Quick Trauma Question

[nvshelat]

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Is trauma an EM thing or surgery thing, or both? If EM participates, is it just intubation or does it depend on the hospital/dept. Tx. 🙂

 

[Febrifuge]

In some places, EM runs everything, and Trauma Surg comes down to the department to watch from the sidelines and take the patient up to the OR. In some places Trauma Surg runs the whole thing start to finish. Totally depends on the hospital. And sometimes, it depends on the day of the week.

 

[12R34Y]

Is trauma an EM thing or surgery thing, or both? If EM participates, is it just intubation or does it depend on the hospital/dept. Tx. 🙂

Most definately depends on the hospital/residency/department etc....

for example the program I'm rotating at right now the EM residents do the airway and another EM resident does the primary survey and fast exam then the rest is pretty much done by surgery. However, it just depends on who wants the skill and who's working as to who gets the chest tubes, central lines, etc....

However, EM always does the airway.

later

 

[DrQuinn]

See above.

Keep in mind that "Trauma Surgery" isn't all its cracked up to be. True, you may get to do a thoractomy once a year... if the Emergency Physician doesn't take it from you, but a lot of your time will be, ugh, the actual in-hospital care of the trauma patients. All those patients with splenic lacs, pulmonary contusions, pneumothoraces that get sent up to the ICU, that's your job.

Oh! The trauma pager just went off again, looks like another one for the unit.

Anyways, at my program, the EM residents run all the traumas except the night before and the day of our Grand Rounds. We do airway, resuscitation, lines, chest tubes, blah blah. We're at a Level 1 trauma center too, things can get crazy.

Q

 

[mikecwru]

You only see one thoracotomy a year? I expect things to be a little more violent in Tampa.

As people have said before, responsibilities vary greatly. I've heard of places where anesthesia comes and does the airway. I may be wrong, but that's the impression I got when I interviewed at Maryland... they specifically have a "trauma anesthesia" rotation where you get the majority of your trauma intubations.

At our program, we do the airway, we alternate for the surgical airway and other procedures along with the person "running" the resuscitation. We have anesthesia backup which I unfortunately used for the first time in my residency this past month on someone with a lot of airway edema but I could ventilate pretty well with a BVM.


mike

See above.

Keep in mind that "Trauma Surgery" isn't all its cracked up to be. True, you may get to do a thoractomy once a year... if the Emergency Physician doesn't take it from you, but a lot of your time will be, ugh, the actual in-hospital care of the trauma patients. All those patients with splenic lacs, pulmonary contusions, pneumothoraces that get sent up to the ICU, that's your job.

Oh! The trauma pager just went off again, looks like another one for the unit.

Anyways, at my program, the EM residents run all the traumas except the night before and the day of our Grand Rounds. We do airway, resuscitation, lines, chest tubes, blah blah. We're at a Level 1 trauma center too, things can get crazy.

Q

 

[Docgeorge]

See above.

Keep in mind that "Trauma Surgery" isn't all its cracked up to be. True, you may get to do a thoractomy once a year... if the Emergency Physician doesn't take it from you, but a lot of your time will be, ugh, the actual in-hospital care of the trauma patients. All those patients with splenic lacs, pulmonary contusions, pneumothoraces that get sent up to the ICU, that's your job.



Q

Hopefully that will be a thing of the past with the development and implamentation of the new Acute Care Surgery (trauma, critical care, and emergency surgery) cirriculum.

 

[DrQuinn]

You only see one thoracotomy a year? I expect things to be a little more violent in Tampa.


mike

shooooooooooooooot, we're the cocaine capital of the world, bro, all our ports from south american bring in a lot of the snow for the streets, lots of penetrating trauma.

I was saying in general, if you're a trauma surgeon, you may do on thoractomy a year... since usually a trauma code will have been called in the ED or in the field. Just trying to de-glorify trauma surgery...

Q

 

[beyond all hope]

Try once a week, at least in my hospital.

We have a trauma team that takes care of traumas, while us 3rd years just do mostly airway. It does mean we get less procedures, but it also means we have more time to take care of our regular patients.

We also rotate on trauma, which is pretty painful, but at least then you get all those procedures.