Is this normal for trauma?

[Foxxy Cleopatra]

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Just wondering...

Is it the norm at most places that ALL patients who come in through the trauma bay/shock trauma get admitted to general surgery? Even those who only have orthopedic issues; like the guy with a femur fracture that needs an ORIF, all CT's are negative (chest/abd/pelvis/c.spine), ortho operates, this guy has no other issues, yet is admitted to the general surgery "trauma" team. In other words, they get to operate but we are the ones who get called all night when the guy is threatening to leave AMA, complains of leg pain, etc? Even better, then we get the honor of coordinating the social work issues and doing all the paperwork to get him out of the hospital...

In my limited residency experience, maybe there is a perfectly valid reason (aka; money) why this happens, it is just not blatently obvious to me now. We work out of a huge county hospital, most of our patients are medicaid (at best), so I realize how understaffed we are. It just seems to me like we are a babysitting service. I have done 2 months of trauma as an intern and I have been in the operating room a whopping 2 times.

I just don't feel like I am becoming any more proficient technically as a surgeon and was wondering if this was the norm. My program has good and bad things about it; I just don't understand why it seems that we do so much patient babysitting.

Thanks

 

[girlwithaknife]

Trauma is largely a babysitting service. I guess that's universal. When we weren't babysitting other services' patients (i.e. ortho, neurosurg), we were dealing with placement issues, as it is a law of nature that most trauma patients are uninsured and need some kind of rehab or long-term care. So much of trauma is non-operative now, even spleen injuries are being managed non-operatively at my institution. I got into the OR 2 or 3 times during my trauma rotation this year, but only for urgent general surgery cases that wound up on the trauma service.

At least at my institution, ortho will take a trauma patient with a truly isolated orthopedic injury. However, if there are ANY issues that may require a consult after admission (like psych), they leave the patient for trauma to handle.

It does seem that trauma gets better for the upper level residents. When the rare case comes in that does go to the OR, it's usually a pretty big one, and they get to do all that ICU management stuff, while we interns do the social work.

 

[droliver]

You really have to lay out the ground rules for your colleagues in orthopedics & neurosurgery re. hospital care of isolated (or predominate) orthopedic or head injuries. When I was the triage officer (& later) chief on trauma I made sure there were no "misunderstandings" about who was going to be assuming care of certain patients when their secondary surverys were done the following morning after admission. I had good relationships with my colleagues in those fields, but if you let them they will dump all over your service. A word of advice I would add is to pick your battles selectively - don't fight over people who are likely to be easy placement or very short stays in the hospital. Be gracious on those and save your good-will capital for the ones you know will be an issue down the road. The important ones to get on someone else's service are the placement problems -> uninsured, psychiatric, closed head injury,or illeagle alien patients requiring rehab. Those people can be in the hospital months sometimes. You've also got to be pretty honest with yourself that some of the patients with signifigant comorbidities are best served on your service for their safety.

 

[md03]

Yep, it's entirely normal.

Unless, say, the pt has an isolated femur fracture, all trauma pts get admitted to trauma. Especially if they can't have their c-spine clinically cleared (anybody with a c-collar goes to the trauma service)

Trauma generally doesn't have many cases for interns. Unless your trauma service also covers general surgery emergencies and it's busy enough so that stuff comes in when residents above you are scrubbed. I did trauma in Aug, and one night I got to do the first part of a lap for a GSW to the belly cuz the chief and the 2 were invoved in a perforated colon. I did that and one appy my whole trauma month (the 2 does the consults and generally takes all the easy cases as well). As much as I like trauma, it really sucked being the trauma intern simply becuase you don't get to the OR as an intern. The intern babysits while everybody else goes to the OR.

 

[Foxxy Cleopatra]

Thanks; at least I know that is just the way things are done. My chief will say after rounds, "make them disappear," and it keeps me busy. Makes me appreciate our social workers more each day.

 

[ckent]

Yup, that's the way that things are done in my school's trauma center too. Ortho gets annoyed too, because they ended up getting consulted on every other patient who is admitted to the trauma service. A lot of trauma surgery does fall under general surgery though, and I'd hate to see what would happen if those orthopods had to run all the trauma codes. It's pretty cool when the surgeons open up people's chest in the trauma bay and start squeezing away at their heart while another does a criceotomy (sp?) and the ER residents put in central lines. Of course, during my two weeks of trauma, I never saw one patient survive that ordeal. If you roll in dead, you are probably dead for good. I guess that the coolest part of trauma though, is that unlike most other patients, if they are able to get you through your initial insult, and you didn't suffer any neurological damage, your recovery will probably be complete. Anyways, just remember how annoying it is to care for patients who aren't really your patients when you try to admit patients into the medicine service who are in the hospital for surgical reasons.

 

[droliver]

Originally posted by ckent
It's pretty cool when the surgeons open up people's chest in the trauma bay and start squeezing away at their heart while another does a criceotomy (sp?) and the ER residents put in central lines. Of course, during my two weeks of trauma, I never saw one patient survive that ordeal.

It's about why there are almost zero indications for ED thoracotomy, get thee to the OR