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Respiratory Therapist Practice Guidelines for Trauma Response |
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The following sets forth guidelines for respiratory therapists practice and response to Level 1 Trauma Alert patients/resuscitation situations within the Vanderbilt Adult Emergency Department.
Absolute Requisites
- Respond promptly to the Level 1 Alert
- Don full BBFP gear
- The therapist shall assist with airway management as directed by the Emergency Medicine physician and/or trauma team leader.
- The therapist's position shall be at the head of the bed to the right of the physician and/or individual performing primary airway management.
Critical Tasks/Principles
- Special attention should be paid to maintaining excellent BLS/ventilation/oxygenation skills at all times.
- Remove ambu bag during ALL patient moves (ex: stretcher to stretcher)
- A quantitative/qualitative end tidal CO2 monitoring (EtCO2) device will remain on ALL intubated patients during their stay in the Emergency Department.
- A fresh EtCO2 detector will be placed on every patient upon their arrival into the trauma bay.
General Patient Care Guidelines
- Patients that require supplemental oxygen will have same delivered via a non rebreather oxygen mask at 12-15 liters per minute.
- Care should be taken not to hyperventilate trauma patients and to keep them normocapniec; unless otherwise directed to by a team leader/physician.
- All intubated patients should receive PEEP at 5cm/H20 as a baseline; increased as directed by the team leader/physician.
RSI Specific Patient Care Guidelines
The overall goal of this procedure is to keep the patient adequately oxygenated (02 sats >90%) and avoid positive pressure ventilation until an endotracheal tube is placed; this is the core principle of RSI. The goal of rapid sequence intubation is to allow that patient to breathe supplemental oxygen via non rebreather mask spontaneously until the administered sedatives and neuromuscular drugs take effect.
- Patients that are undergoing RSI (rapid sequence intubation/induction) are not to be bag-mask ventilated unless their oxygen saturations are <90% or you are directed to do so by the Emergency Medicine physician
- ALL patients that are being mask ventilated should have at least one airway adjunct in place; preferably an appropriately sized oral airway or nasal trumpet.
- ALL bag mask ventilation should occur simultaneously with cricoid pressure; proper two-handed mask seal and adequate rise/fall of the chest.
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