TSICU:Main

This is the main page for Harbor-UCLA Trauma SICU

General Administrative

• TSICU Structure & Function
• Monthly Call Schedule
  • Trauma/SICU Attending
  • SICU Fellows media:July 2019_Fellow.pdf

TSICU:Clinical Documentation

• Adult ICU Progress Note Required Details. Media:Ad Hoc.jpg
  • This AdHoc Note is to be completed every day and PRIOR to starting the daily ICU Progress Note

• Core Measures/Common Conditions
• Hospital Acquired Pressure Injuries (HAPIs)
  • Pressure injuries are to be documented in the medical record (size, stage)
  • Consult wound care team for orders regarding wound care management
• FAST HUGS BID
  • Ensure that his is completed for every TSICU patient daily
• Code Status
  • Clarify code status with patient or patient's next-of-kin, DPoA or SDM, as soon as feasible
  • Ensure this is clarified on the medical record
  • Advanced Directives
• Medication Reconciliation

• Performance Improvement and Patient Safety
  • Safety Intelligence (SI)

Rapid Response Team (RRT)

• Members of the on-call trauma surgery team, including the Trauma Attending, respond to all Surgical Rapid Response pages/overhead calls
• Harbor:Codes

Disaster & Surge Plan

• Harbor:Disaster plan
• Harbor:Surge plan

Contact Information

• TSICU: Phone Numbers
• Los Angeles ED phone directory

Patient Care Management

General

• Housestaff Expectations
• Roles and Responsibilities
• Communication & TeamSTEPPs
• Conduct of Morning Rounds
• Handoffs

Admission to the TSICU

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

From the Emergency Room

• Following approval by the Trauma/SICU Attending, the charge or relief RN will be notified and a unit bed assigned
• At minimum, the following patient information should be conveyed (Name, MRN, admission diagnosis, clinical condition)
• Bed assignment requires notification of bed control
• An ER RN to SICU RN handoff must take place PRIOR to the patient's arrival in the TSICU
• A formal handoff is to take place between a member of the on-call surgery team and a member of the TSICU team
  • iPASS Handoff Tool
• Any clinical concerns or signs of deterioration requires IMMEDIATE notification of the Trauma or TSICU Attending
  • TSICU Mandatory Call Criteria

From the OR

• Patients previously admitted to the TSICU
• New TSICU admissions or patients not previously admitted to the TSICU
• OR to SICU Handoff

• Elective operations in which TSICU admission is anticipated should be communicated with the TSICU at least 1 day prior to the elective case

Transfers & Downgrades

• Trauma/SICU Attending approval is required for all transfers and downgrades
• Out of network patients will require a minimum of 24 hours of observation in a non-ICU monitored bed PRIOR to transfer

Trauma/ACS Service Patients

Non-Trauma/ACS Service Patients

Tests & Orders

Labs

• Harbor:Labs

Point of Care

• POC devices immediately available in the TSICU include:
  • iSTAT
    • Note on cartridges
  • Hemacue
  • Glucometer
• Thromboelastography (TEG)

Diagnostic Imaging

• Harbor:ED Radiology Specs

• CXR
  • Orders for non-urgent CXRs are to be placed at the time of morning rounds PRIOR to the desired day (i.e. Tuesday am CXRs should be inputted during Monday am rounds)
  • Per our agreement with the Radiology Department, CXRs in the TSICU are schedule for 07:00am q day

• Ultrasound

• CT scan

• MRI

Antibiotics

• Harbor:Antibiogram

Equipment & Supplies

• TSICU Map media:TSICU Layout.pptx
• Any broken or defective equipment should be reported IMMEDIATELY to the charge RN, nurse manager, or Dr. Kim
• Surgery house staff are responsible for cleaning up after all procedures. This includes, but is not limited to:
  • Disposing of all sharps in the appropriate sharps container
  • Cleaning all used or dirty equipment with the appropriately supplied cleansing wipes or agents
  • Returning all used equipment to their assigned parking spots in the TSICU or B-bay
• Line Carts
• Ultrasound Machines
• B-bay Supplies

Procedures

• Informed Consent
  • Harbor:Consenting a patient

• iMed Consent
  • Blood Transfusion
    • Harbor:Ordering Blood Products
  • ICU interventions

• TSICU:ASK NICE

Occupational Exposure

• Harbor:Occupational exposure

Referral to One Legacy

• Brain death

Core Clinical Conditions & Management

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

Discontinuing Mechanical Ventilation

• TSICU Extubation Standard Operating Procedure
• Ventilation weaning
• Extubation

Advanced Modes of Ventilation

• APRV
  • media:CCM APRV Algorithm.pdf

• High frequency oscillation ventilation

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 and 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)

Delirium

• CAM-ICU

Endocrine Emergencies

Diabetes medications

• Insulin

Venous Thromboembolism

• DVT
• PE

Educational Resources

1. Numbered list item

Goals & Objectives - Fellow

• Media:SCC ACGME Milestones.pdf

Procedures

Airway & Breathing

Intubation

• TSICU Intubation Protocol

Pigtail catheter thoracostomy

• Step-by-step instructions
• Procedure on a real patient
• Can be considered for spontaneous or small traumatic pneumothorax

Invasive Hemodynamic Monitoring & Access

Central Venous Catheterization

• Internal jugular central venous catheter (CVC) insertion
• Subclavian central venous catheter (CVC) insertion
• Femoral central venous catheter (CVC) insertion