Trauma Surgery/Emergency Medicine?

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grahambranchno9

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Hey guys,

I'm a premed, and I volunteer at a local ER. It's one of Georgia's 3 Level 1 trauma centers and is very busy. When critical patients come in, they go straight to one of four "Trauma Rooms." I've heard that these rooms are for stabilizing the patients, who are usually then taken to a separate OR for surgery.

Is this true? I've seen general surgery residents around the Trauma Rooms. What would happen in these rooms? Any surgery? And where would the Trauma surgeons reside?

Thanks

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It sounds like you are really interested in EM - great for you! Typically we stabilize patients with the trauma team, who are trauma or general surgeons. They are the ones who take the patient to the OR, if they need it. Use this time to learn as much about the ED as you can. You may be surprised - the more interested you are, the more it will show - and the more the doctors there will show you...
 
Hey guys,

I'm a premed, and I volunteer at a local ER. It's one of Georgia's 3 Level 1 trauma centers and is very busy. When critical patients come in, they go straight to one of four "Trauma Rooms." I've heard that these rooms are for stabilizing the patients, who are usually then taken to a separate OR for surgery.

Is this true? I've seen general surgery residents around the Trauma Rooms. What would happen in these rooms? Any surgery? And where would the Trauma surgeons reside?

Thanks
Emergent thoracotomies ("cracking the chest") is done in a trauma bay, but for most other operations, it can usually wait 2 minutes until the patient is in the OR. The resuscitation rooms aren't operating rooms.

In a Level I facility, it's usually surgery that assesses the traumas and runs the resuscitations. Many Level I's also have emergency medicine residencies, and it can depend on the institution what involvement emergency medicine has with the resuscitations. Some places rotate on a daily basis, some places only allow airway management by EM residents, etc.

In the community, the Level 2's and Level 3's usually don't have in-house surgeons. This can vary by state, but in Georgia, Level 2's rarely have in-house surgeons. Trauma resuscitations are solely the job of the emergency physician, and when a patient needs to be admitted or needs to go to the OR, then the trauma surgeon is called. Some Level 2's automatically notify the trauma surgeon of major traumas, and they are required to show up in 15 minutes. When they get there, then they usually run the show.

Regardless, you will get plenty of trauma experience as an emergency physician. If you love to assess and manage the initial resuscitation, then emergency medicine is for you. If you love to assess, manage the initial resuscitation, operate, and follow the patient through the ICU and floor stay (often for weeks), then trauma surgery is for you.

By the way, Georgia has 4 Level I trauma centers:
- Grady Memorial Hospital in Atlanta, an Emory/Morehouse teaching hospital
- University Hospital in Augusta, an MCG teaching hospital
- Medical Center of Central Georgia in Macon, a Mercer teaching hospital
- Memorial Health University Medical Center in Savannah, a Mercer teaching hospital
 
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Thanks for your replies...I wasn't aware of there being a Level 1 in Macon. One more quick thing...is it unheard of for pre-meds to shadow trauma surgeons? Would I be too much of a hindrance? I know people I could ask who I've seen around the ER, but wouldn't want to get in anybody's way.

Thanks
 
Thanks for your replies...I wasn't aware of there being a Level 1 in Macon. One more quick thing...is it unheard of for pre-meds to shadow trauma surgeons? Would I be too much of a hindrance? I know people I could ask who I've seen around the ER, but wouldn't want to get in anybody's way.

Thanks
PM me. I know trauma surgeons at 3 out of the 4 Level I's.
 
this is probably not really important in this discussion, but FYI, University Hospital in Augusta is not level 1. MCG Hospital is the level 1 facility. University Hospital is another hospital (across the street) that was MCG's teaching hospital until 1956. Confusing but true.
 
Trauma surgery is fun, but EM is funner. ;)

Yes, resuscitation happens in the trauma rooms. Like others have said, this is usually done by a team of trauma surgeons, surgery residents, EM attendings, and EM residents. Where I am, the kind of team you get depends largely on the kind of trauma rolling in. Since you're a volunteer in the ED, why don't you ask someone if you can tag along and watch the next time a trauma rolls into your ED? A trauma looks like chaos, but it's organized chaos. If there are medical students around, try asking them what's going on; they might be clueless, or they might be able to tell you what's happening, but it won't hurt to ask.

For your other question, I haven't seen any pre-meds shadowing a trauma surgeon, but it wouldn't hurt to ask. I loved my trauma surgery rotations and while I don't want to do it as a career, I did learn a lot. I've found that most attendings, regardless of field, are pretty open to being shadowed. Just ask! The worse they can do is tell you no.
 
this is probably not really important in this discussion, but FYI, University Hospital in Augusta is not level 1. MCG Hospital is the level 1 facility. University Hospital is another hospital (across the street) that was MCG's teaching hospital until 1956. Confusing but true.
Hmm, I thought MCG's hospital was University Hospital? Oh well. Like I said, I'm very familiar with 3 out of the 4 Level I's in Georgia.

Beaudubbs, are you in Georgia?
 
Some hospitals have trauma teams which come down to the er for the traumas. They can be there when the patient comes in or they could take 15 min to get there. There are usually em residents on the team at least at the hospitals ive worked at. EM attendings do have a level of training do to what needs to be done in a trauma room like if a patient needs thoracotomy. Thats really the only major surgical procedure done down in the er all the rest of the cool stuff is done upstairs. Working in the er has really fueled my drive for em because it combines all the best aspects of medicine and surgery (what can happen in a trauma).
 
Hmm, I thought MCG's hospital was University Hospital? Oh well. Like I said, I'm very familiar with 3 out of the 4 Level I's in Georgia.

Beaudubbs, are you in Georgia?

Southerndoc,
I am an MSIV at MCG, hence my understanding of the strange hospital taxonomy here in Augusta. U from GA too with a name like southerndoc?
 
Ok, I'm bringing this one back from the dead...

I've been volunteering more and more at the ER I mentioned above, and have gained exposure to alot more. I spend a decent amount of time "hanging out" in the trauma bays watching what materializes. Just the other day I saw my first ever procedure-- a chest tube insertion. However, I'm still unsure exactly what a trauma surgeon would do.

I understand that certain procedures (thoractomies, chest tubes, etc.) are performed in the trauma bays. However, these procedures are performed by ER docs, right? And after the patient is stable they are taken to the OR, where the specialist surgeons would step in. Is this correct? Where do the trauma surgeons fit in?

Thanks!
 
I understand that certain procedures (thoractomies, chest tubes, etc.) are performed in the trauma bays. However, these procedures are performed by ER docs, right? And after the patient is stable they are taken to the OR, where the specialist surgeons would step in. Is this correct? Where do the trauma surgeons fit in?

Thanks!
--

I am also curious about the specifics, since I am considering both specialties, but leaning more heavily towards EM than trauma surgery. I currently work in the ED of one of those Georgia level I's, but I'm tucked away from the critical care section of my department and rarely get much patient contact. This sucks for me, because I'm missing out on valuable learning experiences.

I would think, though, that teaching hospitals tend to have protocols that involve their trauma residents moreso than non-teaching facilities, since they need the experience. Would this be an accurate perception?

Anyway, this is a very interesting thread. Thank you all for your contributions! the EM forum is so far my favorite in all of SDN!:love:

N.
 
Ok, I'm bringing this one back from the dead...

I've been volunteering more and more at the ER I mentioned above, and have gained exposure to alot more. I spend a decent amount of time "hanging out" in the trauma bays watching what materializes. Just the other day I saw my first ever procedure-- a chest tube insertion. However, I'm still unsure exactly what a trauma surgeon would do.

I understand that certain procedures (thoractomies, chest tubes, etc.) are performed in the trauma bays. However, these procedures are performed by ER docs, right? And after the patient is stable they are taken to the OR, where the specialist surgeons would step in. Is this correct? Where do the trauma surgeons fit in?

Thanks!

Trauma surgeons are General Surgeons who have done an extra Trauma/Critical Care fellowship. If you get in a car accident and rupture your spleen and you end up at a Level I trauma center, the Trauma Surgeon is going to take your spleen out. They are able to handle just about every abdominal injury and many thoracic injuries. The 'specialist surgeons' you speak of are called if needed for anything else. Most frequently it's either Orthopedics/Spine or Neurosurgery/Spine. Others might include Urology, Cardiothoracics, and Plastics.

The biggest thing the Trauma surgeons do though is related to the second part of their fellowship and something you'll never see in the ER. Namely Critical Care. When you come in to the hospital as a Trauma, it's not like you go to the OR, get your injuries fixed and go home that afternoon. Someone has to take care of you through your recovery. You will be a patient on the Trauma service who will manage your day-to-day needs.

USCDiver - 4 Months Trauma down, 0 more to go!
 
Just so the OP is aware...

Trauma surgery = 6 years (min)
EM = 4 years (max)
 
Just so the OP is aware...

Trauma surgery = 6 years (min)
EM = 4 years (max)

Not only that...

Trauma Surgery = 6 years of Surgery residency minimum followed by in-house call for your whole career

EM = 4 years as an EM resident maximum followed by 12-14 shifts a month for your whole career (with the option to pick up more if you want that fancy boat or Playstation or boat with built in 60inch LCD with Playstation and satellite TV)
 
EM = 4 years as an EM resident maximum followed by 12-14 shifts a month for your whole career (with the option to pick up more if you want that fancy boat or Playstation or boat with built in 60inch LCD with Playstation and satellite TV)
Ahh, I see... I'm certain the husband will be completely behind that idea; not to mention, he will most likely not accuse me of leaving him and the family neglected, right? ;)
 
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