Ed Trauma Flow Sheet
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6DATE:
PATIENT IDENTIFICATION
ED TRAUMA FLOW SHEET
NOTIFICATION STATUS
MECHANISM OF INJURY
TIME OF NOTIFICATION
TIME
ROOM #
INJURY
ARRIVED
ASSAULT
COMMENTS: ___________________________________________________________
DATE
CODE YELLOW PAGED
BURN
___________________________
FRONT
BACK
OTHER:
CRUSH
COMMENTS: ___________________________________________________________
YES
NO
MODE OF ARRIVAL
DROWN
COMMENTS: ___________________________________________________________
POLICE
FALL
DISTANCE: ____________________________________________________________
AMBULANCE
WALK IN
GSW
LOCATION: ____________________________________________________________
AUTO
OTHER
MVC
BICYCLE
MOTORCYCLE
RESTRAINED
UNRESTRAINED
PRE - HOSPITAL CARE
HELMET
STEERING WHL
AIRBAG
EXTRICATED
NO HELMET
OXYGEN THERAPY
DRIVER
PEDESTRIAN
PASSENGER
EJECTED
NONE
STABBING
LOCATION: ____________________________________________________________
VIA
AT
LITERS
AIRWAY
ACLS
DEFIB
OTHER
DEATH ON SCENE
COMMENTS: _______________________________________________
NONE
EOA
ETT
ORAL
ECG
MEDS
IV'S
ESTIMATED TIME OF INJURY
BACKBOARD
CERVICAL COLLAR (TYPES)
DESCRIBED DETAILS
NONE
LONG
SHORT
SCOOP
OTHER
NONE
DRESSINGS
SPLINTS
NONE
NONE
TRAUMA TEAM RESPONSE
NAME
ARRIVED TIME/CALLED IN
ED PHYSICIAN
PRIEST
AGE
SEX
DOB
SURGEON
SIGNIFICANT PAST MEDICAL HISTORY
NSG SUPER
ED TRAUMA RN #1
ED TRAUMA RN #2
ANESTHESIA
MEDICINES
RADIOLOGY
RESPIRATORY THERAPY
CONSULT/DISCIPLINE
NAME
TIME CALLED
TIME ARRIVED
ALLERGIES
VALUABLES ON ARRIVAL
FAMILY NOTIFIED
LAST MEAL
TIME:
ARRIVAL:
LAST TETANUS
NAME:
LMP
UPT
TIME DONE
PART OF THE MEDICAL RECORD
PAGE 1 of 6
8850011 Rev 05/05
ED Trauma Flow Sheet_EMERGENCY ROOM
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