Trauma Surgery During Internship

[Cystospaz]

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Hello,

Im doing anesthesia for residency but as luck would have it I start my internship with trauma surgery...can't say that I am the leading expert on this so I thought I would ask the folks in the surgery forum here for some helpful things to read/know/learn to ease the pain of knowing nothing...thank you kindly for any responses.

 

[dpmd]

You probably have not had ATLS, but if you did a med student rotation in trauma hopefully you got the idea. If you have no experience at all you can pick up an ATLS book and look at the overview chapter at least. They won't expect you to know everything, but a little background on the ABC's will make you feel better. Exactly what your role will be will depend on how your insitution does things. At my hospital, the intern starts off just helping the senior do stuff (take clothes off, write notes, get supplies for procedures that you may or may not get to attempt-time and urgency dictating, corral the med students, getting official reads, calling consults, calling people when my hands are occupied and I need my senior/attending) then as they learn more, they get to do more.

 

[Guile]

At my hospital, the intern starts off just helping the senior do stuff (take clothes off, write notes, get supplies for procedures that you may or may not get to attempt-time and urgency dictating, corral the med students, getting official reads, calling consults, calling people when my hands are occupied and I need my senior/attending) then as they learn more, they get to do more.

So they're basically medical students?

 

[pnle119]

This is what I noticed during my Trauma audition rotation:

The intern, like dpmd pointed out above, functioned primarily to assist the Trauma resident, who was either a PGY-III or the Chief on Trauma. Where I rotated, the Trauma intern was also the SICU/Trauma ICU intern, and they were "confined" to the ICU's (depending on which attending was on call) and only reported to the Trauma bay when called upon by the resident for assistance.

When they did come help out in the Trauma bay, it was usually to scribe while the resident did the surveys. The procedures they got to do, as expected, included chest tubes, FAST scans, central lines, and, of course, suturing. The only time the intern ran the trauma was when there were multiple cases, and even in that situation, the intern always got the less serious cases. Nonetheless, they were responsible for their own H&Ps.

The Trauma intern that was rotating through, i.e. FP or IM intern, was usually given the scutwork which included all the usual floor management issues and doing discharges.

These non-surgical interns rounded with the other residents every morning and were usually assigned the Trauma patients that were admitted to Med/Surg while the Chief and seniors rounded on the ICU patients. The surgical interns, which included the prelims, rounded in the Trauma ICU.

Also, the M&M's were always presented by the seniors or Chief, never the intern.

If I were prepping for a Trauma rotation, things I'd brush up on would include:

-Components of primary and secondary surveys
-How to quickly calculate the GCS
-Reading CXRs
-Indications for thoracotomy
-Indications for DPL vs. ex lap
-Grading system for liver/splenic lacs
-Trauma neck zones
-Knowing the extensions for ortho/plastics/OMFS/neurosurg/urology

 

[kitsunepixie]

Thanks dpmd and pnle119! I also start out with trauma/SICU as my first in-house rotation and hadn't done a non-neurosurgery trauma rotation before, so this was really helpful information.

 

[dpmd]

So they're basically medical students?

No, more useful than med students since I don't have to cosign the note.

Don't get me wrong. A surgery intern at the end of the year-I'm hanging back watching them go through the survey and procedures most of the time. They even get to be on their own in a multi trauma situation, or after I peek my head in and decide nothing big is going on. But an off service intern on their first rotation ever is going to do as their told without independence until they earn some. Be prepared with landmarks for procedures, and what supplies you need, then I will give you opportunities to do those procedures. But when time is of the essence, if you have no clue or no confidence, don't cry when I take it away from you. Oh, and delegating tasks to the students is just fine with me as long as the work gets done right

Where I went to med school, the primary role of the intern was to hang out in the trauma admitting area and perform serial exams on all the stab victims and what not. I don't remember if they even got to attend the activations. They also did all the med surg notes and never got to go to the OR.

 

[JackADeli]

...A surgery intern ...go through the survey and procedures most of the time. ...They also did all the med surg notes and never got to go to the OR.

At our level 1 center, interns made sure paperwork was done (usually by med-students), they did primary survey and clothing strip. Blood sticks if needed. They collected the "wet reads" and followed with to scanners. We were quite busy... so in a few days, they were doing minor components of treatment. This, usually to their detriment, meant they were staying in the trauma bay to suture lacs and such. Depending on how busy and motivated, didn't matter off-service or on-service, they were doing chest tubes within a week or so. Otherwise, there really isn't alot of actual hardcore operating going on in the trauma room. The seniors did the few thorocotomies. If they had their work done, they could hold hook in the trauma ex-laps/splenectomies. They usually were tired and took that time to get a nap while we explored. Also, they would assist rounding in the trauma ICU....

 

[Cystospaz]

Thank you all for the reply...i really appreciate your help.

 

[diel]

I don't know how it is at your programs, but as surg intern , I do a lot more than sitting in the ICU.
I see EVERY single admission or consult to trauma, be that green, yellow or red. I have to be in the bay no matter what, unless I am coding someone up in the ICU. Even if I am in the middle of a procedure (chest tube etc), i gotta speed or drop it and run to the bay whenever I hear an overhead. In the bay, I am the one doing the survey and yell it out loud, while my senior is running the process and my attng stands by, writes his own H&P and makes sure the senior does the right thing.
After the pt is stable, I have to write my HP and follow the pt in the CT scan and VIR or wherever needed. Also, I am the one that does all the suturing (this is where I bring all the med students in), fracture reducing (WITH my attng), lines, tubes.

While doing all that I also carry the trauma pager which covers about 60 to 90 ppl, out of which 24 are in the SICU. I answer all the calls RNs make. Sometimes, when the situation is more serious, ICU RNs will page the Sr directly for advice.
Also, I see every single critical care consult we get from other surgery services.
I have to present my own M&Ms if I was involved. And that is not just on the trauma service - any service. I was in the case, I present. Not my chief or Sr.

There is one thing I never do on trauma though. I never go to the OR if pt needs ex-lap. Sr or Chief in house goes.
But that makes plenty of sense - first - attng needs someone with experience to act fast in the OR, second - my pager never stops beeping.

The point is - Trauma Jr does a LOT in my program. It is not easy, but you learn SO much.

Read the ATLS , know the surveys BY HEART. Never abate from the ABCDE. Speak loudly and clear. Don't let anybody intimidate you.
Always order CXR STAT after lines and tubes...... ppl tend to forget... and that is A BIG error.
Be nice to the SICU RNs - they are the smartest and most hard working of all RNs that exist in this world and they will help you tremendously - don't be afraid to ask for their help.

 

[skiz knot]

... fracture reducing (WITH my attng)...

Really, the GSurg resident reduces fractures at your hospital??? No ortho coverage in the ER?

 

[diel]

Really, the GSurg resident reduces fractures at your hospital??? No ortho coverage in the ER?

We reduce the obvious deformities, the grossly deformed open/closed fractures and dislocations. We also put all the steinman pins, tractions.

There is no ortho residency in my hospital, and the ortho attng comes in in the middle of the night only if there is a true ortho emergency (open Fx or anything else that can not wait until next morning).
The "no ortho guy in the hospital" is getting on my trauma attngs nerves more and more now, so they are thinking to hire a guy that would do all the trauma, cause the private ortho guys we have now in the hospital obviously are not very thrilled about operating on ppl that most of the time will never pay them back (you know, typical trauma patient). Ortho peeps love their spine fusions and elective joint replacements.

So basically, we can't leave the pt with a leg looking like a letter Z until the private ortho doc decides to roll in and fix it. So we do what we can to ease the pain, save the limb, while we are waiting .

 

[Guile]

We reduce the obvious deformities, the grossly deformed open/closed fractures and dislocations. We also put all the steinman pins, tractions.

There is no ortho residency in my hospital, and the ortho attng comes in in the middle of the night only if there is a true ortho emergency (open Fx or anything else that can not wait until next morning).
The "no ortho guy in the hospital" is getting on my trauma attngs nerves more and more now, so they are thinking to hire a guy that would do all the trauma, cause the private ortho guys we have now in the hospital obviously are not very thrilled about operating on ppl that most of the time will never pay them back (you know, typical trauma patient). Ortho peeps love their spine fusions and elective joint replacements.

So basically, we can't leave the pt with a leg looking like a letter Z until the private ortho doc decides to roll in and fix it. So we do what we can to ease the pain, save the limb, while we are waiting .

You must be crazy busy with no ortho resident coverage at night. Our second year ortho guys are the busiest, hardest working residents in the hospital I'd say, with the consult pager going off 30+ times a night sometimes.