BEFORE  PATIENT  ARRIVAL

  • Room temperature > 30˚C
  • Warm IV line
  • Machine check
  • Airway equipment check
  • Emergency medication check
  • Blood Bank notified to have blood available per unit SOP

PATIENT  ARRIVAL

  • Patient identified for surgery as soon as possible
  • Blood Bank notified to deliver blood per unit SOP
  • Ensure large bore IV or CVC access
  • Monitors (SaO2, BP, ECG)
  • Pre-oxygenation

INDUCTION

  • Sedative hypnotic (Ketamine vs. Propofol)
  • Neuromuscular blockade (Rocuronium vs. succinylcholine)

INTUBATION

(Per Airway Management CPG)

  • (+) ETCO2
  • Place orogastric tube

ANESTHETIC

  • Consider TIVA
  • (Volatile anesthetic and/or benzodiazepine) + narcotic
  • Insert additional IV access and/or arterial line if needed

RESUSCITATION

(per Damage Control Resuscitation CPG)

  • Send baseline labs, type and cross if not yet done
  • Follow MAP trends
  • Goal FFP: PRBC: Plt 1:1:1 if Massive Transfusion.  Use Cold Stored Whole Blood (if available)
  • Activate walking blood bank to obtain Fresh Whole Blood (if needed)
  • Goal urine output 0.5-1.0 mL/kg/hr
  • Consider TXA if <3 hours from injury and at risk for hemorrhagic shock
  • Consider calcium 1 gm
  • Consider hydrocortisone 100 mg
  • Consider vasopressin 2-4 IU + 0.04 IU/min
  • Administer appropriate antibiotics
  • Special considerations for TBI as indicated in Severe Head Injury CPG

CLOSING/POST-OPERATIVE

  • Low volume ventilation per Acute Respiratory Failure CPG