EPA: Blunt and Penetrating Trauma (Evaluation & Initial Management)

EPA: Blunt and Penetrating Trauma (Evaluation & Initial Management)

Evaluatee Name*

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Evaluator Name*

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Rotation*

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Date of Assessment*

Phase of Care: Trauma*

UPDATE! You can only select one phase of care. Complete an assessment for each phase of case separately.

Trauma Bay

Procedures

Transition of Care

Trauma Bay: Preparation*

Demonstrates knowledge of ATLS protocols.

Prepares the trauma bay with equipment and personnel for a straightforward trauma resuscitation

Prepares the trauma bay with equipment and personnel for resuscitation of a critically ill trauma patient.

Leads the trauma team, preparing the trauma bay with equipment and personnel and directing ATLS protocols.

Not applicable/not observed

Trauma Bay: Evaluation*

Obtains history and performs basic assessment during trauma resuscitation.

Gathers prehospital information for a stable trauma patient. Gathers relevant information from the patient and performs a basic ATLS survey for a patient who is not critically ill, incorporating other trauma protocols as indicated.

Gathers information from prehospital providers or OSH information for a critically ill trauma patient. Gathers relevant information and performs ATLS on a critically injured trauma patient using an evidence-based, protocolized approach.

Recognizes when deviation from protocol is necessary; identifies missed injuries.

Not applicable/not observed

Trauma Bay: Work-up*

Orders and interprets simple diagnostic studies for a stable patient, including radiologic and lab evaluations.

Orders lab tests and imaging for a critically injured trauma patient, requiring assistance with interpretation.

Orders and interprets diagnostic studies, including radiologic and lab evaluations.

Orders and interprets all diagnostic studies for a trauma patient and develops an operative/procedural intervention plan based on the patient’s condition.

Not applicable/not observed

Trauma Bay: Management*

Develops a differential for a straightforward patient.

Develops a comprehensive differential for a patient (not critically ill). Recognizes when a patient may need procedural or operative intervention. Considers hemorrhagic shock in a hypotensive trauma patient.

Develops a comprehensive differential for a critically ill patient. Recognizes hemorrhagic shock and initiates a MTP when indicated. Recognizes the need for operative or procedural intervention and responds to subtle changes in vital signs

Manages a critically ill trauma patient.

Not applicable/not observed

Procedures: Nonoperative Trauma

Intervenes on a nonoperative trauma patient with straightforward problems (eg, holds pressure on or sutures lacerations, applies bandages).

Intervenes on a nonoperative trauma patient with more complex problems WITH assistance (eg, splinting, pelvic binder application).

Intervenes on a nonoperative trauma patient with complex problems WITHOUT assistance (eg, pelvic binder, traction splint).

Oversees intervention on a nonoperative trauma patient with complex problems

Not applicable/not observed

Procedures: FAST

Performs a FAST exam with assistance but is unable to interpret the findings

Performs a FAST exam and interprets normal and obviously abnormal exams.

Performs a FAST exam and identifies subtle abnormalities.

Adjusts technique to perform and interpret a FAST exam, considering patient-specific factors and mechanism of injury (eg, pregnancy)

Not applicable/not observed

Procedures: Invasive

Serves as an observer or requires significant guidance for all procedures.

Performs a complex procedure such as central line or chest tube placement with assistance.

Perf straightforward & complex bedside proc w/o assist (ie, CVL and CT placement). Req guidance for invasive proc: resus thoracotomy or REBOA placement. Initiates but requires help to treat severe hem shock.

Perf most procedures independently but requires some guidance for invasive procedures: resuscitative/clamshell thoracotomy or REBOA placement. Treats severe hem shock (ie rapid access to the chest/abdominal cavity, aorta cross-clamping, 4-quad packing).

Not applicable/not observed

Transition of Care: Communication with Patients/Caregivers

Communicates with a patient/caregiver(s) with cultural humility and provides timely updates.

Customizes communication to a straightforward patient/caregiver(s) about management plans, considering personal/systemic biases; misses some elements when discussing expected outcomes and the anticipated treatment course.

Communicates patient care information with cultural humility to caregivers of a complex or difficult trauma patient.

Customizes emotionally difficult news (eg, changes to the operative plan, adverse outcome, end-of-life discussion) with cultural humility, negotiating conflicts with the patient or health care team and facilitating goals-of-care discussions.

Not applicable/not observed

Transition of care: Communication with other providers

Demonstrates understanding of receiving consultant recommendations from other services and conducts an effective handoff of a trauma patient who is not critically ill. Places indicated consults for a trauma patient who is not critically ill

Communicates with all trauma team members regarding next steps but omits some important elements. For noncritically ill patient, identifies and places indicated consults and coordinates consultant communications and interdisciplinary care.

Communicates with all team members regarding next steps, capturing all potentially important elements. Identifies and places consults for a critically ill trauma patient. Provides feedback to team members about performance.

Maintains clear communication in a high-stress situation and provides constructive feedback to supervisors. Oversees identification and placement of indicated consults for all trauma patients

Not applicable/not observed

Transition of Care: Documentation

Accurately documents trauma resuscitation

Provides timely and complete communication in the medical record for all members of the health care team to view

Gathers relevant information from OSH and synthesizes it into the institution's EMR system

Reviews and provides feedback about documentation in the medical record

Not applicable/not observed

Transition of Care: Best Practices

Accesses national best practice guidelines for management of trauma patients, requiring assistance to apply them

Identifies system factors that can impact trauma patient safety and lead to deviation from best practice guidelines

Applies national best practice guidelines to address a trauma patient’s comprehensive needs and analyze outcomes

Critically appraises evidence and integrates national best practice guidelines in local management protocols, tailoring recommendations to an individual trauma patient

Not applicable/not observed

Transition of Care: Care Coordination

Initiates the process of floor/ICU admission or transition to the OR for nonemergent care of a stable patient.

Articulates a care plan that considers priorities of multiple injuries. Performs an effective handoff to a rehab unit for recovery from complex injury. Elicits and incorporates patient preferences and needs in a plan for transition of care after trauma.

Communicates with all team members and coordinates complex care plan discussions. Implements a care plan that considers priorities of multiple injuries in straightforward patient. Initiates floor/ICU admission or transition to the OR for complex patient.

Oversees transfer of a patient to a long-term or home care setting and effectively navigates barriers for a patient with limited social and economic resources

Not applicable/not observed

Overall Performance*

Based on your observation, what level of autonomy would you trust the resident to perform this task at the next encounter?

Limited Participation: Learner has basic knowledge and skills, attending does show and tell

Direct Supervision: Attending provides active help

Indirect Supervision: Attending provides passive help

Practice Ready: Attending is available but is not needed for routine cases/presentations, but input may be needed for complex cases

Comment*

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