Jump to content

"Trauma Packs"


Recommended Posts

The term "Trauma Pack" has been used by physicians and nurses in one of our ICUs and in some ORs when there is a STAT need for blood products. This is term is not in our SOPs and has not been used, until recently, in this hospital. When asked to define "Trauma Pack", the RN calling the blood bank has no idea what she is asking for and tells us that's what the order says.

Does anyone use the term "Trauma Pack"? If so, how do you define it, when is it used, what turn around time is expected, etc?

Link to comment
Share on other sites

We don't use the word trauma pack but we have a "red chest" policy for trauma patients who are going to be massively transfused. The "red chest" is a red cooler and when ER calls for a red chest we get 6 prelabelled O neg packed RBCs ready for them to pick up. They bring an emergency release form with patient labels and we attach a label to each unit and to each unit tag. We ice pillows to place in the cooler with blood. As part of our protocol, we thaw 4 units of AB FFP and make sure that we have 5 random donor platelets available (not pooled). ER is too supply us with a specimen as soon as possible so that we can switch the patient to type specific.

Link to comment
Share on other sites

Our "Trauma Pak" is a bag with pre-registered identification, stamped "Trauma labs" order form, all tubes needed, and blood bank bracelet.

Nurse/phlebotomist opens the bag and there's all the stuff needed.

"STAT Trauma" is our overhead page that the trauma might be bloody and we rush a box of 5 O Pos to them.

Link to comment
Share on other sites

We are in process of developing massive transfusion protocol. We have MTP pack #1,2...etc. Once the attending initiate the protocol we will start stnading pack every 15 mins. May be one of your nurse/resident/physicians woked at other trauma center and they may be using trauma pack.

Link to comment
Share on other sites

At our hospital we have what we refer to as the "Trauma Coolers" Six units of leukoreduced O pos irradiated red cells and two units of leukoreduced "O Neg" irradiated red cells. What is put in the coolers is "prepared" ahead of time and in the fridge waiting for the call. The units are documented on an emergency release form, segments have been pulled and labeled and put into a plastic bag for future xmatch on patient and the units have all been verified to be available and ready for issue.

We have coolers designated just for this purpose and are "prelabled" and just need to have the ice blocks and temp indicator placed inside along with all the units.

Link to comment
Share on other sites

We do not have a "trauma pack." We have refrigerators in the OR and ER that each have 6 O neg red cells in them. If someone wants trauma blood, they call the blood bank, give the patient identification (such as it is), and we unlock the door. They tell us which units they took. When we get the signed emergency release form, we re-stock the refrigerator. If they use them all up, we have 4 tagged O negs in the blood bank they can come for. Usually we can get them on type specific before that point.

Link to comment
Share on other sites

  • 1 year later...

Monica,

We have two sets of 6 O neg and one set of 6 O pos set aside for trauma massive transfusion activations. Our massive transfusion protocol is basically a keep-ahead order. We will send 6 units of RBCs, and have one unit of SDP ready to go, and 4 units of AB FFP thawed. If ER asked for x number of RBCs, we set up the same amount to fill the keep ahead order ready. We don't do anything else- just keep it ready. That has worked better than any other formula I have worked with at the other trauma centers where I have worked.

BC

Link to comment
Share on other sites

We couldn't for the most part keep up with that supply of O negs. The ER has a fridge with 4 that they can use immediately. Then they call us for more. The massive transfusion protocol that is being developed would be starts with 4 units of blood, then 40 minutes later its 4 more units, 4 FFP, and 1 SDP, then 40 minutes later it would be 4 more units, 4 FFP, and depending on lab values may be another SDP, and a Cryo pool. And so on and forth for the extend of the protocol being in place.

I think the biggest problem we have is our computer systems it makes it really hard.

Link to comment
Share on other sites

See what they think about a simple keep-ahead policy. They take 2 units of whatever, you set up 2 more. You can save a lot of time and trouble that way, and keep from wasting a lot of FFP.

As far as the O negs, make the protocol O pos for adult males. We keep about 100 O negs on the shelf, and that is how we do it. Granted, we use a lot- there were 6 level 1 traumas between midnight last night and 800 this morning, with 1 massive transfusion protocol activation. We transfused 2 O neg and around 40 other units, 25 of which were A pos, the type of the MTP activation patient. I am about to go in this morning and do the review. We use downtime protocols for massive transfusions. No computer can keep up.

BC

Link to comment
Share on other sites

Ellis, It really dosen't matter what we think a trauma pack is.

Ask the physicians asking for it what they expect when they order it. Once they tell you their expectations then you have a base line to work from. When ever I have tried to guess what they have wanted I have never quite got it right.

I have found that physicians are like everyone else. The way things happended where they were before is the only way to do things even if they have gone from a 1500 bed level I trauma center to a 15 bed rual hospital. Some times they have to be told, "sorry we just can not do that" by your medical director. That's assuming your medical director is will to do that.

Link to comment
Share on other sites

Addressing John's comments: Establishing "trauma pack" criteria is going to have to be a cooperative effort. If you ask the physicians what they want, you will never be able to fill their request. But, if you tell them what you can reasonably provide in a short period of time, then you can come to an understanding. Until then, you will just have to borrow a line from "Treasure of the Sierra Madre":

"Trauma packs? We ain't got no trauma packs. We don't need no trauma packs! I don't have to show you any stinkin' trauma packs!"

BC

Link to comment
Share on other sites

Thanks for making my day! I really enjoy your posts and your sense of humor! Belva in Nebraska

Addressing John's comments: Establishing "trauma pack" criteria is going to have to be a cooperative effort. If you ask the physicians what they want, you will never be able to fill their request. But, if you tell them what you can reasonably provide in a short period of time, then you can come to an understanding. Until then, you will just have to borrow a line from "Treasure of the Sierra Madre":

"Trauma packs? We ain't got no trauma packs. We don't need no trauma packs! I don't have to show you any stinkin' trauma packs!"

BC

Link to comment
Share on other sites

  • 3 weeks later...

We have a combo of both situations: We're in a Level I trauma, so we keep 20 O Pos units and 2 O Neg units in the ER for emergent uncrossed use. An alarm sounds in the blood bank when this fridge is opened.

We have also recently started a Massive Transfusion protocol, where we set up "packs" of 6 red cells, 4 FFP, and 1 SD platelet repeatedly until the trauma is controlled.

Link to comment
Share on other sites

Tell me about that alarm system. I am looking at putting a small BB refrigerator between my two trauma halls. We have 6 level 1 trauma suites, with a supply hallway between them. But, I would like to know when someone opens the refrigerator. I am looking for a system to alert me.

BC

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Recently Browsing   0 members

    • No registered users viewing this page.
  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.