the completion of the trauma H&P’. Any and all significant
changes in patient condition while in the ED should be documented completely in
the medical record.
Daily Census
A daily census will
be the responsibility of the off-going chief resident and his/her team. Updated
census information should be complete for morning rounds. All patients admitted
to or consulted by the service should be represented on the census. The census
must include the following: name, MR#, DOB, diagnoses, location. Procedures are
optimal but optional. Discretion should be used when populating the paper
census with data that is regularly changing and exists in SCM. ED and OR
mortalities should be listed on the weekly M&M list.
Procedure Documentation
All procedures (deep
lines, chest tubes, arterial lines, intubation, LP, laceration closures,
bronchs, trachs, etc.) should have a procedure note completed in SCM in detail.
A. The attending physician will be notified prior to performing a
procedure. We realize there are emergent situations that necessitate immediate
performance of procedures that would preclude prior attending physician
notification.
B. Procedure notes should be completed for all procedures regardless
of whether the attending is present or absent.
C. The supervising attending physician for after hours procedures is
the attending on call.
D. Please remember that the medical record is a legal document. Think
before you write or finalize. Do not ventilate disagreements in the medical
record. The attending faculty assumes the liability for your actions and your
words. Daily progress, as well as any and all acute changes in patient
condition should be documented in the chart completely, accurately and legibly
with the appropriate date and time.
4. Trauma Admission Orders
Computer trauma order
sets ARE TO BE USED FOR ALL trauma service patients. PLEASE INSURE THAT ORDERS
ARE COMPLETED IN A TIMELY FASHION. It is appropriate to enter admission orders
PRIOR to seeing the patient I the EM caller indicates that admission is a
certainty (chest tube has been placed, CT-proven appendicitis, mechanical
ventilation, etc). If admission is uncertain, wait until the patient has been
evaluated by the Trauma/Emergency Surgery resident before writing admission
orders. All emergent consults should be seen within 60 minutes of consultation.
ALL DIRECT ADMITS
MUST BE SEEN AND ORDERS WRITTEN WITHIN 60 MINUTES OF ARRIVAL.
B. General
Surgical Emergency Patients and UKMC Inpatient Consults
The vast majority of
emergency general surgery patients are admitted via the UK Emergency Department
(ED). Occasionally, there will be direct inter-facility transfer from referring
hospitals to the ICU or floor that will bypass ED evaluation. Emergency general
surgery patients present either as:
1. A referral from another hospital and physician. *Trauma/Emergency Surgery residents should
see general surgery referrals accepted from another hospital as soon as
possible after those patients’ arrival in the UK ED. * Patients accepted in transfer by other
general surgery services (Green and Gold) or Green and Gold patients that
present in the ED for evaluation are and remain the primary responsibility of
the Green or Gold Surgery service chief resident.
2. A consult from the ED attending. The Trauma/Emergency Surgery service is responsible for the
evaluation of ALL general surgery UK ED** consults in adults (generally ≥ 15, sometimes negotiated with
Pediatric Surgery).
**The Trauma/Emergency service should and will evaluate all ED
general surgery consults. It is permissible to triage appropriately to other
general surgery services (Green and Gold) but only after appropriate evaluation
and reasonable diagnostic possibilities have been established. The Blue surgery
attending must approve such transfer. The triage or transfer of service should
be arranged between the chief surgical residents and/or between service
attendings not between junior house officers.
All ICU surgical
consults and in house UK emergency consults (including emergent Kentucky Clinic
consults) are the responsibility of the Trauma/Emergency Surgery service. Colorectal
surgery consults involving nonemergency malignant disease, anal disease and IBD
should be directed to the colorectal surgeon on call 24/7.
The chief surgical
resident in house (PGY4 or PGY5) assumes ultimate responsibility for the timely
evaluation, management, and disposition of all general surgery emergency patients.
This responsibility also includes the timely notification of the attending
physician. A Communication Guideline-When to Notify for call etiquette to/from
the Chief Resident is provided (http://uktraumaprotocol.blogspot.com/2013/04/communication-guideline-when-to-notify.html).
NOTIFICATION
OF CONSULTANTS
Consultant(s)
evaluation is frequently required for the complete evaluation and treatment of
the multiply injured patient. Timely consultant notification and patient
evaluation are necessary to minimize emergency department length of stay and to
insure high quality patient care. The Section of Trauma and Critical Care has
established the following guidelines. We expect the Trauma/Emergency Surgery
service residents to adhere to these guidelines. Consultants should be notified
promptly following completion of the secondary survey (<20 minutes after
patient arrival) or sooner if their services are required (acute neurosurgical,
face team, cardiothoracic, or orthopedic intervention). Consultants should
respond to a page within 10 minutes. Consultants should be present for patient
evaluation within 20 minutes of notification. Consultation should be performed
by an upper level resident (PGY2 or higher) or faculty. Interns should not be
notified for ED patient evaluation unless all other members of the consultant team
are involved in priority patient care that precludes their presence.
TRAUMA
SERVICE WARD
A single geographic
location for all trauma patients will improve patient care, facilitate rounds,
reduce phone calls, and reduce housestaff workload. Pavilion A 7th
floor and PavH 8th floor have been designated as the
trauma/emergency surgery service wards. These wards also include Orthopedic
trauma.
ADMISSION
OFFICE NOTIFICATION POLICY FOR THE BLUE SURGERY SERVICE
The decision
regarding hospital admission, level of care (ICU, progressive care, floor,
telemetry), and admitting service can be made rapidly (<20 minutes) for the
vast majority of patients. With the exception of patients taken directly to the
OR, the trauma/emergency surgery service will insure that the admitting process
is initiated at the completion of the secondary survey or within 20 minutes of
patient arrival. Admitting office notification should occur as soon as possible
for a patient taken directly to the OR. Prompt notification of the admitting
office will allow bed hunting/assignment to proceed simultaneously with ED
evaluation thereby avoiding needless bed assignment delays. A working
diagnosis, sex, and hospital area (ICU, progressive care, telemetry, floor) are
all the information needed to initiate a bed search. Once a bed has been
assigned and before the patient is transferred from the ED, admitting must have
the patient's name and the name of the admitting service attending physician.
Admitting office notification can be accomplished by entering the information
directly in the computer. Do not call admitting because this is time-consuming
and inefficient!
Trauma alert reds who
require ICU care should be moved to the ICU as quickly as possible. To
facilitate this, an open ‘Trauma Bed’ is maintained at all times. Furthermore,
the ICU Charge RN and the HOA will respond to TA Reds to communicate bed
availability and facilitate rapid admission of the most critically injured to
the Trauma/Surgical ICU.
II. Call
Coverage Responsibility
Call coverage teams
will consist of Senior Surgical Resident (PGY 4 or 5), a midlevel surgery
resident (PGY2 or 3), and an intern. Night call and work hours will conform to
the ACGME work hours and night call standards. During some months, additional
senior, midlevel and first year residents (EM, Pulmonary, Anesthesia, OB/GYN,
PM&R, Surgery, OMS) will rotate on the service. These additional resident
resources will be integrated into the service to provide additional coverage in
compliance with ACGME work hour standards.
A. Referring
Physician Calls
Receiving referring
physician calls is a necessary part of resident education. Calls from a
referring physician (including UKMDs) are the responsibility of the chief
resident (PGY 4 or 5). Any other resident or intern receiving such a call
should immediately forward the call to his/her chief resident. The Call Center
will AUTOMATICALLY accept all trauma referrals and immediately facilitate
transfer without contacting the trauma chief resident unless they specifically
request to do so OR it appears, at the discretion of the call center, that the
patient may require immediate surgery. Brief patient info will be conveyed by
digital pager to the trauma chief resident. The resident then has the
opportunity to follow-up with the referring MD by phone thru UKMDs.
REMEMBER THAT THEY
ARE ASKING FOR OUR ASSISTANCE. MANY REFERRING HOSPITALS DO NOT HAVE THE
RESOURCES TO CARE FOR THESE PATIENTS. ALL patients referred by an outside
physician are to be accepted in transfer by the chief surgical resident unless
otherwise instructed by the Trauma/Emergency surgery service attending on call
(NO EXCEPTIONS).
B. ICU Call
Primary ICU calls for
Blue Surgery Service patients are the responsibility of the PG2 or PG3 on call.
The Critical Care Nursing Staff have been instructed to direct all calls to the
PG2 or PG3 on call. Interns receiving ICU calls will refer them to an upper
level resident.
C. Floor Call
Primary floor calls
are the responsibility of the Blue Surgery Intern on call. Monday to Friday
7a-5p, calls for patients on PavA 7-100 and -200 should be directed to Charles
Spillman, PA-C or Yvonne Rice, APRN, respectively. Questions or problems
regarding floor patients should be directed to the chief surgical resident on
call.
III. Patient
Rounds
Patients rounds
should occur twice daily on all Trauma/Emergency Surgical Service patients and some
consults. Patient Care Guides have been provided to facilitate communication on
rounds and should be provided to all patients BY THE TEAM.
A. Morning
Rounds
The chief surgical
resident assumes primary responsibility for the timing and conduct of rounds.
In general, daily morning rounds begin at 6:00 am with a brief handoff to
include only new events of the night. The walking handoff for the ICU should
occur while walking through the ICU. These quick handoffs should not exceed 30
minutes in most cases. Residents from each call team are to be present for
rounds. Given that this is not always possible, a resident from each of the
call teams should be present so that information transfer occurs in an orderly
fashion. Formal work rounds should follow.
B. Attending
Rounds
Daily attending
rounds will be arranged between the faculty on service and the senior surgical
residents. Residents should present patient information in a clear, concise,
and detailed format facilitating the completion of rounds in a thorough but
timely fashion. Presentations by students on rounds or at sign out is
encouraged but requires a certain persistence and fortitude on the part of the
student.
C. Discharge
Planning Rounds for Ward Patients
Discharge planning
with the Trauma Case Managers/Social Workers/Pharmacists/Dietitian/Others will
occur EVERY DAY at approximately 9:30am in PavA 7th Floor Smart
Rooms. These rounds are mandatory for the surgical intern on-call. These
rounds are multidisciplinary, facilitate patient care, and insure timely patient
discharge.
IV.
Patient Discharges and Service Transfers
A.
Hospital Discharge*
Patient
discharge from the hospital should be timely and efficient. This process is
facilitated by discharge planning rounds. Timely and cordial interaction with
the nursing staff that provide discharge teaching and with the social worker
who arranges extended care [i.e. Subacute Nursing Facility (SNF), Acute
Rehabilitation, Home Health, etc.] is critical. The Trauma Case Manager will be
responsible for coordinating discharge of the multiple injured patients to
home. When patients are identified for discharge, the nursing staff should be
notified on the day prior to discharge and an ANTICIPATE DISCHARGE ORDER should
be written in SCM. Discharge orders and prescriptions will be completed the
evening before or by 8:00am on the day of discharge. The following critical
errors are often made in patient discharges:
1. Patients
are not scheduled for subspecialty appointments prior to discharge (i.e.
Neurosurgery, Orthopedics, ENT, Plastics, etc.)
2. Patients
are not given adequate supplies or medication**. This is poor patient care,
results in unnecessary patient calls, and is unfair to the patient and their
family. Please make sure that patients are given adequate medication and
supplies to make it to their first clinic appointment. Prescriptions should be
written in SCM Rx Writer and electronically submitted to the patient’s
pharmacy, filled thru meds-to-beds at UK Chandler Retail Pharmacy, or printed
for attending signature during sign out.
3. Appropriate
labs and X-rays are not being ordered for the first clinic visit.
4. The
first blue surgery clinic appointment should be scheduled according the
guideline (http://uktraumaprotocol.blogspot.com/2014/11/clinic-follow-up-sgb.html). Not all patients require a Trauma/Emergency Surgery service clinic
appointment. Please check with chief surgical resident, attending physician, or
case manager before scheduling a follow-up appointment.
5. The
attending physician of record for the discharge summary is the attending on
service when the patient is discharged from the hospital.
**Trauma
service residents will not prescribe narcotic pain medications after hours or
on weekends. Patients should be instructed to contact the clinic during regular
working hours for narcotic pain medications.
B. Service to Service
Transfers
Multiple or single system injury
patients can be transferred to an appropriate subspecialty service when they
are stable. Coordination of the transfer process is
the primary responsibility of the chief surgical resident. The Blue Surgery
Service should function as a consultative service after transfer of the patient
when consultation is appropriate for good patient care. See ED
Triage-Determining Admission Dispo (http://uktraumaprotocol.blogspot.com/2014/08/ed-triage-determining-admission.html)
See Trauma Tertiary Exam and Transfer of Service (http://uktraumaprotocol.blogspot.com/2013/05/trauma-tertiary-exam-and-transfer-of.html).
V. Clinic
Responsibility
A.
Trauma/Emergency Surgery Clinics
There are two clinics
for the service. The main clinic for the service is Tuesday 8:30 am – 4:30.
Residents are expected to attend in accordance with the resident duty hour
restrictions. All patients seen by a resident should be staffed by an attending
physician unless otherwise instructed.
B. Clinic
Phone Calls
During weekday
working hours, clinic phone calls that cannot be handled by the clinic staff will
be referred to the Trauma Case Manager (TCM), the Social Worker (SW), the Chief
Resident or the Attending. Residents will be contacted by the clinic for
prescriptions or medication** renewals. If the patient needs to be seen by a
physician, the clinic will try to accommodate the patient during clinic hours.
This avoids long delays and unnecessary co-pays for our patients. During
evening hours and on weekends all patient phone calls will be directed to the
Chief surgical resident on call.
VI. OR
Scheduling
A. Emergent
The booking of
emergent surgical cases is the primary responsibility of the chief surgical
resident.
B. Elective
Inpatient*
The booking of
elective surgical cases on Trauma/Emergency Surgery inpatients is the primary
responsibility of the chief surgical resident. *The clinic personnel OR the
O.R. Scheduling Office must be notified about elective inpatient booking so
they can keep our schedule correct.
C. Elective
OR Scheduling for clinic patients
The Surgical
Residents are ultimately RESPONSIBLE for ALL ELECTIVE SCHEDULING OF O.R. CASES
FOR CLINIC PATIENTS.
1. All cases should be posted by completing the O.R. Case Posting
form. The patient name, procedure, estimated time, CPT code, and attending on
service at the time of surgery are the necessary information.
2. Same Day Surgery Patients and Outpatients should have and
H&P*, consent*, appropriate preoperative labs*, and a referral to anesthesia
clinic (when appropriate) prior to the day of surgery. (*This should be given
to clinic personnel).
3. Completed O.R packets should be hand carried to the O.R scheduler
prior to the patient leaving the clinic whenever possible.
The Trauma/Emergency
Surgery service has elective operating room time every Thursday and Friday.
Cases must be booked no later than 24 hours prior to Surgery. Do not wait until
the last minute to book elective cases. The chief surgical resident is
responsible for checking, verifying, and establishing case order. This should
be accomplished along with the surgical attending on service. A daily O.R case
list with resident surgeon and student assignments for the following day should
be broadcast by the Chief Resident each night.
PERSONNEL
Trauma Nurse Coordinator (TNC) Name: Stephanie Devore, RN Phone: 859-257-1231 Pager: 330-2319
The TNC is
responsible for program administration, quality assurance activities, and
systems problem solving. The TNC maintains and facilitates the trauma registry
for the purpose of research and quality assurance. Clinically, the TNC
evaluates quality of care, especially during the initial assessment and
resuscitative phase.
The TNC also
coordinates ATLS and other education related activities.
Trauma Case Managers (TCM’s) Name: Amie Newell, RN. Office: 859-323-5318. The TCM’s are responsible
for: 1. Discharge planning-determining patient disposition early and making
appropriate referrals to outside agencies accordingly; directing consultation
of Rehabilitation Medicine and Physical Therapy as necessary; serving as a
liaison with Orthopedics and other specialty services; along with nursing,
identifying patients needing Home Health Referrals, outpatient equipment needs,
and teaching needs; teaching and guiding housestaff; serving as a liaison
between the Blue surgery service and nursing-keeping nursing abreast of the
current plan of care and keeping surgeons abreast of the nursing plan of care;
along with nursing, making adjustments in the nursing plan of care to meet
patient outcomes; developing and monitoring protocols related to the care of
trauma patients.
Chemical Dependency Counselor- Our Professional Counselor,
David C. Maynard, MA, LPCC (cut my credentials if they are cut for others) is
available to trauma patients for a wide range of reasons, including alcohol and
substance use, traumatic stress, and depression. If you are a patient and
in need of his services, he can be reached at 859-323-0881.
Trauma Outreach Coordinator-Amanda Rist, RN, BSN. Office: 323-1116. The Injury Prevention Coordinator
works inside UK and in the community to educate the public and develop programs
that reduce injury occurrence. The IP Coordinator is considered an expert in IP
and is a resource for questions about preventing future injury in our patients.
Orthopedic
Case Manager: David Bartley, RN, BSN.
Office: 859-323-2029. The Case Manager is responsible for discharge
planning for the Ortho Fracture, Reconstruction, Hand and Sports Medicine
services for the University of Kentucky Medical Center. The Case Manager
attends daily multidisciplinary rounds that include Physicians, Pharmacy,
Social services, Physical and Occupational Therapy. Discharge planning
includes visiting patient to assess social situation and identify barriers to
DC. Case Management works closely with nursing staff to discuss issues,
communicate Plan of Care and educate for timely discharges once patient is medically
ready.
Ortho PI Coodinator-Ellen
Williams, RN, BSN. Phone 859-323-2403 Pager: 330-0025. The Orthopaedic
Trauma Nurse Coordinator is responsible for quality assurance and performance
improvement activities as related to trauma patients with orthopaedic injuries.
The Ortho Trauma Coordinator facilitates, maintains, and manages the trauma
registry with specific emphasis on the PIPS. Additionally, the Ortho
Trauma Coordinator evaluates quality of care of ortho trauma patients and
provides education to their care providers.
A.
Trauma/Critical Care Conference*
There is a mandatory
trauma/acute surgery/critical care conference Monday and Wednesday at noon
(time and topic to be confirmed by the faculty covering at VA). All team
members are expected to attend unless patient care responsibilities preclude
attendance.
LEGAL
RESPONSIBILITY
Many trauma patients
become involved in civil or criminal cases. Consequently, residents sometimes
receive a subpoena to testify in these cases. Under most circumstances, the
responsibility to testify in court belongs to the attending faculty member that
supervised the case. Please bring all subpoenas involving testimony in these
cases to the immediate attention of the Section Chief of Trauma and Acute Care
Surgery (Phil Chang) or to the Medical Director (Andrew Bernard). All other
medical practice/legal issues should be brought to the immediate attention of Trauma
Medical Director.
TRAUMA/EMERGENCY
SERVICE PROTOCOLS
There are a number of protocols that govern the treatment
and care of Trauma/Emergency Surgery Service patients. The surgical residents
are expected to be familiar with these protocols and to adhere to them. All of
the protocols are located at uktraumaprotocal.blogspot.com.
DISCLAIMER
These guidelines are not intended as a directive or to present a
definitive statement of the applicable standard of patient care. They are
offered as an approach for quality assurance and risk management and are
subject to (1) revision as warranted by the continuing evaluation of technology
and practice; (2) the overall individual professional discretion and judgment of
the treating provider in a given patient circumstance; and (3) the patient’s
willingness to follow the recommended treatment.
