Trauma Panels

[ERMudPhud]

The amylase versus lipase discussion got me to thinking. What labs are routinely ordered if anything on presentation to your ER for all blunt and/or penetrating trauma patients? The reason I asked is that my current hospital has a "trauma panel" with an insane range of things most of which I don't even know how to interpret.

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[EMIMG]

It all depends on the situation.

All patients get the standard CBC, Lytes, BUN, Cr, Glucose, and try for the urine on them. They also like UDS and ETOH on the patients.

Blunt trauma typically add the Amylase.

Pediatric Trauma (which gets transferred from our instution), they like to have all "LFTs" (Amylase, Lipase, AST, ALT, Alk Phos).

Typically patients get the standard C-spine, Chest, Pelvis

Also, many will get Type and Screen vs. Type and Cross.

But, many orders are attending/Resident dependent.

 

[DrQuinn]

At our place, (I'm doing this from memory), our trauma patients get:

CBC, BMP, ABG (with the surgery-important base deficit), UA, UDS, BAL (I think), Amylase, AP Chest, AP Pelvis.

Q, DO

 

[frog4brooke]

It's been a while but,

CBC
ABG
Chem-7
Tox & UDS
Lactic Acid
Type and Screen

PXR: Chest, Pelvis(not always) and C-Spine

If we are taking them to the scanner, we hold the C-Spine and do CT C-spine.

Pretty much all of our "alpha" trauma gets a fem stick-A nice little set up the syringe has a stop cock, so you can first pull up the ABG, then turn it and get the rest. The labs for this are prewritten and we have to mark off anything we do not want. I can't remember if it includes amylase or not.

The "bravos" don't routinely get a fem stick and we can be more selective with their labs.

 

[EMRaiden]

I personally feel that the only lab tests necessary for the majority of Trauma patients are an ABG (with a Hgb), and a Type and Cross.

Frog4brooke: If you skip the c-spine to do a CT, why not skip the pelvis XR as well?.. the CT Abdomen /Pelvis will give you significantly more information about pelvic fractures and save you time in the long run... (ie you don't have to stand around waiting for the portable XR's to get done).

As for the UDS/EtOH, have you changed your mind about the dispo of a trauma patient because of the alcohol?...
If they are altered and sober= CT/ workup
If they are altered and drunk= CT/ workup.
Significant trauma and sober = CT/workup
Significant trauma and drunk = CT/workup

 

[LaCirujana]

Originally posted by EMRaiden
I personally feel that the only lab tests necessary for the majority of Trauma patients are an ABG (with a Hgb), and a Type and Cross.

I agree, except generally we only get a T&S, unless its obvious we're going to be
A. dumping a bunch of blood products into the patient, or
B. we're going to the OR.

People w/significant head injuries usually get coags since neurosurg wants them prior to putting in any sort of ICP monitor.

 

[frog4brooke]

Frog4brooke: If you skip the c-spine to do a CT, why not skip the pelvis XR as well?.. the CT Abdomen /Pelvis will give you significantly more information about pelvic fractures and save you time in the long run... (ie you don't have to stand around waiting for the portable XR's to get done).

As for the UDS/EtOH, have you changed your mind about the dispo of a trauma patient because of the alcohol?...
If they are altered and sober= CT/ workup
If they are altered and drunk= CT/ workup.
Significant trauma and sober = CT/workup
Significant trauma and drunk = CT/workup [/B]

As I mentioned, We do not always get the Pelvis X-ray. You are right on the $ if we are going to the scanner and are getting belly veiws we don't shoot a pelvis. We normally do try and get the Chest X-Ray and it is up on pax by the time we are ready to roll to the scanner.

As I mentioned, the orders are prewritten (one of our trauma surgeons designed them) so the UDS/Tox is always done. I think that it could help legally in the end (not sure), but it can also help give us a heads up for withdrawl, DT's, ect; We end up keeping a lot of the "alpha's" in the unit for a little while. I agree in the trauma bay setting the UDS/Tox is not very important.

Sorry have not been on trauma since July, but this is what I remember from the experience.
F4B

 

[Docxter]

Originally posted by QuinnNSU
At our place, (I'm doing this from memory), our trauma patients get:

CBC, BMP, ABG (with the surgery-important base deficit), UA, UDS, BAL (I think), Amylase, AP Chest, AP Pelvis.

Q, DO

Why would you need an ABG routinely for calculating Base Excess? A VBG in a non-torniquet'd good sized vein will be just fine, if the patient is not in severe shock.

 

[beyond all hope]

What's the utility of a routine ABG if they're not on a vent? Acidosis is treated with fluids, which you're doing anyway. If you've got a shocky patient maybe, to see where you are.

Agree with BAL/EtOH level and Urine tox doesn't change dispo - it's documentation purposes mostly.

Our 'trauma panel' is based on tests actually required. Most of our management is based on clinical signs. I don't think we have any routine labwork, but these are the basics

Vitals, vitals, vitals (with GCS as a vital sign)
CBC, chem 8, type and screen if think they need blood/operation, coags
x-rays as indicated (ie no C-spine for GSW abdomen) -> we rely heavily on scans for stable patients
Accucheck for ALOC

 

[DrQuinn]

Originally posted by Docxter
Why would you need an ABG routinely for calculating Base Excess? A VBG in a non-torniquet'd good sized vein will be just fine, if the patient is not in severe shock.

Not ordered by me, its a routine lab draw if there is a trauma alert.

Q, DO