Only like trauma?

[coffeebeing]

---

Members don't see this ad.

What specialty should you go into if you only like trauma? I'm having a helluva time decidingg which specialty to go into. Trauma surgery would be ideal, but I don't enjoy the rest of general surgery enough to do a residency. I don't like ER when there's no trauma. What am I supposed to do, pick the least evil? I'd be interested to hear about how other likeminded people made their decision.

 

[Blade28]

Hmmm...what exactly do you like about trauma? Is it the sick patients? The fast-paced adrenaline-rush? The operating? Managing said patients in the ICU?

Looks like you're potentially interested in:

*ER
*Trauma/Surgical Critical Care (a fellowship after General Surgery)
*General Surgery
*Other critical care fellowship (like Pulmonology)
*Possibly Anesthesia

 

[southerndoc]

Even the busiest trauma surgeons also do general surgery.

 

[Winged Scapula]

Even the busiest trauma surgeons also do general surgery.

And even the busiest ERs also have periods without trauma.

 

[Winged Scapula]

What specialty should you go into if you only like trauma? I'm having a helluva time decidingg which specialty to go into. Trauma surgery would be ideal, but I don't enjoy the rest of general surgery enough to do a residency. I don't like ER when there's no trauma. What am I supposed to do, pick the least evil? I'd be interested to hear about how other likeminded people made their decision.

Unfortunately, in EVERY field of medicine and EVERY job in the world, you have to take the good with the bad. That means that Trauma Surgeons also have to do general surgery, including things like debriding decubiti, doing Trachs and PEGs (which will be a big part of your SICU procedure list), and other less "exciting" things. EM physicians have to see R/O MI, the bipolar patient off his meds and the middle of the night "I've had this pain in my 3rd toe for 3 months" complaints.

The decision will come down to whether or not you want to medically manage the Traumas or surgically manage them. If you want to run codes, do primary and seconary surveys, do some procedures, etc. then EM would be your choice. However, if you want to actually take the patient to the operating room, then you'll have to suffer through a general surgery residency. If you like the broken bones aspect, then choose Ortho with a Ortho Trauma fellowship. IMHO, that's really the distinction - either way you will have to suffer through some less appealing aspects of the field you choose to get to the light at the end of the tunnel. I didn't like a lot of aspects of general surgery, but I loved operating and it was a means to an end (ie, a surgical fellowship).

 

[erichaj]

Maybe you should get counseling about your adreneline addiction.

Just a thought. lol. 😀

 

[TxMed]

Maybe you should get counseling about your adreneline addiction.

Just a thought. lol. 😀

this would be great in one of those mountain dew commercials from a few years ago.

commercial starts with op getting ready in the morning like any other doc. then a flurry of trauma as op runs back and forth across town to each hospital's trauma bay to keep the adrenaline high.(while drinking a mountain dew)

follow-up commercial with op in betty ford for trauma/adrenaline addiction (drinking a mountain dew)

tm

 

[erichaj]

lol, ok but if you make the commercial I want half the profits. We can use coffebeing as our doctor/actor. (only if he/she looks good in pictures and if he/she has not yet seeked counseling).

Wait, come to think of it, I want someone famous and little crazy. How about Mr. T?

 

[TxMed]

lol, ok but if you make the commercial I want half the profits. We can use coffebeing as our doctor/actor. (only if he/she looks good in pictures and if he/she has not yet seeked counseling).

Wait, come to think of it, I want someone famous and little crazy. How about Mr. T?

mr.t has got to be the patient. and the adrenaline junky doc wrestles him down by choking him with his chains (which reportedly weigh nearly 100lbs)...after this adrena-doc goes for 2 chest tubes and a thoracotomy tray...even though mr.t only as a 2cm lac (on his leg).

 

[coffeebeing]

Whoa, I'm way better looking than Mr. T. Besides, I need the money from that commercial to feed my adrenaline addiction. All that base jumping don't pay for itself! In all seriousness, I know you gotta take the good with the bad in any specialty, but my interest is so focussed that anything that's not trauma just bores me, and I'm going to be unhappy regardless of which specialty I choose.

Does anyone know the number to Trauma Addicts Anonamous?

 

[RastaMan]

As an ER doc, you can deal with only the initial stabilization of trauma patients, which is what you seem to be interested in.
As a trauma surgeon, you deal with the initial stabilization, OR management, SICU, and ward management of trauma patients. This can often take months, and includes lots of non-adrenaline producing dressing changes, PEG changes, electrolyte management, etc.
As other posters have mentioned, you can't just focus on trauma, although you can make it your research focus in academics. And besides, after a while, would just taking care of trauma patients really be that much of an adrenaline rush? Trauma resuscitation is often fairly cookbook stuff. Often times, the patient arrives to the ED intubated and/or stable and theres not very much "exciting" stuff to do. Things rarely are as dramatic and emotional as the TV show.

 

[erichaj]

You go through your ATLS, you may have to place a few lines that half the time the nurses do anyway. If they are in shock you give fluids and maybe have to cardiovert. You most likely will order studies. After that you will have to call the specific specialty to come in and do their thing.

The problem is that now you are liable for what happens to them in the ER. Your the first there and you have to stabalize them.

Sometimes a patient comes in completly out. Now you have to run a bunch of tests to find out why etc etc. That is not that fun. It's not adreneline.

You are going through a phase. Kinda like when you first got kissed or laid. All you want is more.

 

[lowbudget]

You are going through a phase. Kinda like when you first got kissed or laid. All you want is more.

LOVE IT! SDN is the best website EV-ER.

 

[erichaj]

you like that. LOL 😱 😀

I got lots of those.

 

[RastaMan]

wait a minute....I want to be in a medical field where all I do is get kissed and laid. Hmmm, after watching Grey's anatomy, perhaps surgery would have been the right field for me.

 

[Winged Scapula]

wait a minute....I want to be in a medical field where all I do is get kissed and laid. Hmmm, after watching Grey's anatomy, perhaps surgery would have been the right field for me.

Don't believe it...you're too busy as a surgical resident to be getting laid in the call room.

Or maybe that was just me!

 

[RastaMan]

So I'm supposed to believe someone with years of experience as a surgical resident as well as my own experiences over the most wise and holy of TV shows, Grey's anatomy? No way.

Oh yeah, and to the OP, discount what I originally said. I learned on the 2nd wisest of all TV shows (ER) that he/she who work at Cook County do thoracotomy and chest tube in ED every day.

Final nugget of wisdom from ER and Grey's anatomy...he/she who do 60 minutes of CPR in patient with asystole ALWAYS makes patient recover completely without any deficits.

 

[Winged Scapula]

So I'm supposed to believe someone with years of experience as a surgical resident as well as my own experiences over the most wise and holy of TV shows, Grey's anatomy? No way.

Oh yeah, and to the OP, discount what I originally said. I learned on the 2nd wisest of all TV shows (ER) that he/she who work at Cook County do thoracotomy and chest tube in ED every day.

Final nugget of wisdom from ER and Grey's anatomy...he/she who do 60 minutes of CPR in patient with asystole ALWAYS makes patient recover completely without any deficits.

You forgot about surgical residents delivering babies in the ED (between getting kissed and laid in the call rooms, natch)! TV shows are soooo realistic (of course if I and my surgical colleagues looked like the starrs of tv shows, perhaps I would be doing more kissing, etc.)

 

[erichaj]

WAIT, I got laid everyday as a resident. Sometimes patients cute daughter, sometimes, residents or respiratory techs or you know anyone who likes the white coat. it was great. Much better than the tv shows.

OH YEAH, THEN I WOKE UP. 😡 😍

 

[meddog1]

I think trauma could be cool to work around if there weren't so many wacky personalities in the mix. Ever notice in the trauma bay how everyone around you is freaking out and yelling at each other - usually needlessly? What's up with that? Even when the protocol is down to where your "trauma-team-machine" is well-oiled, you get those certain folks who are always loud, demanding, and sometimes, just plain nuts. That aspect of it is omnipresent and it blows (IMHO). 🙄

 

[beyond all hope]

I thought I would be a ED trauma guru when I started my residency. I was hardcore into trauma.

Then I actually DID trauma. Treated trauma victims in the ED, in the ICU and on the floors in major trauma centers on both East and West coast.

Frankly, most trauma victims in an inner city ED were asking for it. Yes there are innocent bystanders (every last one, if you believe the patients) but most of the people being shot/stabbed/beat up/run over were jerks/drunks/druggies/bangers who would just as soon do it to someone else.

In a suburban ED where I work now it's mostly elderly falls and MVAs. Usually not exciting. I also hate giving bad news to good people.

Then you've got the monotony of trauma. Yes, monotony. After awhile, it's all kinda the same. Once you stabilize the patient (only required for a small minority of trauma victims) it's off to panscan, multiple x-rays, and then trying to get them out of the hospital but you can't because they're homeless/drug seekers or just a pain in the butt.

Trauma surgery itself is pretty cool if you like being a surgeon. Otherwise it's painful hours and no thanks.

Just wait until it's 4 am, you're trying to sew up a drunk's head and he's screaming at you and moving around because you won't give him Demerol. If you're still into trauma, go for it.

 

[Bobblehead]

Also keep in mind that trauma can be a high burnout area to some physicians. I've worked with several who much prefer their non-trauma ER in the middle of their career over the high volume level 1 trauma center at the beginning of their career.

And if you think you'd like to be a trauma surgeon I strongly encourage you to hang out with an attending who is in the middle of his career. Taking trauma call when you're 50 is a whole lot different than doing it when you're 30. Also keep in mind that work hour regulations don't extend to attending physicians.

 

[Winged Scapula]

In a suburban ED where I work now it's mostly elderly falls...

Don't you hate those trauma pages for "fall from standing"?

My favorite calls from my former residency program, were the patient who was found down, without a mark on them, but because they happened to fall into the street or onto the middle of the road, they somehow became a trauma. Can't tell you how many medical admits I had to ask for because of those lame calls by the ER.

 

[coffeebeing]

Trauma surgery itself is pretty cool if you like being a surgeon. Otherwise it's painful hours and no thanks.

With so many trauma cases now managed nonoperatively, going through surgery residency just to do trauma surgery seems like a waste, doesn't it?

 

[njbmd]

Don't you hate those trauma pages for "fall from standing"?

My favorite calls from my former residency program, were the patient who was found down, without a mark on them, but because they happened to fall into the street or onto the middle of the road, they somehow became a trauma. Can't tell you how many medical admits I had to ask for because of those lame calls by the ER.

Hey there,
My favorite calls are the ones for the LOLs who come in to the ER and are lying around on a stretcher for hours until one of the ER docs talks to them, finds out they have fallen in their history and calls a Trauma alert NOW in the ED. The patient won't have a mark on them but all of a sudden bunches of folks start to descend on them at once carrying things like thoracotomy trays when they actually needed a good primary care person to adjust their meds.

njbmd🙂

 

[docB]

Yes ERs and ER docs truly suck and are just as stupid as can be. Since we spend most of our time curled up in a corner of the ER drooling on ourselves our only recourse is to call bogus consults. So, that being said, can we let this tangent of the original thread die or do we need to pull out the stories of surgeons doing wacky things?

 

[mikecwru]

Yes ERs and ER docs truly suck and are just as stupid as can be. Since we spend most of our time curled up in a corner of the ER drooling on ourselves our only recourse is to call bogus consults. So, that being said, can we let this tangent of the original thread die or do we need to pull out the stories of surgeons doing wacky things?

Those stupid OR doctors! (Since no one can name our specialty correctly.)

My favorite interaction recently with a surgeon.

Me: "It'll take about 25 minutes for that FFP."

(in an almost 5 year old girl like whine): "We need it NOW. Why is it taking so long today?")

Me: "Uhhhh... cause it's fresh FROZEN plasma... it's got to thaw, dude."

But why sit and player hate?

These threads always deteriorate the same way.

mike

 

[Winged Scapula]

Yes ERs and ER docs truly suck and are just as stupid as can be. Since we spend most of our time curled up in a corner of the ER drooling on ourselves our only recourse is to call bogus consults. So, that being said, can we let this tangent of the original thread die or do we need to pull out the stories of surgeons doing wacky things?

Not stupid but a bit defensive!

No offense meant; most ER physicians are fantastic and do a great job, but IMHO, my former residency program had an ER that would call these bogus trauma consults. Even had one of the attendings there admit that they called a Trauma Page because he, "didn't have any (ER) residents to see the patient", so it seemed appropriate to bring all in-house surgical residents and anesthesia, respiratory, etc. down to the Trauma Bay to see someone who walked into the ED.

But you're right...we weren't trying to hijack the original thread and I hope you'll consider that the above is two people's experiences and not meant to convey any disrespect toward ED physicians as a whole. Besides, you have to admit that the events that njbmd and I posted about are a bit ridiculous.

 

[mikecwru]

Not stupid but a bit defensive!

No offense meant; most ER physicians are fantastic and do a great job, but IMHO, my former residency program had an ER that would call these bogus trauma consults. Even had one of the attendings there admit that they called a Trauma Page because he, "didn't have any (ER) residents to see the patient", so it seemed appropriate to bring all in-house surgical residents and anesthesia, respiratory, etc. down to the Trauma Bay to see someone who walked into the ED.

But you're right...we weren't trying to hijack the original thread and I hope you'll consider that the above is two people's experiences and not meant to convey any disrespect toward ED physicians as a whole. Besides, you have to admit that the events that njbmd and I posted about are a bit ridiculous.

NJBMD rotated through my hospital and I'm assuming her experiences are those at her home institution and not during her rotations with us. It's inappropriate for an ED doc to call a trauma page without meeting established criteria or at least evaluating a patient and using judgement, but two caveats:


1. Critically ill people can WALK into the ED; they do it all the time, including trauma patients.
2. "Found down" with poor responsiveness and no mechanism in the middle of the street in my opinion it's not inappropriate to assume trauma until proven otherwise. I've had plenty of these arrest or have cspine fractures, etc. These are the patients if we don't have a clear mechanism and the "pan CT" is negative, I won't fight for a trauma admission; a medicine admission can be appropriate if they're still gorked without an obvious cause. GRANTED, this is found "down" with no information. I had a guy recently that was "found down" on a park bench. Assuming he did not fall from the sky onto the bench, the chance of trauma is zero, so I cancelled the trauma page.

mike

 

[Winged Scapula]

Thanks Mike.

You are absolutely correct that critically ill people walk into the ER all the time; it is amazing how sick people can be before they come in. My example was simply referring to a situation which I was a part of and the patient was not critically ill.

There are criteria which need to be met for a trauma; my problem was with ED physicians who did not bother to know the criteria but rather exploited the fact that a Trauma page would get the patient seen and dispo'd sooner. Of course, this was frequently brought up in Trauma M&M and the defense was that, "we get yelled at when we don't call trauma pages for some patients, so we figured it was better to be 'safe than sorry' and call it". True, but still not appropriate use of the Trauma system (at the hospital of my experience).

 

[docB]

Not stupid but a bit defensive!

You're right. Too many nights, too much coffee and too little sleep. Mea culpa.😳

 

[ERMudPhud]

Don't you hate those trauma pages for "fall from standing"?

My favorite calls from my former residency program, were the patient who was found down, without a mark on them, but because they happened to fall into the street or onto the middle of the road, they somehow became a trauma. Can't tell you how many medical admits I had to ask for because of those lame calls by the ER.

Some of this you have to blame on ACS. I keep getting hate mail from our local trauma board whenever I admit an old lady with fall from standing height with a nonoperative pubic ramus fx or rib fx's to medicine. Even if ortho is consulted for the pelvis I still get hate mail from the trauma board even though ortho really isn't interested in admitting them. When our time comes for renewal of our trauma center designation ACS reviews our records and dings us if we have too many cases where trauma wasn't consulted or someone else admits a "trauma." Just today I got an email saying that we can now do exactly what I've been doing which is admit isolated nonoperative fractures sustained by falls from standing height to the hospitalists. But even this email said that if they fell off a curb (4inches) they had to got to trauma since this didn't count as standing height.

My best found down in the road case though was an old very jaundiced cirrhotic drunk signed out to me as, "found down, sleeping it off". Ah, the perils of signout. A few hours later the nurses tell me that his pressure is dropping and he's getting tachycardic. I go and reasses him and discover that his right thigh is twice the size of his left and has what looks like a tire mark on it. I end up putting a cordis in him and dumping every blood product in while getting a CT which includes his thigh. I also call a trauma consult. The CT shows active extravasation of contrast into his thigh from a probable femoral artery injury. The trauma surgeon calls back eventually and says its isolated extremity trauma call ortho.I tell him he's nuts but agree to give it a try. I call ortho knowing full well their response is going to be, "You've got to be F'ing kidding me." I call trauma back and get told he's clearly endstage liver can't medicine take that at which point I draw the line and say, "No!, your coming in now to take this guy to IR or the OR whichever you think will work" The best part is I get a letter from the trauma board asking me to justify my treatment since the patient died two months later of hepatic failure and the delay in getting a trauma consult and in getting the patient from the ER to SICU was deemed the proximate cause of his death. I wanted to write a short note saying the delay was from the trauma surgeon refusing to come see the patient but I did the political thing and wrote that I called for a trauma consult as soon as I realized the gravity of the situation and that although I regret the delay in getting the patient to the SICU that we were providing the patient with every known blood product for resuscitation as rapidly as the blood bank could pump them out so I doubted that the SICU could have done anything different.

 

[beyond all hope]

We have a pretty good system at Stony Brook, basically a two tier system.

One is a 'trauma consult' for serious but nonemergent trauma, we get the senior surgery resident to see a patient after we've already worked them up. The consult can either be helpful (finds fractures that we missed) or painful (he's still got C-spine tenderness, get flex-ex. If those are negative and he's still tender, get an MRI). I don't like to get a trauma consult unless it means trauma admission.

The Code T: trauma alert brings down everyone in the hospital, including anesthesia and the trauma surgeons. We don't like to call a code T unless we're pretty sure that the patient has a serious traumatic injury. Unfortunately, Code T does not assume trauma team admission, which I find annoying. If it's bad enough to call a code T, trauma should take the patient.

The way we did it at Temple, calling a trauma alert meant automatic trauma admission. This made the ED run a lot smoother. Note it doesn't make that much more work for trauma: they still write a full H&P whether it's a consult or admission, and pretty much follow the patient the same way, consult vs admit. The only extra work was discharging the patient if they could go home, but this is probably less work than the arguements we have now about whether or not the patient needs to be admitted. I rotated on trauma only three months ago so I still remember how it works.

I'm of the opinion that I call specialists for two reasons
1) Admit for further workup
2) Procedure that I can't do myself

I don't like to call a consult just to get a second opinion. Either the patient is emergent and needs emergent help (scope from GI, cath from cards, OR for appy) or admission (r/o MI, NPO/IVF for SBO, etc), or the patient has a nonemergent problem that can be seen as an outpatient (nondisplaced fracture, chronic HTN, etc)

On the flip side, when I'm ready to admit, I'm ready. None of this 'let's call another service and see if they want it'. They don't, or I'd have already admitted to them.

 

[Winged Scapula]

You're right. Too many nights, too much coffee and too little sleep. Mea culpa.😳

S'all right! Why don't you relax tonight, get yourself something more decent than In-n-Out and go to Lotus of Siam?

 

[Winged Scapula]

Some of this you have to blame on ACS. I keep getting hate mail from our local trauma board whenever I admit an old lady with fall from standing height with a nonoperative pubic ramus fx or rib fx's to medicine. Even if ortho is consulted for the pelvis I still get hate mail from the trauma board even though ortho really isn't interested in admitting them. When our time comes for renewal of our trauma center designation ACS reviews our records and dings us if we have too many cases where trauma wasn't consulted or someone else admits a "trauma." Just today I got an email saying that we can now do exactly what I've been doing which is admit isolated nonoperative fractures sustained by falls from standing height to the hospitalists. But even this email said that if they fell off a curb (4inches) they had to got to trauma since this didn't count as standing height.

I know..you're darned if you do, darned if you don't. And I'll admit that the same thing happened at my residency program and you had to feel for the ED attendings. Often times they called an inappropriate trauma based on the info that the transporting team gave - garbage in, garbage out. Then again, they've turned away patients straight to Ortho who should have a Trauma consult at the least, which Ortho ends up getting anyway, but typically hours later, when we're trying to get some shut eye.

Its a thankless system and I do appreciate those in ED who are thoughtful about patient management and how patients are best served.

So, is a 3 in curb ok - or is that still a trauma? 😉

 

[ERMudPhud]

So, is a 3 in curb ok - or is that still a trauma? 😉

Actually the email was very clear that absolutely anything above standing height required a trauma consult which made me wonder how high heels fit into that definition.

 

[Apollyon]

S'all right! Why don't you relax tonight, get yourself something more decent than In-n-Out and go to Lotus of Siam?

Blasphemy!

 

[roja]

=Stories! Stories!




1- Before I started at my program, one of our surgical residents fiance (about 5'8" was wearing 2 inch heels) fell from stranding. She died of a massive bleed about a day later

2. Drunk who came in s/p fall from standing with some minor trauma. Definately drunk. One of our less qualified surgical residents (thankfully a rare thing in our institution, IMHO) said "well, he's crossing his legs so he must be okay." Had a subdural and SAH.

3. Recently had a guy with a witnessed fall from standing. Intubated in the field, had a massive subdural with shift, went ot the OR.


All these stories illustrate is "when its your time to go, nothing is gonna save you..." sheesh. How fracking hard and unlucky do you have to be to fall from standing and get a massive bleed????



What the heck was this thread about?


Ernesto? Trauma? 😕

 

[Winged Scapula]

Actually the email was very clear that absolutely anything above standing height required a trauma consult which made me wonder how high heels fit into that definition.

Some of those heels can be deadly, especially when the men wear them (have you seen some of those things the club kids and transvestites wear?!) 😱

 

[Winged Scapula]

Blasphemy!

Believe me, I have MISSED In-an-Out Burger (and FatBurger) while out here on the east coast...can't find them anywhere, but Lotus of Siam is good and relatively inexpensive (rated as best Thai in the US by Gourmet magazine last year).

 

[Winged Scapula]

1- Before I started at my program, one of our surgical residents fiance (about 5'8" was wearing 2 inch heels) fell from stranding. She died of a massive bleed about a day later...How fracking hard and unlucky do you have to be to fall from standing and get a massive bleed????

Gosh...that's awful, and hard to imagine the force with which she hit her head. But as you note, when your numbers up, its up.

 

[Dr.MISHKA D.O.]

anyone want to work my trauma shifts next month....I trade two to one for medicine side of the ED. For that matter I will give you my vacation to work the floor this month.

LOL

trauma sucks... panscan, have some scared surgical intern getting yelled at, put in chest tube, repeat.

My 0.02

Best Wishes

The Mish