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Home | Articles | Admission | Trauma Admissions

Trauma Admissions

Last updated 14th May 2021

Most common admissions are for NOF#, however can include any form of fracture. NOF# should be operated on within 48 hours (aim is to do them the next day)

Initial Admission/Clerk-in

  1. Initial clerk in would have been done by the surgical registrar in ED. This usually includes mechanism of injury, a VTE form and management plan
  2. A FY1 clerk in would require a thorough assessment including a medical assessment
  3. Try to complete/ discuss treatment escalation plans/ DNACPR status
    • i) If DNACPR is present in the community (available to see on patients KIS when doing Med Rec, print this out and get registrar to fill in the form)
    • ii) If not present, discuss about this based on situation

 Bloods

  1. Bloods would have initially been done by ED team
  2. Ensure 2 tubes of G&S have been sent to labs

HEPMA

  1. Suspend any potential nephrotoxics prior to operation – including NSAIDs, ACEi. Prescribe all medications on HEPMA and then suspend these to reduce errors.
  2. Suspend antiplatelets and anticoagulants

Anticoagulants

  1. Warfarin
    • Target INR for operation <1.4
    • Often patients are given 10mg of IV Vitamin K
    • Recheck INR prior to surgery, if still >1.4 a further dose needs to be given or discuss with haematology
  2. DOAC
    • Discussion with surgeon, anaesthetist and haematologist needed – may require levels

Analgesia + Laxatives

  1. For NOF#, emergency department would have done a iliaca fascia block
  2. Ensure adequate analgesia has been prescribed, regular paracetamol, PRN codeine or oromorph.
  3. Most patients may require PCAs – refer to Analgesia section under general surgery for this. Beware of patients with dementia who may not be able to use this – nurse control or regular analgesia would be needed

Fasting

  1. Check with on call reg when is patient due operation
  2. Start IV maintenance fluids as most patients won’t be able to tolerate oral fluids
  3. Last meal should be 6 hours before operation