What's the bloodiest/goriest surgical specialty to work in?

[IcedTea]

Hmm...I'd say vascular or CT, maybe ortho....what do you think?

Which specialties can things get really messy?

In case you're wondering why I started this thread, it's for two reasons: 1) It's something different and kinda amusing and 2) Yes, I have a secret fetish for blood (I think all people who desire to become surgeons have this secret fetish as well but they're just too afraid to admit it) I want to become a surgeon in the bloodiest/goriest specialty! lol

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[maxheadroom]

Burns. We'll go through several units of blood in a few minutes when we excise a large burn on the trunk. The OR looks like a serial killer was in there when we're done. To make it better, you keep the burn OR super hot and when it's that hot you can smell the blood.

 

[Chronic Student]

I will second burns.

I started out a scrub tech and have done ops in every specialty and there is the occasional trauma or ruptured AAA that knows no gore bounds. However, on any sort of a regular basis burns are where its at.

When you've got an eighty %er and the skinning begins it is just a bloody ****ing mess. Towel clips through the fingers and kerlix wrapped around the toes and suspended from the ceiling with the flesh being stripped off is a real horror movie.

No to mention that the room is 98 to 99 degrees, the french fry lights are on and your trauma booties are filled with a gallon of sweat.

Hospitals are notoriously cheap and the place where I did burns provided a cooler with iced down gatorade. I mean c'mon, this is a place that doesn't like you to open extra towels because it costs money. So, if they are providing refreshments you know its bad.

 

[Blade28]

Burns or very rarely, trauma.

 

[Pir8DeacDoc]

Probably doesn't fill your blood fetish (if things go well) but we do some crazy things to our head and neck patients in terms of resections. We affectionately call them "face offs" and sometimes people can get a little squemish with the way people look intraoperatively.

 

[Winged Scapula]

Bloody probably burns or livers (although operating on a pregnant woman with blood and breast milk squirting everywhere is not for the squeamish - having just finished one. See I DO stay in the hospital after 4 pm! . )

For sheer gore, I'll agree with Pir8. I loved those H&N cases where you peel the face off!

 

[core0]

I have never seen blood loss routinely dictated as liters until I did liver transplant.

David Carpenter, PA-C

 

[Castro Viejo]

Probably doesn't fill your blood fetish (if things go well) but we do some crazy things to our head and neck patients in terms of resections. We affectionately call them "face offs" and sometimes people can get a little squemish with the way people look intraoperatively.

I hate those.

 

[Chronic Student]

OK, I forgot liver transplants.

When I was a bloodbanker we would routinely have (to start with) 30 Units of PRBC's, 20 FFP and 5 doses of platelets ready and then stay ahead.

 

[tussy]

I used 50 units once during a redo liver transplant. It's not that gory though - it bleeds so swiftly that you don't appreciate the volume.

Surg onc can have some nasty stuff - i was involved with a huge pre-sacral tumour where we basically cut the guy in half. A hemipelvectomy is plenty gorey.

 

[ddmo]

While the above mentioned may win in terms of blood volume and some of the vascular/truama stuff may have occasional bloody moments; joint replacements I think are more routinely messy with bone dust, joint fluid, and blood splattering all over the surgeon, the ceiling, the walls, etc. When you are broaching the femoral half of a total hip, the blood shoots out from the femur with every blow of the mallet straight back in your face. This is one of the reasons you'll see the surgeons wearing the space suits that cover their entire face and wearing knee high booties. Not to mention the use of power tools.

 

[Chronic Student]

I scrubbed joints almost exclusively for a number of years. Does not even come close to a burn case. The entire goal of a debridement is to get to viable (read bleeding) tissue and then you can graft it.

Anyway, just my opinion.

 

[Blade28]

This is one of the reasons you'll see the surgeons wearing the space suits that cover their entire face and wearing knee high booties.

Ah yes, I've worn one of those before! Comes with a built-in fan that circulates air in the "helmet" portion of the suit!

 

[SocialistMD]

I've scrubbed more liver transplants that did not require a single transfusion than I have burn debridements/escharotomies that didn't require one, so I vote burns.

 

[Pir8DeacDoc]

I hate those.

Ahh they are aweome man..

I'm early in my training but I'm still amazed at how we put them back together. They often look pseudohuman when all is said and done

 

[DoctaJay]

I got up close and personal on a burn case one time and so far it was the only thing that made me squeemish. I mean...they were just shaving away, like the patient's hand was a potato or something.

.....disgusting, and very very very very very very very very bloody.

 

[Blade28]

Burns is by far the bloodiest. All that debridement (we use the Wick knife here).

 

[Winged Scapula]

Burns is by far the bloodiest. All that debridement (we use the Wick knife here).

Psst...its Weck.

 

[Blade28]

Psst...its Weck.

Shoot. I meant Weck.

 

[maxheadroom]

Weck blade? That's the sissy knife. Give me the Watson.

 

[Dunce]

Head & Neck wins hands down for gore

caution: click link if you dare
http://www.head-face-med.com/content/3/1/5/figure/F14?highres=y

 

[IcedTea]

Wow so I guess burns wins hands down. Does sound pretty gruesome.

 

[IcedTea]

Head & Neck wins hands down for gore

caution: click link if you dare
http://www.head-face-med.com/content/3/1/5/figure/F14?highres=y

Daym when I first saw that, I was like: Is that human? lol
I've never seen something like that before. wowaweewa! (Borat)

 

[zippa]

Out of curiosity, why are the ORs for the burn unit kept so hot.

 

[ctdocMD]

ive seen some bad trauma

 

[Blade28]

Out of curiosity, why are the ORs for the burn unit kept so hot.

Acidosis + hypothermia + coagulopathy = deadly triad

It's tougher to clot when you're cold.

 

[maxheadroom]

In addition to the triad of death, it's pretty simple. Your skin is the most important thermoregulatory organ that you have. A large burn obviously compromises your ability to regulate body temperature and maintain fluid balance.

On top of that, large burns require the patient to be uncovered and exposed.

Patients need a hot room and the french fry lights.

 

[Cheisu]

I understand why they keep the lights on now.

But, wow. That seriously must be the closest thing to "hell" on earth. Everyone sweating, and the smell of burnt skin and singed hair, along with the smell of blood, and you're all hot and frustrated with everything.

Wow.

 

[Cheisu]

While the above mentioned may win in terms of blood volume and some of the vascular/truama stuff may have occasional bloody moments; joint replacements I think are more routinely messy with bone dust, joint fluid, and blood splattering all over the surgeon, the ceiling, the walls, etc. When you are broaching the femoral half of a total hip, the blood shoots out from the femur with every blow of the mallet straight back in your face. This is one of the reasons you'll see the surgeons wearing the space suits that cover their entire face and wearing knee high booties. Not to mention the use of power tools.

I'm sure you're an ortho surgeon, aren't you?

 

[zippa]

As a follow up to my previous question...

Do the surgeons wear the "space suits"* (with the fans) like ortho when operating on them or do they just suffer through the heat? Also who normally works on burn victims? Plastics, General, or Trauma?

*Just to add...I know its for contamination prevention and the flying pieces of debris, but I thought it might be helpful to cool down the doc, esp with the fan and all.

 

[Winged Scapula]

As a follow up to my previous question...

Do the surgeons wear the "space suits" (with the fans) like ortho when operating on them or do they just suffer through the heat?

Suffer. The space suits worn by Ortho are not for cooling purposes but to prevent contamination in artificial joint and other hardware.

Also who normally works on burn victims? Plastics, General, or Trauma?

All of the three. Most burn units are probably run by a PRS, Trauma/CC or a General Surgeon (possibly with additional Burn fellowship training).

 

[MossPoh]

Gee. You guys make burn surgery sound so appealing. I did walk by as they were working on some guy's leg and it looked like the hotel room scene from "Dexter" (if any of you watch that). I never knew about the lights though. That sounds like misery for all parties involved.

 

[Blade28]

I'm sure you're an ortho surgeon, aren't you?

I think he's an MS-IV.

Do the surgeons wear the "space suits"* (with the fans) like ortho when operating on them or do they just suffer through the heat? Also who normally works on burn victims? Plastics, General, or Trauma?

*Just to add...I know its for contamination prevention and the flying pieces of debris, but I thought it might be helpful to cool down the doc, esp with the fan and all.

As Winged Scapula said, we just suffer in the heat. And as she correctly pointed out, the space suits' fans are to help circulate air so you don't breathe stale air the entire case - it's certainly not enough to cool you down.

 

[maxheadroom]

We've tried out some of the cooling vests that are on the market. They work fairly well, but you're still totally soaked after a fairly large burn. I keep a few fresh pairs of underwear and socks in my OR locker because it makes you feel soooooo much better to put on dry clothes at the end of those cases (especially if you have 10 minutes for a quick shower, too).