Why isn't EM considered Primary Care?

[Med Ed]

The letter of the law is that EDs can turn away non-emergent patients.

A simple "Thank you" would have sufficed.

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[Cyberdyne 101]

And trauma surgery isn't exactly the most beloved field to begin with... It's basically complication central, unpredictable call, etc. It's like doing a fellowship after GS that will make your lifestyle worse, not better, and won't improve your pay all that much. Screw that.

I believe most trauma surgeries are orthopedic-related.

 

[Mad Jack]

I believe most trauma surgeries are orthopedic-related.

Most of the ones I saw were penetration injuries or internal hemorrhages from MVCs. Totally depends on where you live. Penetrating injuries are far more common in inner cities, and are often the bulk of the major traumas you'll see aside from MVCs. And MVCs would typically have internal injuries (everything from ruptured spleens to SDHs) far more than bone fractures. Ortho was a two or three times a day consult, but trauma surg was getting one or two dozen rings a day. We were a level 1 though- maybe most of the broken bones were going to community hospitals while we got the **** shows, which usually aren't just some dude with a broken leg or some lady that fell and fractured her scaphoid.

 

[Cyberdyne 101]

Most of the ones I saw were penetration injuries or internal hemorrhages from MVCs. Totally depends on where you live. Penetrating injuries are far more common in inner cities, and are often the bulk of the major traumas you'll see aside from MVCs. And MVCs would typically have internal injuries (everything from ruptured spleens to SDHs) far more than bone fractures. Ortho was a two or three times a day consult, but trauma surg was getting one or two dozen rings a day. We were a level 1 though- maybe most of the broken bones were going to community hospitals while we got the **** shows, which usually aren't just some dude with a broken leg or some lady that fell and fractured her scaphoid.

My post basically paraphrased information from this site:
http://ortho.stanford.edu/trauma.html
Not sure if that 70% refers to their hospital or in general.

Like you said, it might vary depending on the location.

 

[AnatomyGrey12]

Most of the ones I saw were penetration injuries or internal hemorrhages from MVCs. Totally depends on where you live. Penetrating injuries are far more common in inner cities, and are often the bulk of the major traumas you'll see aside from MVCs. And MVCs would typically have internal injuries (everything from ruptured spleens to SDHs) far more than bone fractures. Ortho was a two or three times a day consult, but trauma surg was getting one or two dozen rings a day. We were a level 1 though- maybe most of the broken bones were going to community hospitals while we got the **** shows, which usually aren't just some dude with a broken leg or some lady that fell and fractured her scaphoid.

Yeah at the hospital I work at most traumas are penetrating or MVAs as well. The trauma surgeons and their team are in charge of all trauma patients the duration of their stay at the hospital, they consult with other specialists of course. A large amount of the trauma surgeon's time is spent on medical management.

Often the ortho injuries aren't deemed worthy of an immediate operation. Usually the ortho bros just tack it in the schedule for the following day unless an artery is severed or something else like that.

Complete tangent- I used to think the term "ortho bro" was just a dumb stereotype until I worked with real orthopedists and man I can only say that the stereotype exists for a reason... The biggest bunch of pre-madonnas I have ever met.. One guy was trying to bump a general surgeon who was doing a colectomy on a patient with some serious dead bowel because he had declared his hand fracture patient "more emergent"

That was an interesting conversation to watch..

 

[Mad Jack]

My post basically paraphrased information from this site:
http://ortho.stanford.edu/trauma.html
Not sure if that 70% refers to their hospital or in general.

Like you said, it might vary depending on the location.

Here's the thing- 70% of major traumas may have orthopedic complaints, but that isn't their major complaint a lot of the time. Like, you'll get someone who comes in s/p MVA, and they've got two broken legs, a ruptured spleen, and a subdural. Trauma surg saves their life, after which ortho comes in and fixes all the splintery bits, and neurosurg does a crani to keep them from going full vegetable on you. Trauma surg manages the trauma beginning to end in that case, ortho is just contributing to the effort (unless they have extensive neurological damage, in which case neurosurg was taking the lead and trauma and ortho were running consult).

 

[IslandStyle808]

I don't know why it would be. They are usually tertiary care doctors that should be dealing with incidents/illness when they happen. Primary care docs (ex. internal med, peds, family med) try to prevent such occurrences from reaching that point .

 

[Cyberdyne 101]

Here's the thing- 70% of major traumas may have orthopedic complaints, but that isn't their major complaint a lot of the time. Like, you'll get someone who comes in s/p MVA, and they've got two broken legs, a ruptured spleen, and a subdural. Trauma surg saves their life, after which ortho comes in and fixes all the splintery bits, and neurosurg does a crani to keep them from going full vegetable on you. Trauma surg manages the trauma beginning to end in that case, ortho is just contributing to the effort (unless they have extensive neurological damage, in which case neurosurg was taking the lead and trauma and ortho were running consult).

I don't think it was referring specifically to major traumas:
"More than 70% of all surgical interventions for trauma patients are orthopaedic in nature."

It's possible they're counting injuries like ankle and elbow fractures, which require surgical intervention, but are not exactly "major traumas."

Honestly, I have no idea. I've never worked in a trauma unit.

 

[Mad Jack]

I don't think it was referring specifically to major traumas:
"More than 70% of all surgical interventions for trauma patients are orthopaedic in nature."

It's possible they're counting injuries like ankle and elbow fractures, which require surgical intervention, but are not exactly "major traumas."

Honestly, I have no idea. I've never worked in a trauma unit.

I worked the ED and surgical ICU. I mean, maybe ortho is involved in 70% of cases, but trauma surg is involved in 100% in some capacity. And ortho isnt saving lives, generally, they're just putting stable trauma patients back together (a totally necessary and awesome thing, mind you, because most of us like walking and talking) but in the case of penetrating trauma (much more common in some areas than others) ortho is rarely involved and it's pure trauma surg.

 

[darkjedi]

I've rotated on the trauma service and agree with @Mad Jack . Generally speaking at my hospital, trauma patients that require surgical intervention go onto the trauma service. For severe neurosurgical cases, they sometimes take over care. We have an entirely separate ortho trauma service that can sometimes take patients if the injury is primarily ortho, but they generally act as a consult. The injuries I saw on trauma ranged from old lady falls, to blunt trauma, to multiple penetrating injuries. It will heavily depend on your location the breakdown. Philly has some pretty rough spots, so penetrating trauma is pretty high, maybe like 50/50 compared to blunt.

 

[Zebra Hunter]

For all those that are in love with the idea of trauma surgery because of what you see on TV, just remember, trauma is, for the overwhelming majority of cases, not a surgical disease.

 

[Cyberdyne 101]

I've rotated on the trauma service and agree with @Mad Jack . Generally speaking at my hospital, trauma patients that require surgical intervention go onto the trauma service. For severe neurosurgical cases, they sometimes take over care. We have an entirely separate ortho trauma service that can sometimes take patients if the injury is primarily ortho, but they generally act as a consult. The injuries I saw on trauma ranged from old lady falls, to blunt trauma, to multiple penetrating injuries. It will heavily depend on your location the breakdown. Philly has some pretty rough spots, so penetrating trauma is pretty high, maybe like 50/50 compared to blunt.

Are you going into surgery?

 

[Mad Jack]

This actually isn't really true anymore. There's been some good research on changing injury patterns in MVCs. Basically through a combination of the change in car design/protection and the change in human body habitus (more central adiposity), internal injury rates have gone down significantly and long bone fractures gone up.

I stand corrected. Recall bias is a powerful thing- you tend to remember the really bad ones with internal injuries way more than the guy who breaks an arm or fractures a leg but is otherwise fine. I mean, unless ortho is your thing I guess, then it's bones for days.

 

[Goro]

Americans getting fatter is changing their injury patterns?????

This actually isn't really true anymore. There's been some good research on changing injury patterns in MVCs. Basically through a combination of the change in car design/protection and the change in human body habitus (more central adiposity), internal injury rates have gone down significantly and long bone fractures gone up.

 

[vantheman]

And trauma surgery isn't exactly the most beloved field to begin with... It's basically complication central, unpredictable call, etc. It's like doing a fellowship after GS that will make your lifestyle worse, not better, and won't improve your pay all that much. Screw that.

The trauma surgeons at my hospital are some of the grumpiest human beings I have met. Not really that surprised considering they are mostly older men with families and still have to work 24 hour shifts.