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HUNTER KILLER

MOTION PICTURE ARTWORK © 2018 SUMMIT ENTERTAINMENT, LLC. ALL RIGHTS RESERVED.

A FAVOR A SIMPLE FAVOR

A FAVOR

A SIMPLE FAVOR

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IT TAKES A PAIR TO BEAT THE ODDS

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IN THEATRES THIS SEPTEMBER

BY

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Neurology Department 744 52nd Street, 5th Floor Oakland, CA 94609 tel: 510.428.3590 fax: 510.601.3974 www.childrenshospitaloakland.org

Jennifer Martelle Tu MD, PhD Pediatric Neurology

UCSF Division of Pediatric Cardiology - East Bay Providers Lisa Arcilla, MD, FACC Kishor Avasarala, MD, FACC Alok Bose, MD, FACC Christopher Chyu, MD Gregg Helton, MD, FACC Neeru Kaushik, MD Gregory Kurio, MD, FACC Kathleen Newkument, MD, FACC Hitendra Patel, MD, FACC Howard Rosenfeld, MD, FACC Scott Soifer, MD, FACC

747 52nd St., Oakland, CA 94609-1809

747 52nd Street Oakland, CA 94609

Cardiology Clinics Oakland 744 52nd St. Oakland, CA 94609 Tel: (510) 428-3380 Fax: (510) 428-3381 Berkeley 3000 Colby Street, Suite 301 Berkeley, CA 94705 Tel: (510) 428-3380 Brentwood 1181 Central Blvd., Suite B Brentwood, CA 94513 Tel: (925) 979-3200 Fairfield 5030 Business Center Dr., Suite 380 Fairfield, CA 94534 Tel: (707) 863-9000 Napa 3443 Villa Ln., Suite 2 Napa, CA 94558 Tel: (707) 863-9000 San Ramon 2303 Camino Ramon, Suite 175 San Ramon, CA 94583 Tel: (925) 979-3200 Sonora 12791 Cabezut Rd. Sonora, CA 95370 Tel: (925) 979-3200 Walnut Creek 2401 Shadelands Drive Walnut Creek, CA 94598 Tel: (925) 979-3200

747 52nd Street Oakland, CA 94609

Greenbrae 1300 S. Eliseo Dr., Suite 204 Greenbrae, CA 94904 Tel: (510) 428-3380 www.childrenshospitaloakland.org

PRIMARY SURVEY

SECONDARY SURVEY

TIME: _______________

CRITICAL CARE FLOW SHEET Date: ______________ Time activated ______________

Triage Category 1 Med Stat Trauma Stat: Full / Partial

Upgrade Time_________________

PATIENT INFORMATION

SPONTANEOUS CLEAR SLOW RAPID APNEIC

LABORED COARSE WHEEZING DIMINISHED R L

Allergies__________________________________ Language Barrier ___________________ Interpreter Used __________________________________ Medical History_______________________________________________ LMP__________ Immunizations__________ Last Tetanus __________

TIME NOTIFIED TIME RESPONDED

SURGICAL ATTENDING

SOCIAL SERVICES

YES

NO NEUROSURGEON

Not Required

SURGICAL RESIDENT

RADIOLOGY

YES

NO ORTHO SURGEON

Not Required

ED ATTENDING

SECURITY

YES

NO SPECIALIST

ED RESIDENT

RESPIRATORY THERAPY YES

NO

ANESTHESIOLOGIST

LAB

YES

NO

PHARMACY

YES

NO

PRE-HOSPITAL INFORMATION

EYE OPENING (E)

PATIENTS OLDER THAN 2 YEARS

VITAL SIGNS _____________________________________________________ + LOC

CPR

INTUBATED

AIR BAG DEPLOYED

MOTOR VEHICLE

C-COLLAR

FRONT / SIDE / OTHER / NO

DRIVER PASSENGER

FRONT

SEAT BELT TYPE:

REAR

LAP

KED

MEDICATIONS/TREATMENT _______________________________________________________________________________________

BACKBOARD

SEAT BELT

O2

CAR SEAT

YES

NO

YES

NO

YES

NO

YES

NO

SHOULDER

UNKNOWN

IV

/

IO

/

NONE

FLUIDS RECEIVED ______________________________________________

MOTORCYCLE / BICYCLE SCOOTER / SKATEBOARD

DRIVER HELMET NO HELMET UNKNOWN PASSENGER HELMET NO HELMET UNKNOWN

NUTRITION SCREEN: ARE YOU CONCERNED ABOUT YOUR CHILD'S DIET? (CIRCLE ANSWER)

DOMESTIC VIOLENCE SCREEN: RE: PATIENT'S CAREGIVER/ADULT IS THERE "REASONABLE SUSPICION" OF DOMESTIC VIOLENCE (CIRCLE ANSWER) SUICIDE SCREEN: AT RISK?

Y

/

N

PHYSICIAN NOTIFIED NAME: _________________________________

AVOIDS EYE CONTACT

DEPRESSED / FLAT AFFECT

POOR HYGIENE / DISHEVELED

ANXIOUS / AGITATED

INAPPROPRIATE

HALLUCINATIONS: VISUAL / AUDITORY

SUICIDAL / HOMICIDAL IDEATION

NURSING NARRATIVE; TIME AND INITIAL EACH ENTRY See additional Epic documentation

CPR in progress upon arrival

YES

YES

COLD CLAMMY DIAPHORETIC ACTIVE BLEEDING EST. BLOOD LOSS_____________

PATIENTS YOUNGER THAN 2 YEARS (4) (3) (2) (1)

SPONTANEOUS TO VOICE TO PAIN NONE

VERBAL RESPONSE (V)

(5) (4) (3) (2) (1)

ORIENTED CONFUSED INAPPROPRIATE WORDS INCOMPREHENSIBLE NONE

(5) (4) (3) (2) (1)

COOS, BABBLES IRRITABLE CRIES TO PAIN MOANS TO PAIN NONE

MOTOR RESPONSE

(6) (5) (4) (3) (2) (1)

OBEYS COMMANDS LOCALIZES TO PAIN WITHDRAWS TO PAIN FLEXION TO PAIN EXTENSION TO PAIN NONE

(6) (5) (4) (3) (2) (1)

NORMAL SPONTANEOUS WITHDRAWS TO TOUCH WITHDRAWS TO PAIN ABNORMAL FLEXION ABNORMAL EXTENSION NONE

TRANSPORTED FROM: SCENE __________________________________________ HOSPITAL ________________________________ CLINIC / DOCTOR’S OFFICE ________________________________________ MECHANISM & TIME OF INJURY/HISTORY OF ILLNESS ______________________________________________________________________________________ __________________________________________________

N N

(4) SPONTANEOUS (3) TO VOICE (2) TO PAIN (1) NONE

MODE OF ARRIVAL: AMBULANCE COMPANY_________________________________________________ HELI CARRIER _____________________________________________ PRIVATE CAR ________________

ALERT COOPERATIVE RESPONDS TO VERBAL

PUPILS EQUAL 2

CRYING CONFUSED COMBATIVE

REACTIVE

3

UNEQUAL

4

5

PURPOSEFUL MVMT TO PAIN LETHARGIC UNRESPONSIVE SLUGGISH

NONREACTIVE

6

7

ATRAUMATIC

ABRASION ________________________________________ LACERATION______________________________________ HEMATOMA ______________________________________

EARS CLEAR

HEMOTYMPANUM R L BLOOD R L EXTERNAL TRAUMA ______________________________

EYES CLEAR

EYELID TRAUMA GLOBE TRAUMA

GCS QUALIFIER:

NO

INTUBATED

HOVER MAT

PINK SLIP

EASY LIFT

NECK ATRAUMATIC TRACHEA MIDLINE NON-TENDER C-SPINE: CLEARED

TRACHEAL DEVIATION R L TENDER ABRASION ________________________ LACERATION______________________ HEMATOMA______________________ RADIOLOGICALLY COLLAR PLACED

CLINICALLY

SEDATED

PARALYTICS

TIME TEMP PULSE RESP

BP

O2SAT

O2

Size:

Amount

Rate/hr.

Time: Amount Infused

IV / IO / IV Lock #2 Site:

Total Infused

Time/ Initials

IV Solution

Size:

Amount

EYE(S) OBSTRUCTION

Total Infused

IV Infusion: Time

Site: Rate/hr

33 Initials

ABRASION ______________________ LACERATION ____________________ HEMATOMA ______________________ ABSENT

PELVIS STABLE UNSTABLE NON-TENDER TENDER BLOOD AT THE MEATUS

ABRASION ______________________ LACERATION ____________________ HEMATOMA ______________________

UPPER EXTREMITIES NORMAL EQUAL PULSES ABRASION _________

DEFORMITY ABSENT PULSES LACERATION_________

SWELLING DIMINISHED PULSES HEMATOMA ______________

LOWER EXTREMITIES NORMAL EQUAL PULSES ABRASION _________ ATRAUMATIC NON-TENDER TENDER

ETCO2 PAIN SCORE TOOL

DEFORMITY ABSENT PULSES LACERATION_________

SWELLING DIMINISHED PULSES HEMATOMA ______________

DEFORMITY

GCS

LEFT RIGHT

E

V

ABRASION ______________________ LACERATION ____________________ HEMATOMA ______________________

INTERVENTIONS M

TIME Intubation Size____________

heme + / -

MEDICATIONS

LABS

Time Sent/ Time Recv’d

CBC CBC w/diff CHEM 8 METAPPOC UA-POC LAB

Dose

Time/ Initials

Route

Results

Time/ Initials

Time/ Initials

Chest Tube Size___________ right / left Tourniquet Time: Location__________________

Abdomen/Pelvis

Glu:_____ BUN:_____ CR:_____ AST:_____ ALT:_____

Gluc:_____ Bili:_____ Ketone:_____ SG:_____ Blood:_____ Arm/Leg pH:_____ Prot:_____ Urobili:_____ Nitrite:_____ LE:_____ CT of PT:____ PTT:____ INR:_____ TEG: CT of U-Pregnancy Tox Screen eFAST MD Name QC ETOH -/+ MRI of pH:____ pCO2:____ PO2:_____ BE:_____ HCO2:_____

Lactate Lipase Blood Gas

Other

pH:____ pCO2:____ PO2:_____ BE:_____ HCO2:_____

TYPE &_____________ Time sent:

Massive Transfusion Protocol Initiated time: POCT

Urine Cx - Time Sent:

Time:

Glucose:

Time:

Glucose:

Time:

Glucose:

Time:

Glucose:

Bld Cx - Time Sent:

CSF - Time Sent:

OUTPUT Urine

NG

INTAKE Emesis Chest Tube

PO

GT

Condition at discharge:

Good

Fair

Guarded

Critical

Time ___________

Report given by STAR protocol

Expired

Discharge teaching reviewed and patient/caregiver acknowledges HB Level (circle)

1

2

3

4

5

CC 31-75 min

CC additional 30 min x_____

SIGNATURE/TITLE/PRINT 1. ___________________________________ 2. ___________________________________ 3. ___________________________________

PHYSICIAN SIGNATURE

Cleansing_______________ Dressing________________

Cardiac Monitor 12 Lead EKG Rapid Infuser Warming Measures: Warm Blanket Lights Portawarm Increase Room Temp Fluid Warmer Isolation Type: _________________________

Patient Disposition: Admit ___________ Transfer _____________________________________ Home

Ice_______________________ Splint____________________

Results

Chest

Na:_____ K:_____ CA:_____ Cl:_____ CO2:_____

COAGS

Time

Time Sent/Rec’d

Lateral C-Spine

Bagged for UA

68307 (11/18)

Time/ Initials

RADIOLOGY

Hgb:____ HCT:____ RBC:____ WBC:____ Plt:_____

QC

Foley/Cath Size___________

ALCOHOL SCREEN DEFERRED PER POLICY

Total Infused

Total IV Fluids Received____________________ TIME

CM @ Lip________________ cuff / uncuffed

NG/OG Size______________

TIME:__________ CORONER NOTIFIED__________________________________________________________COUNTY:_________________________

Amount Amount Remaining Infused

ASYMMETRICAL EXPANSION ABRASION ______________________ LACERATION ______________________ HEMATOMA ____________________________

FIRM DISTENDED TENDER PRESENT

PUPILS

* LABEL IDENTIFIED INJURIES

ALCOHOL SCREEN PER POLICY

Time: Amount Infused

ABDOMEN SOFT FLAT NON-TENDER BOWEL SOUNDS

R-REACTIVE N-NONREACTIVE

Emergency Re-Triage

TIME:__________ ORGAN DONATION NETWORK NOTIFIED_________________________________________________________________________

Rate/hr.

CHEST SYMMETRICAL EXPANSION ATRAUMATIC CREPITUS MUFFLED HEART TONES

VITAL SIGNS

Y / N

GAIT BELT

IV Solution

R L __________________________ R L __________________________

BACK

NO

LIFT ASSIST DEVICE NEEDED?

WARMING MEASURES

HEAD/FACE

DISABILITY PEDIATRIC GLASGOW COMA SCALE (GCS)

Contact Person: _______________________________________________ Relationship: _______________________________________________

TIME ARRIVED

CHEST EXPANSION: ADEQUATE Y SYMMETRICAL Y RALES RHONCHI

PINK PALE WARM GRAY DRY CYANOTIC CAP REFILL: < 2 SEC > 2 SEC PULSES: NORMAL WEAK ABSENT

Primary Care Provider: _________________________Last Meal/Fluid ____________________ Current Meds ________________________________________

PATIENT ARRIVAL TIME: ____________________ RESPONSE DATA

CLOTHING REMOVED

CIRCULATION

Name __________________________________________ DOB____________ Age __________ Sex M / F Actual/Est. Weight__________ Kg.

Time/ Initials

EXPOSE

C-SPINE PRECAUTIONS: C-COLLAR BACKBOARD KED

BREATHING / VENTILATION

Downtime 1 2 3 4

IV / IO / IV Lock #1 Site:

TIME: _______________

AIRWAY / C-SPINE CLEAR / PATENT OBSTRUCTED BLOOD/VOMITUS/SECRETIONS INTUBATED

ED Attending Signature

Print Name

Surgical Attending/Surgeon

Print Name

D

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