Resuscitation in the ICU

By "resus," are you talking about acute resuscitation such as CPR?

By "resus," are you talking about acute resuscitation such as CPR?

Well, possibly. I was actually thinking of a situation where the patient comes in to the ED and if they are coding, that is handled there, as well as the initial workup (CT, labs drawn etc.)

Basically, you stay in the ED just long enough to decide does this pt need to go emergently to the OR, to the ICU or the floor?

Although, I ahve heard of another approach whereby the Trauma pt bypasses the ED altogether and goes straight to a trauma resus area in the ICU. I beleive that Cook County in Chicago and UCSD in San Diego do something like this?

In the ED I used to work in, it was not unusual at all for a sick trauma to come in and they would stay in the ED for an entire shift getting fluids, blood etc. Neurosurg would want to hold them in the ED to put the ventriculostomy in, trauma surg would keep them down there to do all sorts of procedures, things that in my mind would be better done in the ICU. In my mind, the best run traumas in the ED were the ones where the patient came in, was assesed, labs drawn, images taken and then they scooted out to the unit or the OR. In and out in 30 minutes or less.

In our critical care area of the ED, you ahd a team of two nurses and one tech who shared (most nights) three ICU type patients along with 3 telly-type patients. So, when you have a sick trauma in one of those bays requiring one on one care, that leaves 1 nurse (who may or may not have the tech to help because they may be tied up in the trauma as well!) with 2 icu pts and three telly patients. Seems that that is a bad thing.

Maybe this is unique and most places don't do it this way. Perhaps that's why I think it's a "novel" idea and no one else does! :-)

What is the norm where you are?

A few years ago when I worked at an integrated SICU (level 1 trauma ICU/CVICU), I had a co worker who worked at another level 1 trauma center SICU and she said that they have a trauma bay in the SICU and they handle all the prelim labs/xray/ct/line placement/fluid resus/consults, then send the patient to OR if need be. I thought this was very interesting, because what we did was get the patient after initial ER resus, and we'd still have to assist in placing swans/ventriculostomies, and perform fluid additional fluid tanking if need be after the swan is placed by using starling curve. I'm not sure if they still do that but can you imagine? As if working in a trauma SICU doesn't entail enough roadtrips already, lol you'd have to include the preliminary one's that's done when they first come in the ER. I feel those nurses are soooo knowledgeable and I was so glad she was my preceptor then because I learned so much from her. But I'm done with trauma now, it got to me, I found CVICU patients more appealing.

i think most level 1 trauma centers have a '"trauma team" who respond whenever a trauma arrives to the ER ( at least our big inner city hospitals do), and that they acutally come from the trauma icu unit down to the ER. So really, if we are talking about emergency resus, i think it is better to stabilize in the ED ( with the trauma icu team) before transport. coding on an elevator is never fun, but if necessary, hope we are on route to where the patient needs to be going instead of just getting him out of the ER.

i think most level 1 trauma centers have a '"trauma team" who respond whenever a trauma arrives to the ER ( at least our big inner city hospitals do), and that they acutally come from the trauma icu unit down to the ER. So really, if we are talking about emergency resus, i think it is better to stabilize in the ED ( with the trauma icu team) before transport. coding on an elevator is never fun, but if necessary, hope we are on route to where the patient needs to be going instead of just getting him out of the ER.

So you have Trauma ICU nurses who respond to the ED? All we ever had was docs. The nurses were all ED. I always wondered if it might be a good idea to have some ICU nurses involved for continuity of care sake. I did a rotation in school at a major children's hospital and they did something similar. Anytime a trauma alert was called, 2 nurses for the PICU came to the ED with the trauma team. If it because clear that the kid wasn't going to need ICU care, they "stood down," otherwise, they were in the Trauma room helping out and getting to know "their" new patient.

Exactly. Works very well.

we have a trauma team, but most of the time that consists of keeping them alive long enough to get them to the or, and then the or keeps the sort of alive until they get to us then we get to resusictate them.

usually massive pressors ( i had a pt come back from surgery on 100 mcg of levophed and the bp was in the 70's per art line and the anesthesiologist was like, oh he's fine, and left!) level i fluid resuscitator, possibly 2 (one for blood products and one for fluids), and as many residents, interns and staff physicians that can fit into the room all yelling orders at the rn's.

oh, and the code cart as close as humanly possible with all the emergency drugs already pulled from pyxis. bicarb, epi, atropine, the works. whew. just talking about it makes me jittery! :uhoh21:

yeah, aint it great???!!

I currently work in a Level I Trauma/Surgical ICU.

At our hospital, there is the ED and there are two large rooms inside of the ED where the traumas are brought. The trauma team responds to all of the traumas. For example, if it were a level I trauma... the team consists of: junior/senior surgical resident, junior/senior ortho resident, anesthesia, an ER nurse, a trauma/surgical ICU nurse, there are also trauma nurse specialists in house most hours of the day, the lab, xray, blood bank brings blood, pharmacy brings 7.5% hypertonic saline boluses, security, chaplain, house supervisor, an OR nurse... sometimes two... and of course the attending physician... and before you know it, there are 30 people in the room.

We do intial and then secondary assessments in the trauma room.... if the patient is stable enough, we take them directly to CT scan.... if the fast sono was positive and the patient is unstable, they go to the or directly.....sometimes when they are stable, but we know they need to go to the OR, we take them to CT scan, then to the unit where we place lines and then head over to the OR..... but if they are coding when they come in, we have everything we need in the trauma bay to code, and certainly enough people! :)

the team consists of: junior/senior surgical resident, junior/senior ortho resident, anesthesia, an ER nurse, a trauma/surgical ICU nurse, there are also trauma nurse specialists in house most hours of the day, the lab, xray, blood bank brings blood, pharmacy brings 7.5% hypertonic saline boluses, security, chaplain, house supervisor, an OR nurse... sometimes two... and of course the attending physician...

Wow. I used to work as a tech in the ED of a level I Trauma center. For our highest level of activation (we had 3), we got trauma attending/fellow, senior resident, junior resident, anesthesia, x-ray, respiratory therapy (to run a vent if needed) and er staff. Techs had to go to the blood bank (on the 6th floor) to get blood, techs drew labs (unless they wanted an ABG then the nurse did it. The OR charge nurse got paged and held a room for 30 minutes. Chaplain, security, house supervisor didn't even know about it unless an ED nurse paged them. Ortho and neuro (who were needed in almost all serious traumas) didn't come until trauma surgery consulted them (and then sometimes not until the ct/x-rays were shot.

we had a second level that brought the junior resident, x-ray, RT and we went to get blood.

The lowest level got you x-ray and ortho only. It was used for long bone fractures mainly. ED docs handled everything else.