Trauma Admissions memo – original signed document – update July 2016

All patients with traumatic injuries requiring admission MUST go to the trauma service or another surgical sub-speciality service.  The only possible rare exception would be if the traumatic injury can be unequivocally attributed to an acute cardiac evat or the patient is at high risk of acute cardiac dysrhythmia/ischemia as determined by the ED attending. Patients with serious medical conditions (i.e alcohol withdrawal, acute kidney injury, electrolyte abnormalities, DKA) with a traumatic injury cannot go to medicine and must be admitted to the appropriate surgical service.  These patients can be placed in the SICU or step-down unite for management of their medical issues.

A traumatic injury that will be managed non-operatively is not a reason for a medical admission.

Red Trauma:  Automatic admission to the Trauma Service unless:

***The ED attending agrees that the patient can be discharged and the senior/chief resident writes at progress note indicating that their plan for discharge and appropriate follow-up.  The progress note MUST include the name of the surgical attending with whom the case and disposition was discussed.

Yellow/Gree Trauma:

• More than one organ system injury: Trauma Service.
• Syncope with significant trauma**:  Trauma Service.
• Syncope with isolated intracranial bleed**: Neurosurgery Service or Trauma Service (If there is an argument as to which service, the patient should go to Trauma)
• Isolated facial trauma not requiring ICU: Service covering facial trauma.
• Isolated genitourinary trauma: Trauma Service
• Isolated upper extremity fracture: Orthopedic Service ***New***
  • (DO NOT ADMIT TO MEDICINE)
• Isolated lower extremity fracture: Orthopedic Service.
• Pelvic Fracture:
  • Hemodynamically unstable and/or accompanied by significant blood loss:
    • Trauma Service. Otherwise, Orthopedic Service.
  • Hemodynamically stable
    • Orthopedic Service
• Altered mental status (or post-concussive syndrome) after mechanism of trauma except for syncope (i.e. pedestrian struck, assault, motor vehicle crash):
  • Trauma service, even if trauma work up is negative.
• Rib fractures: Trauma Service
• Isolated vertebral fractures after trauma: Neurosurgery