Purpose: Avoid the impact of time lost in the Trauma Room
(however limited) when operative intervention must be performed immediately
to prevent loss of life. To minimize
delays to the operating room and initiate lifesaving surgical
interventions.
Goal: Consider entirely bypassing the ED and transporting the patient
directly to an OR that is prepared. DOR resuscitation can be suggested by
prehospital personnel based upon field assessment or by the ED charge nurse based
upon the report. Direct to OR activation can be made only by the Trauma Chief
resident or Attending based.
1.
Thoracic injury with open cavity
2.
Evisceration of abdominal contents
3. Penetrating
injuries or impalement of the
neck, chest, abdomen, or pelvis with SBP < 90
4. Profound shock (adults: SBP <80)
with CT or ultrasound evidence of hemoperitoneum
5. Massive blood loss on scene or en route with ongoing
uncontrollable external loss (excluding GSW to head)
Published 5/20/19 (A Bernard/S Priest); Reviewed 11/7/23 (A Bernard, C Reynolds)
