Emergency Services Trauma Flow SheetHospital Logo Patient Sticker

Example

Date:

Patient Arrival Time:

N/A Pre-Hospital Treatment Transporting Ambulance_____________________________________________________________________________________ O2 @ ______L/min/ IV: Needle size______________ Backboard NC NRB Ambu LR _________________ Long Short Ked Airway Medications ________________ Scoop Oral Nasal Other _____________________________ Bilateral Head Supports ET tube # _____ @ _____cm C-Collar o n: Yes____ No ____ Splint on _________________ Ice on __________________ CPR started @ (time)______________ Dressing ________________ Other __________________ Date of Injury: ________________ ___ Time of Injury: _ _________ Pre-hospital trauma team alert notification: Yes No Hospital Trauma Team Activ atio n Yes____ No____ Time of Trauma Team Activation: _______________ Trauma Team Members Type of Vehicle Team members notified: Time Called Time Arrived Car Nurses x _________________ Truck ATV Physician / CNP / PA Moto rcycle Boat Bicycle Lab X-ray Other_____________________________________ Other ____________________ Mechanism of Injury Restraint Devices Speed of vehicle ________ MPH Rollover Lap belt Airbag deployed Ejected Shoulder belt Helmet Number of vehicles 1 2 3 >3 Rearend Car seat Unrestrained Steering wheel deformity T-Bone Starred windshield Head on Fall Penetrating Blunt Thermal Other Fell from: GSW Assault Burn Hanging Stabbing Height____________ ft. Other Other Cold exposure Animal related Crush Heat exposure Near drowning Pedestrian

Emergency Services Trauma Flow SheetInitial Assessment

Example

AIRWAY DISABILITY Patent Suctioning Glasgow Coma Score Initial Disch Oral Airway Bag Mask Eye Opening Nasal Airway O2 __________________ L. Spontaneously 4 ET ________________ Commen ts To Speech (Shout) 3 Trach To Pain 2 ______ ______ Crico _____________________________________ No Response 1 BREATHING Verbal Response RL Normal Agonal Confused 4 (Consolable, Cry) Lung sounds Shallow Nasal flaring Clear Stridor Tachypnea Inappropriate Words 3 (Persistent Cries, Screams) Rales Dyspnea Grunting Rhonchi/Wheezes Retracting Absent 2 Incomprehensible Words (Grunts, Restless) Decreased In tercostal Paradoxical Absent Substernal Cough No Responses 1 ______ ______ Motor Smoker Yes No Unk CIRCULATION Obeys (Spontaneous) 6 Capillary Refill: None Delayed (> 2 sec) Normal (< 2 sec) Localized Pain 5 Pulses Present: Carotid Femoral Radial Pedal Withdrawal to Pain 4 Flexion to Pain 3 Palpated Pulse Regular Irregular (Decorticate) Heart tones Audible Absent Jugular Vein Distension No Yes Extension to Pain 2Spontaneous Respiratory Effort Oriented (Coos, Babbles) 5

Bleeding Controlled Uncontrolled NA No Response to Pain 1 ______ ______ Skin Color Pink Pallor Cyanotic Total GCS Score ______ ______ DuskyFlushed Mottled

Area of Injury Allergies : Tetanus: ________ LMP:_________ Wt: ___________ Procedures Time Procedure Results ET Tube _____ Combitube ____ Size ______________________ Secured @ ______________cm FiO2 ___________________ % Central Line/ IV Size ____________________ Fr Site _______________________ Solution___________________ Warming Measures Fluids Mechanical Bair Hugger Blankets NG Tube Size _____________________ Color____________________ OW = Open Foley / Quick Cath Size ____________________ A = Abrasion Fc = Closed Fracture Wound Color____________________ B = Burns Fd = Dislocation P = Paralysis Neck immobilization CMS: C = Crepitus Fo = Open Fracture S = Edema C-Collar Applied: ___________ Before___________________ After ____________________ D = Deformity L = Laceration Ta = Total __________________________ Splinting ___________ ___ ___ Location:__________________ E = Ecchymosis Na = Near _________________________Amputation Amputation

Emergency Services Trauma Flow SheetSecondary Assessment

Example

Input Output Head/Scalp Eyes Mouth Ears Source Prior to PEARL ED Total Source Prior to Arrival ED Total Arrival Intact Rash Intact No drainage IV Fluids Burns Urine eyes Teeth Drainage Laceration Raccoon Emesis Abrasions Pain EOMS follows Missing teeth Right Left Chest Tube Bruising Battle Visual Acuity OD ____/____ Dentures intact Clear Clear Signs Other OS ____/____ Comments_________ Blood Clear Neck Chest Heart Sounds Blood Intact C-Collar Symmetrical Chest Pain Present Fresh Frozen Pain Asymmetrical Swelling Plasma Location_______________ Distant Trachea midline Paradoxical movement Time of onset ___________ Absent Trachea deviated Location _____________ Activ ity @ onset ________ Sub-q emphysema Crepitus Flail chest Belongings Personal Difficulty swallo win g Location_____________ Other _________________ Clothes Abdomen / Pelvis / GU Purse Abdomen Bowel Sounds Pelvis Wallet Soft Distended Last Intake: Present Intact Jewelry ____________________________________________________________________ Nontender Rigid Food ________________ Absent Pain ______________________ Given to: Liquid _______________ Hyperactive ____________________________ Tender Name ________________________________________________________________________at meatus ____________ Hypoactive Blood Comments: Relationship __________________________________________________________________ Blood at rectum ____________ Nursing Staff __________________________________________________________________ Instability _________________ Posterior Extremities Nurse Notes: Intact Intact Deformity Fracture Pain Pain Comments _________________________________________ Deformity ____________________________________________________ Comments _________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ Pupil Reaction Pain Scale CommentsTime Tem p P R BP SaO2 O2 L/min S-slow U-unequal 0-10 B-brisk D-dilated Pain F-fixed = - Equal C-closed by swelling Scale Type

/ / / / / / / / / / / /

Right Left

Medication

Medications Given Dose Route Time Given Initials

RN Signature: ______________________________________________________________________________Q/trauma2/trauma/trsystemdevelopment/sdtaskford/flowsheetdraft/09-09