TSICU:Main

This is the main page for Harbor-UCLA Trauma SICU

Admin Updates & Reminders

• Please ensure continued and timely use of the OR to TSICU Handoff Tool
  • media:OR_to_TSICU_RN_Handoff_Tool_.pdf

• Ensure that Admit to ICU order is placed PRIOR to patient arrival in the SICU
  • media:ER_to_SICU_Workflow_v2.pdf

TSICU:General Administrative

• Monthly Call Schedule
  • Trauma/SICU Attending media: TR_07-19.pdf
  • SICU Fellows media:July 2019_Fellow.pdf

• TSICU Map media: TSICU Layout.pdf

• TSICU: Phone Numbers

• TSICU:Consult Services

• Los Angeles ED phone directory

TSICU:Mandatory Call Criteria

• media: TSICU_Mandatory_Call_Criteria_Final.pdf

TSICU:Patient Care Management

TSICU:Admissions

*Every admission to the TSICU requires Trauma/SICU Attending approval

TSICU:Antibiotic Stewardship

• media:2018 Harbor-UCLA Antibiogram.pdf

Referral to One Legacy

• Brain death
• media:Tissue_and_Organ_Donations.pdf

Core Clinical Conditions & Management

Assessment & Management of the Injured Patient

• Roles & Responsibilities of the Trauma Team
  • media:Trauma_roles_and_responsibilities_revised.pdf
• Trauma Team Activation and Response
  • media:Trauma_team_activation_and_response.pdf
• Initial Assessment and Management of the Trauma Patient
  • media:Initial_assessment_and_management_of_the_trauma_patient.pdf
• Blunt Head Trauma Evaluation
  • media:Blunt_head_trauma_evaluation.pdf
• Traumatic Intracranial Hemorrhage Algorithm
  • media:Traumatic_Intracranial_Hemorrhage.pdf
• Blunt Neck Trauma Evaluation
  • media:Blunt_Neck_Trauma_.pdf
• Blunt Cerebrovascular Injury Evaluation and Management
  • media:BCVI_Evaluation_and_Management.pdf
• Cervical Spine Evaluation and Injury Management
  • media:C-Spine_Injury_Evaluation_and_Managment.pdf
• Penetrating Neck Trauma evaluation and management
  • media:Penetrating_neck_trauma_evaluation_and_management.pdf
• Evaluation of the thoracolumbar spine after blunt trauma management
  • [[media:
• Blunt Chest Trauma Evaluation and Management
  • media:Blunt_Chest_Trauma_.pdf
• Rib Fractures and Flail Chest
  • media:Rib_Fractures_&_Flail_Chest.pdf
• Pneumothorax or Hemothorax
  • media:Pneumothorax_and_Hemothorax.pdf
• Pneumomediastinum Evaluation and Management
  • media:Pneumomediastinum.pdf
• Blunt Cardiac Injury
  • media:Blunt_Cardiac_Injury.pdf
• Penetrating Precordial Trauma
  • media:Penetrating_Precordial_Trauma.pdf
• Blunt Aortic Injury
  • media:Blunt_Aortic_Injury.pdf
• Blunt Abdominal Trauma
  • media:Blunt_Abdominal_Trauma.pdf
• Solid Organ Injury Management (Kidney, Spleen, Liver)
  • [[media:
• Genitourinary Trauma (Kidney, Ureter, Bladder)
  • [[media:
• Penetrating abdominal/flank/back injury evaluation and management*
  • [[media:
• Pelvic Fractures
  • [[media:
• Blunt Peripheral Vascular Trauma
  • [[media:
• Penetrating Peripheral Vascular Trauma
  • [[media:
• Traumatic Injury Potentially Requiring Catheter Based/Endovascular Intervention (Algorithm excludes patients requiring emergent operative management)
  • [[media:
• Evaluation and Management of Extremity Compartment Syndrome
  • [[media:
• REBOA
  • [[media:
• Harbor-UCLA Medical Center Massive Transfusion Protocol Fact Sheet
  • [[media:
• The Continuous Process of Performance Improvement
  • [[media:
• ACS TQIP: Orthopedic Best Practices in the Management of Orthopedic Trauma
  • [[media:
• ACS TQIP: Geriatric Trauma Management Guidelines
  • [[media:
• ACS TQIP: Geriatric Trauma Management Guidelines
  • [[media:

Shock

• Undifferentiated shock
• Hypovolemic
  • Hemorrhagic Shock
  • Massive Transfusion
• Cardiogenic
  • Acute coronary syndrome (main)
  • ACLS (Main)
• Distributive
• Resuscitation Endpoints
  • IV fluid resuscitation
  • IVF composition
• Ultrasound: In Shock and Hypotension

Pulmonary

Initiating Mechanical ventilation (main)

• Ventilation modes
• Recruitment maneuver
• Ventilator associated lung injury
• Ventilator high pressures

Discontinuing Mechanical Ventilation

• TSICU Extubation Standard Operating Procedure
  • media:Standardized_Work_-_3WICU_Morning_Rounds_v.4.pdf
• Ventilation weaning
• Extubation

Acute Respiratory Distress Syndrome

• ARDSnet Ventilator Settings

Advanced Modes of Ventilation

• APRV
  • media:CCM APRV Algorithm.pdf

• High frequency oscillation ventilation

• Extracorporeal Membrane Oxygenation

Renal

Acid-base disorders

• Anion gap acidosis
• Non anion gap acidosis

Electrolyte abnormalities

• Hyper
  • Hypernatremia
  • Hyperkalemia
  • Hypercalcemia
  • Hypermagnesemia
  • Hyperphosphatemia

• Hypo
  • Hyponatremia
  • Hypokalemia
  • Hypocalcemia
  • Hypomagnesemia
  • Hypophosphatemia

Renal Replacement Therapy

• CVVHD
• IHD

Sepsis & Septic Shock

• Sepsis (Main)
• Initial Antibiotics in Sepsis (Main)

Infections in the ICU & Appropriate Selection of Antibiotics

Surgical Site Infections

• Superficial
• Deep
• Organ Space

Traumatic Brain injury

• Glasgow Coma Scale

Moderate-to-severe traumatic brain injury

• Elevated intracranial pressure

Spinal Cord Injury

• ASIA Score
• Spinal cord syndromes

Neurologic Emergencies

Seizure

• Anticonvulsant levels and reloading

Alcohol withdrawal seizures

• CIWA Protocol

CVA

• NIH Stroke Scale

Management of Hemorrhage in Patients on Antithrombotic Therapy

• Anti-platelet agent reversal
• Anticoagulant reversal for life-threatening bleeds

Pain, Agitation, Delirium, Immobility, and Sleep (PADIS)

• ICU sedation

Delirium

• media:CAM-ICU.pdf

Endocrine Emergencies

Diabetes medications

• Insulin

Venous Thromboembolism

Chemical Prophylaxis

• Lovenox 30mg SubQ q12 hrs (if Cr Clearance > 30)
  • Check AntiXa level every week EXACTLY 4 hours after 3rd dose of lovenox
    • prophylactic goal: 0.2-0.6
    • therapeutic goal: 0.6-1.2
• Recheck AntiXa level after each 3rd dose if dose is changed until you are at goal
• Recheck level every week (usually qMonday) for all patients
• If renal dysfunction order heparin 5000 Units SubQ q8 hrs (search “SURG DVT/VTE prophylaxis” order set)