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I may just be having a language issue here, but can anyone please tell me if there is a difference between surgical critical care and trauma surgery. Thanks. Lets go Redsox!
critical care/trauma
- Thread starter walterjay7
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While there are fellowships which combine the two, they ARE different entities.
As its name implies, Surg Crit Care involves the management of critically ill surgical patients. Bear in mind that a 'Surgical" patient is not necessarily someone who has had surgery (ie, can be trauma patients, GI bleeds, pancreatitis, etc.). These fellowships focus on primarily the medical management of these patients - ie, vent management, meds, typical ICU stuff - you will probably learn some procedures like Bronchs, PEGs, Trachs, etc.
Trauma Surgery is a fellowship after a general surgery residency which focuses on the management of Trauma patients - again, these may not be surgical (ie, many blunt traumas are not) but if the patients have a surgical need, the fellow will be doing the operating. A Critical Care fellow, even one with a General Surgery background, supposedly doesn't operate allowing them to focus on medical management (but apparently, there is some operating going on uner the table). Most trauma surgeons and fellows also spend time doing general surgery (ie, gastric bypasses, hernias, etc.) when not in the Trauma Bay or on Trauma call. the focus of this fellowship is to train you to handle Traumas and their management, surgical or not. As you can see, this is why many programs combine Crit Care with the Trauma Surgery fellowship.
Hope this helps.
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Thank you for your response. Is the lifestyle of a critical care surgeon similar to that of a trauma surgeon and are there surgical critical care fellowships that don't combine trauma. I guess i'm confused because FREIDA only lists surgical critical care under fellowships and not trauma. Do you complete a critical care/trauma fellowship after gen. surg. and then decide b/t critical care or trauma. Sorry, I'm having a hard time with this.
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The lifestyle of a Critical Care attending is generally much better than that of a Trauma Surgeon. Hours are fairly regular for a Critical Care Attending, and you generally aren't coming in at odd hours as a Trauma Surgeon might do.
There are Surgical Critical Care fellowships that do not combine trauma. The reason you can't find Trauma on FREIDA because it lists only fellowships that lead to Board Certification (ie, like Surgical Critical Care) - Trauma does not currently have a Board. Trauma fellowships are found at places like www.trauma.org or www.east.org. These will also list combined programs (some are only 1 year - 9 months Critical Care, 3 months Trauma Surgery, some are a full year of each and some add some research time to the mix).
Trauma Surgery is often not a full-time job - many Trauma Surgeons also take call as SICU attendings, rounding with the residents, etc. while not on Trauma call (at my hospital, they rotate on a weekly basis. The SICU attending operates, does procedures, and rounds with the ICU team but doesn't take Trauma call during that week. Other weeks he/she will take Trauma call and will be responsible for operating on Trauma patients if they should need it.) Most Trauma Surgeons who are Critical Care Boarded spend their time in the SICU but they don't exclusively do one or the other. However, you may choose to do so depending on your practice environment.
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Wouldn't most trauma cases that come into the ED be referred to the specialist? I don't exactly understand what trauma surgeons really do.
Let's say some guy comes into the ED with a GSW to the head and some type of operation must immediately be done. Wouldn't the attending NS handle this procedure?
Let's say some guy comes into the ED with a GSW to the head and some type of operation must immediately be done. Wouldn't the attending NS handle this procedure?
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Sure, NS will do the crani, but will they admit him and take care of all his other needs (vent, non-cranial injuries, F/E/N)? Not in a million years. Trauma/Critical Care services spend lots of their time taking care of patients' basic needs while the specialty services take care of their particular areas. The trauma service "owns" the patient while the consult services merely take care of small details.
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As maxheadroom notes, getting the specialty surgical services to take on ALL of the care of the Trauma patient is difficult at best, impossible at worst. Generally, these patients are on the Trauma/Critical Care Service who manages everything else that the specialty service is not - and often, still gets the pages regarding the specialty service issues as well.
However, many Traumas are not a sole specialty service issue - ie, patients may have multiple injuries - Ortho, Neuro, etc. in which case again Trauma remains the "fall-back" service who manages the total package.
Finally, JKDMed asks what a Trauma Surgeon does. Remember not all Traumas are isolated body system injuries (as noted above). Trauma surgeons generally operate when the injury is abdominal, in the chest or extremities, calling in other specialists (ie, Vascular or CT) if they are uncomfortable with managing the extent of the surgical injury. Most surgical traumas are not GSWs to the head (requiring NS input) but rather blunt to the abdomen (perhaps requiring a splenectomy, pancreatic debridement, liver resection), penetrating to the chest or abdomen (requiring a thoracotomy, chest tube, bowel resection,etc.) These are generally operated on by a Trauma surgeon and then managed by the Trauma Service. And, as noted in my post above, many Trauma surgeons also spend time doing General Surgery as Trauma becomes more and more non-operative.
However, many Traumas are not a sole specialty service issue - ie, patients may have multiple injuries - Ortho, Neuro, etc. in which case again Trauma remains the "fall-back" service who manages the total package.
Finally, JKDMed asks what a Trauma Surgeon does. Remember not all Traumas are isolated body system injuries (as noted above). Trauma surgeons generally operate when the injury is abdominal, in the chest or extremities, calling in other specialists (ie, Vascular or CT) if they are uncomfortable with managing the extent of the surgical injury. Most surgical traumas are not GSWs to the head (requiring NS input) but rather blunt to the abdomen (perhaps requiring a splenectomy, pancreatic debridement, liver resection), penetrating to the chest or abdomen (requiring a thoracotomy, chest tube, bowel resection,etc.) These are generally operated on by a Trauma surgeon and then managed by the Trauma Service. And, as noted in my post above, many Trauma surgeons also spend time doing General Surgery as Trauma becomes more and more non-operative.
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Recent discussions by the AAST (american assoication for surgery of trauma) have focused on what the direction of trauma surgery holds for the future, espeically since more injuires can often be managed nonoperatively. Points of discussion include:
- addition of non trauma emergency surgery to the specialty (incureasingly the trauma surgeons are doing this anyway)
- potential for addtional training in trauma related ortho and neurosurgery for those interested.
- better representation of critical care by the AAST.
Anywhere I've been (between school, electives and my current program, total of 4 places) and places people I know have been, very often those folks with critical care certification are also trauma surgeons and handle both. Though, as previously stated, there is no formal certification for trauma surgery.
Note that it still takes a surgeon to manage many injuries nonoperatively, as one has to recognize when the nonoperative management fails and the pt needs an operation after all.
Usually, the trauma surgeon manages the global care of a trauma patient with multiple injuries (or multiple potential injuires) For example, if the pt has rib fractures and a femur fracture, ortho generally wont' take the pt on their service (they don't want to handle the rib fractures and assoicated respiratory issues). Generally the specialty services will only take pts who definitely have isolated injury (like isolated hip for othro or isolated head injury for neurosurg) But if a head injury pt also has facial fractures, neurosurgery is much less likely to take the pt.
Sometimes it's annoying, becuase the trauma surgeon can wind up just babysitting pts that specialty services are seeing (eg may be that ortho and ENT are addressing the injuries). However, there is nothing like doing a trauma laparotomy on a pt with major abdominal injuires!
- addition of non trauma emergency surgery to the specialty (incureasingly the trauma surgeons are doing this anyway)
- potential for addtional training in trauma related ortho and neurosurgery for those interested.
- better representation of critical care by the AAST.
Anywhere I've been (between school, electives and my current program, total of 4 places) and places people I know have been, very often those folks with critical care certification are also trauma surgeons and handle both. Though, as previously stated, there is no formal certification for trauma surgery.
Note that it still takes a surgeon to manage many injuries nonoperatively, as one has to recognize when the nonoperative management fails and the pt needs an operation after all.
Usually, the trauma surgeon manages the global care of a trauma patient with multiple injuries (or multiple potential injuires) For example, if the pt has rib fractures and a femur fracture, ortho generally wont' take the pt on their service (they don't want to handle the rib fractures and assoicated respiratory issues). Generally the specialty services will only take pts who definitely have isolated injury (like isolated hip for othro or isolated head injury for neurosurg) But if a head injury pt also has facial fractures, neurosurgery is much less likely to take the pt.
Sometimes it's annoying, becuase the trauma surgeon can wind up just babysitting pts that specialty services are seeing (eg may be that ortho and ENT are addressing the injuries). However, there is nothing like doing a trauma laparotomy on a pt with major abdominal injuires!
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I did a 4th year elective with a Trauma Surgeon at a Level 2 Trauma Center in FL... we did a lot of rounding on patients in the NICU and SICU and ICU... obviously we had NeuroSx on any patients with intracranial pathology, but we did all the initial assessments on any traumas ocming in, and did the surgerys (besides intrathoracic and intracranial).
We also did several GS and vascular surgeries during the month (not sure if my attending was BC in Vascular, but we did some axillo-fem bypasses)... some choleys, pancreatic, etc surgeries.
Not sure about hte accredidation of my attenidng, but his title was "Assistant Director, Trauma Surgery."
Hope this helps.
Q, DO
We also did several GS and vascular surgeries during the month (not sure if my attending was BC in Vascular, but we did some axillo-fem bypasses)... some choleys, pancreatic, etc surgeries.
Not sure about hte accredidation of my attenidng, but his title was "Assistant Director, Trauma Surgery."
Hope this helps.
Q, DO
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