ER vs. Trauma Surgery Questions

Rhomboidlips · Jan 24, 2006

Hey everyone,
I just have a couple quick questions. I recently heard of ER doc's "handling" the exciting parts of trauma's at some facilities. Does this mean that they are just consulting occasionally in the trauma bays? Does this occur at academic facilities with trauma teams or only at smaller hospitals? My ideal job would be EM doc while handling the ABC's (exciting part) of the trauma cases at an academic institution...is this possible?

roja · Jan 24, 2006

I am at an academic program. We handle all the trauma rescus's. We handle ABC's, etc. Trauma is a consultant. They can put in feed back interms of what thye would like done but we handle stabalizing the patient until they 1-go to the OR or 2-ICU/admission

Rhomboidlips · Jan 25, 2006

roja said:
I am at an academic program. We handle all the trauma rescus's. We handle ABC's, etc. Trauma is a consultant. They can put in feed back interms of what thye would like done but we handle stabalizing the patient until they 1-go to the OR or 2-ICU/admission

THanks for the response. Is your situation common in academic institutions? I know it does not work that way in ours. We have a trauma team of residents from a variety of services...many from surgery...that are paged when a trauma arrives and they handle the ABC's and whether to proceed to the OR or ICU/Admit. ER docs only consult if there is some medicine problem on the patient or difficult procedures...etc. Your response has definitely pushed me toward EM...thanks!

FoughtFyr · Jan 25, 2006

[email protected] said:
THanks for the response. Is your situation common in academic institutions? I know it does not work that way in ours. We have a trauma team of residents from a variety of services...many from surgery...that are paged when a trauma arrives and they handle the ABC's and whether to proceed to the OR or ICU/Admit. ER docs only consult if there is some medicine problem on the patient or difficult procedures...etc. Your response has definitely pushed me toward EM...thanks!

Where I am (a large academic center) the set up is almost the same as Roja's - we handle the airway (everytime, no execptions) and split "running the code" with trauma surg on an even/odd day schedule. When not running the code we are the "procedures" docs (chest tubes, FAST, trauma central lines, etc.), when we run it, TS does the procedures. The "to the OR or not" decision is the trauma staff surgeon's alone - but he/she definately relies on our assessment.

- H

Rhomboidlips · Jan 25, 2006

This is great....I'm pretty new here...what does running the code mean? Where do the common ER patients fit in? In between traumas you are treating them?

FoughtFyr · Jan 25, 2006

[email protected] said:
This is great....I'm pretty new here...what does running the code mean? Where do the common ER patients fit in? In between traumas you are treating them?

"Running the code" is acting as the team leader for the trauma resus. Making all of the assessment and treatment decisions to stabilize the patient.

We get ~1000 level 1 or 2 traumas/yr. here, which translates to just under 1 per 8 hour shift. So yes, we work our regular patients and the traumas are just an "aside" during the shift. Some busier places may have different systems when trauma volumes mandate it, but I like the way we run it. And yes, you must be able to multi-task. It is not unusual to be asked a significant question regarding another patient in the middle of a trauma.

- H

roja · Jan 25, 2006

We run all our trauma's. We don't hand them off. However, realize that EM is much more than running trauma's. What you will find is that most of us, as our training moves on, find trauma to be the least challenging aspect of EM.

Trauma is very routine and is driven by algorithm. It looks glam on the surface but really requires little diagnostic skill.

Complicated medical patients are WAAAAAAAAY more interesting and exciting. Much more challenging.

Procedures are definately fun, but you have to like all aspects of medicine to enjoy EM: ob, gyn, peds, medicine, cards, ortho, surgery, trauma, optho, fp, ID, hemeonc.

DrQuinn · Jan 25, 2006

Remember that trauma surgery is not only doing (or helping the ED) in the initial resuscitation, but also the LONGGGGGGGGGG hospital stay and follow up that some multi-system traumas require.

Example:

We had a transvestite that was stabbed multiple times during a trick... they immediately went to the OR after intubation/chest tubes in the ED. (She was in the ED maybe 20 minutes). This was 45 days ago, and she is still in the SICU... i.e. the residents are STILL rounding on her every morning!

Q

mikecwru · Jan 25, 2006

I agree with trauma vs medical comments, but you have to give a little respect to some blunt trauma cases, they can be challenging.

mikd

roja said:
We run all our trauma's. We don't hand them off. However, realize that EM is much more than running trauma's. What you will find is that most of us, as our training moves on, find trauma to be the least challenging aspect of EM.

Trauma is very routine and is driven by algorithm. It looks glam on the surface but really requires little diagnostic skill.

Complicated medical patients are WAAAAAAAAY more interesting and exciting. Much more challenging.

Procedures are definately fun, but you have to like all aspects of medicine to enjoy EM: ob, gyn, peds, medicine, cards, ortho, surgery, trauma, optho, fp, ID, hemeonc.

EctopicFetus · Jan 25, 2006

When I interviewed at USC (Southern Cal) they ran all of their traumas basically solo with TS serving as a consultant only. Their PD seems very strong and at LA County there is no shortage of patients or traumas I believe they stated they see 217,000 patients total! Not sure on the trauma numbers but I am sure they arent lacking. I do recall them saying they were happy that when MLK lost their Level 1 status they were slammed with extra traumas. It seems like those guys did a ton of procedures. Anyways just my $0.02

Jeff698 · Jan 26, 2006

QuinnNSU said:
We had a transvestite that was stabbed multiple times during a trick... they immediately went to the OR after intubation/chest tubes in the ED. (She was in the ED maybe 20 minutes). This was 45 days ago, and she is still in the SICU... i.e. the residents are STILL rounding on her every morning!

That's about the best description of why I'd rather pass on the 'glory' of trauma surgery. For that matter, I suspect that's also why most surgeons would rather pass on trauma. 🙂

Take care,
Jeff

ER vs. Trauma Surgery Questions

Rhomboidlips

Junior Member

roja

Full Member

Rhomboidlips

Junior Member

FoughtFyr

Full Member

Rhomboidlips

Junior Member

FoughtFyr

Full Member

roja

Full Member

DrQuinn

My name is Neo

mikecwru

M.D. = Massive Debt

EctopicFetus

Keeping it funky enough

Jeff698

EM/EMS nerd

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