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Upload File : |
<?php
$target_dir = "../../uploads/";
$filename = basename($_FILES["Trauma_Slip"]["name"]);
$target_file = $target_dir . basename($_FILES["Trauma_Slip"]["name"]);
$uploadOk = 1;
$imageFileType = strtolower(pathinfo($target_file,PATHINFO_EXTENSION));
if(isset($_POST['trauma_checklist']))
{
PatientManager::Requesttraumachecklist("$_GET[prescriptionid]","$_GET[patientid]","$_POST[further]","$_POST[Pneumo_Haemothorax]","$_POST[Fluids_Started]","$_POST[iv_fluids_started]","$_POST[Full_Survey]","$_POST[Perineum]","$_POST[Back]","$_POST[Pelvic_Fracture]","$_POST[Internal_Bleeding]","$_POST[Ultrasound]","$_POST[CT]","$_POST[Peritoneal]","$_POST[Spinal_Immobilization]","$_POST[Neurovascular_Status]","$_POST[Hypothermic]","$_POST[contraindication]","$_POST[Nasogastric_Tube]","$_POST[Chest_Drain]","$_POST[None_Indicated]","$_POST[leaves_patient]","$_POST[Analgesics]","$_POST[Antibiotics]","$_POST[None_Indicated2]","$_POST[tests_imaging]","$_POST[Examinations]","$_POST[Abdominal]","$_POST[vascular]","$_POST[care_discussed]","$_POST[Receiving_Unit]","$_POST[Primary_team]","$_POST[Other_Specialists]","$_POST[Trauma_Chart]","$_POST[Trauma_Slip]","$_POST[enteredby]");
if (move_uploaded_file($_FILES["Trauma_Slip"]["tmp_name"], $target_file)) {
echo "The file ". basename( $_FILES["Trauma_Slip"]["name"]). " has been uploaded.";
} else {
echo "Sorry, there was an error uploading your file.";
}
}
?>
<br>
<div class='row'>
<div class='col-sm-12'>
<form method="post" enctype="multipart/form-data">
<table class='table table-bordered'>
<tr>
<td clospan='2'><h3 align="center">Trauma Care Checklist</h3>
<h4 align="center">Immediately after primary & secondary surveys</h4> </td>
</tr>
<tr>
<td><label><b><li>Is Further Airway Intervention Needed?</b></li></label>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "Yes" name="further"><span> Yes </span></div>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "NO" name="further"><span> No </span>
</div>
</td>
</tr>
<tr>
<td>
<label><b><li>Is There A Tension Pneumo-Haemothorax ?</li></b></label>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "Yes, Chest Drain Placed" name="Pneumo_Haemothorax"><span> Yes, Chest Drain Placed</span></div>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "No" name="Pneumo_Haemothorax"><span> No </span></div>
</td>
</tr>
<tr>
<td>
<label><b><li>IS The Pulse and Fluids Started ?</label></b></li>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "Yes" name="Fluids_Started"><span> Yes </span></div>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "Not Available" name="Fluids_Started"><span> Not Available </span></div>
</td>
</tr>
<tr>
<td>
<label><b><li>Large-bore IV placed and fluids started </label></b></li>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "Yes" name="iv_fluids_started"><span> Yes </span></div>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "Not indicated" name="iv_fluids_started"><span> Not indicated </span></div>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "Not Available" name="iv_fluids_started"><span> Not Available </span></div>
</td>
</tr>
<tr>
<td>
<label><b><li>Full Survey For (and control of)External bleeding, Including : </label></b></li>
<input type="checkbox" value= "Scalp" name="Full_Survey"><span> Scalp </span>
<input type="checkbox" value= "Perineum" name="Perineum"><span> Perineum </span>
<input type="checkbox" value= "Back" name="Back"><span> Back </span> </span>
</td>
</tr>
<tr>
<td>
<label><b><li>Assessed For Pelvic Fracture by: </label></b></li>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "Exam" name="Pelvic_Fracture"><span> Exam</span></div>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "X-ray" name="Pelvic_Fracture"><span> X-ray</span></div>
<div class="checkbox"> <div class="checkbox"> <input type="radio" value= "CT" name="Pelvic_Fracture"><span> CT</span></div>
</td>
</tr>
<tr>
<td>
<label><b><li>Assessed For Internal Bleeding By: </label></b></li>
<input type="checkbox" value= "Exam" name="Internal_Bleeding"><span>Exam
<input type="checkbox" value= "Ultrasound" name="Ultrasound"><span>Ultrasound
<input type="checkbox" value= "CT" name="CT"><span>CT</span>
<input type="checkbox" value="Peritoneal lavage" name="Peritoneal"><span>Peritoneal lavage</span>
</td>
</tr>
<tr>
<td>
<label><b><li>Is Spinal Immobilization Needed? </label></b></li>
<div class="checkbox"> <input type="radio" value= "Yes,Done" name="Spinal_Immobilization"><span> Yes,Done
<div class="checkbox"> <input type="radio" value= "Not Indicated" name="Spinal_Immobilization"><span> Not Indicated
</td>
</tr>
<tr>
<td>
<label><b><li>Neurovascular Status of all 4 limbs Checked? </label></b></li>
<div class="checkbox"> <input type="radio" value= "Yes" name="Neurovascular_Status"><span> Yes
<div class="checkbox"> <input type="radio" value= "Not Indicated" name="Neurovascular_Status"><span> Not Indicated
</td>
</tr>
<tr>
<td>
<label><b><li>IS the patient Hypothermic? </label></b></li>
<div class="checkbox"> <input type="radio" value= "Yes, Warming" name="Hypothermic"><span> Yes, Warming
<div class="checkbox"> <input type="radio" value= "No" name="Hypothermic"><span> No
</td>
</tr>
<tr>
<td>
<label><b><li>Does the Patient Need(if no contraindication) </label></b></li>
<input type="checkbox" value= "Urinary Catheter" name="contraindication"><span>Urinary Catheter
<input type="checkbox" value= "Nasogastric Tube" name="Nasogastric_Tube"><span>Nasogastric Tube
<input type="checkbox" value= "chest drain" name="Chest_Drain"><span>Chest Drain
<input type="checkbox" value= "None Indicated" name="None_Indicated"><span>None Indicated
</td>
</tr>
<tr>
<td ><H3 align="center">Before team leaves patient</H3></td>
</tr>
<tr>
<td>
<label><b><li>Has the Patient been Given </label></b></li>
<input type="checkbox" value= "Tetanus Vaccine" name="leaves_patient"><span>Tetanus Vaccine
<input type="checkbox" value="Analgesics" name="Analgesics"><span>Analgesics
<input type="checkbox" value="Antibiotics" name="Antibiotics"><span>Antibiotics
<input type="checkbox" value="None Indicated" name="None_Indicated"><span>None Indicated
</td>
</tr>
<tr>
<td>
<label><b><li>Have All tests and imaging been Reviewed </label></b></li>
<div class="checkbox"> <input type="radio" value="Yes" name="tests_imaging"><span> Yes</span></div>
<div class="checkbox"> <input type="radio" value= "No, Follow-up Plan in Place" name="tests_imaging"><span> No, Follow-up Plan in Place</span></div>
</td>
</tr>
<tr>
<td>
<label><b><li>Which serial Examinations Are Needed </label></b></li>
<input type="checkbox" value= "Neurological" name="Examinations"><span>Neurological
<input type="checkbox" value= "Abdominal" name="Abdominal"><span>Abdominal
<input type="checkbox" value= "vascular" name="vascular"><span>Vascular
<input type="checkbox" value= "None" name="Examinations"><span>None
</td>
</tr>
<tr>
<td>
<label><b><li>Plan of care discussed with: </label></b></li>
<input type="checkbox" value="Patient/Family" name="care_discussed"><span>Patient/Family
<input type="checkbox" value="Receiving Unit" name="Receiving_Unit"><span>Receiving Unit
<input type="checkbox" value="Primary team" name="Primary_team"><span>Primary team
<input type="checkbox" value="Other_Specialists" name="Other_Specialists"><span>Other Specialists
</td>
</tr>
<tr>
<td>
<label><b><li>Relevant Trauma Chart or Form Comleted? </label></b></li>
<div class="checkbox"> <input type="radio" value= "Patient/Family" name="Trauma_Chart" ><span> Patient/Family
<div class="checkbox"> <input type="radio" value="Not Available" name="Trauma_Chart" ><span> Not Available
</td>
</tr>
<tr>
<td><label> Trauma Slip</label><input name="Trauma_Slip" type="file" class='form-control'></td>
</tr>
<tr>
<td><input type='submit' name='trauma_checklist' value='Submit' class='btn btn-success'></td>
</tr>
</table>
</form>
</div>
</div>