traumas

[corona 247]

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I am currently on a trauma clerkship in which the trauma team, consisting of a trauma surgeon attending, a senior and junior gen sx resident plus one EM resident make the up team. During traumas, the EM docs in the ED dont participate. Am interested in EM, and was wondering if this setup is the norm for most level one trauma hospitals.

I am interested in EM, but would not want to "defer" traumas to the surgery team to assess/tx. Thanks!

 

[146233]

At many hospitals in Chicago, you'll find a surgical attending and an EM attending in the room. The resident spots rotate monthly between EM and surgery 2nd and 3rd years. The EM attending is very involved in trauma care, and the EM resident is responsible for obtaining and maintaining an airway. There are a few hospitals (*cough* Stroger) that are similar to what you describe.

If you don't want to 'defer' traumas to surgeons for assessment, then don't work at a Level 1 Trauma Center. 🙂 Non-TC ED's assess and tx all they want before transferring to an appropriate facility. Just remember that definitive treatment for many types of trauma will be surgery; no way around it.

 

[docB]

Here are a few of the more useful of the approx 7 zillion threads sparked by med students realizing that EM is not all about trauma. Check these out and do some additional searches. It’s been flogged beyond death before.

http://forums.studentdoctor.net/showthread.php?t=338713

http://forums.studentdoctor.net/showthread.php?t=254706

http://forums.studentdoctor.net/showthread.php?t=249166

http://forums.studentdoctor.net/showthread.php?t=220570

http://forums.studentdoctor.net/showthread.php?t=202136

http://forums.studentdoctor.net/showthread.php?t=191364

http://forums.studentdoctor.net/showthread.php?t=189083

http://forums.studentdoctor.net/showthread.php?t=142346

 

[GeneralVeers]

I am currently on a trauma clerkship in which the trauma team, consisting of a trauma surgeon attending, a senior and junior gen sx resident plus one EM resident make the up team. During traumas, the EM docs in the ED dont participate. Am interested in EM, and was wondering if this setup is the norm for most level one trauma hospitals.

I am interested in EM, but would not want to "defer" traumas to the surgery team to assess/tx. Thanks!

At our residency the ED physician/Resident manage the airway, and intubate if necessary. The actual trauma code is run by the Trauma attending and the rotating trauma resident.

Most level I-II trauma centers have codes run by the surgeons, however ED physicians still deal with the "trauma alerts" which are basically handled in the same methodical way. The ED physician then notifies the the trauma surgeon if the patient needs admission or has a surgical injury.

 

[AmoryBlaine]

At many hospitals in Chicago, you'll find a surgical attending and an EM attending in the room. The resident spots rotate monthly between EM and surgery 2nd and 3rd years. The EM attending is very involved in trauma care, and the EM resident is responsible for obtaining and maintaining an airway. There are a few hospitals (*cough* Stroger) that are similar to what you describe.

If you don't want to 'defer' traumas to surgeons for assessment, then don't work at a Level 1 Trauma Center. 🙂 Non-TC ED's assess and tx all they want before transferring to an appropriate facility. Just remember that definitive treatment for many types of trauma will be surgery; no way around it.

Saw a good presentation that said something like "trauma is 95% of the appeal for medical students and 5% of the practice."

I'm planning to do EM, but trauma sucks. My M3 rotation was basically like being on any other surgical service except that instead of having scheduled cases in the morning, you took 30 hour calls and got woken up to 3am to get to cut the thong off some lady from an MVC.

 

[basementbeast]

at a community level 2 trauma center, i handle all trauma either by my self or with a surgeon (who is supposed to show up within 30 minutes if it is a serious trauma)......

 

[146233]

Saw a good presentation that said something like "trauma is 95% of the appeal for medical students and 5% of the practice."

Amen. It's definitely a good rotation for those with a penchant for the dramatic. 😉

 

[Jeff698]

I get my butt kicked sufficiently with the sick medical patients that I would be perfectly happy to have a surgeon come down for every trauma and allow me to continue taking care of all my other patients, uninterrupted.

Now, I certainly like sticking tubes in people as much as the next guy, but there's not exactly a shortage of sick patients going around.

Sadly, I have to drag my butt into all of our traumas. Our highest level activation has a senior EM and surgery resident working together on the initial assessment and resuscitation. The surgery guys will take over as the patient heads off to the CT scanner, assuming they actually turn out to be sick and need admission. Our second year EM resident owns the patient from the clavicles up and doesn't budge from there until the airway is secured and that part of the body has been completely poked and prodded.

I now have a month's worth of experience as a third year running the traumas this way and, with very rare exception, it works well. I've not had any clashes with our surgeons. Last year, I never had even the hint of trouble from our surgeons when managing airways.

The key to working with surgeons is to be aggressive but not let your ego get in the way of taking care of the patient.

In general, physician egos are the biggest threat to patient safety, regardless of specialty.

Take care,
Jeff

 

[deleted52758]

i think we get a pretty good trauma experience at stroger. that's why multiple programs come to our facility, to train under some of the leaders in trauma surgery. but like everyone said, trauma is really not that special.

At many hospitals in Chicago, you'll find a surgical attending and an EM attending in the room. The resident spots rotate monthly between EM and surgery 2nd and 3rd years. The EM attending is very involved in trauma care, and the EM resident is responsible for obtaining and maintaining an airway. There are a few hospitals (*cough* Stroger) that are similar to what you describe.

If you don't want to 'defer' traumas to surgeons for assessment, then don't work at a Level 1 Trauma Center. 🙂 Non-TC ED's assess and tx all they want before transferring to an appropriate facility. Just remember that definitive treatment for many types of trauma will be surgery; no way around it.

 

[joeG]

At Bellevue we run the trauma until the trauma service arrives. At that time, we usually work on it together. We always do airway and in general do the primary survey. Procedures are split between services.

 

[kungfufishing]

We always have the airway, alternate days running it; this only applies to trauma team activations. Otherwise, it is ours until we consult it out. As stated above, not quantum physics regardless of institutional setup and although sometimes satisfying in a tangible sense, really sick trauma patients dont need to be in the ED very long.

 

[paramed2premed]

I know, Iknow, this has been hashed over before.

Nonetheless, the last issue of Annals added yet more grist for the mill, looking a the necessity of surgical prescence at trauma activations. While you can quibble with the methodology of these particular papers, they reflect a growing awareness that "mandatory surgical presence" may not stand up to the evidence, or the economics, in the future.

Or maybe we'll just keep doing what we've always done, 'cuz that's the way we do it.😉

 

[Febrifuge]

At the place I used to work, the trauma pager goes off, and you get EM staff, EM residents, and EM support people, as well as RT and I think the Rad Techs have one.

When the patient arrives, we take a look at the patient, and the pit boss tells the ER tech when to page the trauma team, and with what priority. Sometimes, based on mechanism or info from an outside hospital, we'll page Surgery just before the patient rolls in.

It's a good system and seems to benefit everyone. Surgery doesn't have to drop what they're doing to come see someone with a negative FAST, good labs, and nothing wrong on x-ray. Meanwhile, they know that if we're paging them highest priority, we really really need them.

Traumas are cool and all, but I found that surgeons appreciate when you can let them do their surgical thing, and not make them come downstairs if they're not needed. They have plenty of business as it is.

Your mileage may vary of course, by institution and personalities.

 

[Bring It On]

The attending is over looking the following: someone covers head/airway; next peson assigned from neck to belly; next person pelvic to knees; next peson; below knees....one person stands at a board and documents what is being called out, ie. BP/RR/P/meds given, etc..no one else speaks excepts the attending at the head of the patient....prior to patient arriving lab/xray are waiting..if ortho is needed/paged stat/neuro needed paged stat/etc.this runs smooth as a baby's butt....very organized/quiet/no panic/no running around wasting time.🙂

 

[EM_Rebuilder]

The attending is over looking the following: someone covers head/airway; next peson assigned from neck to belly; next person pelvic to knees; next peson; below knees....one person stands at a board and documents what is being called out, ie. BP/RR/P/meds given, etc..no one else speaks excepts the attending at the head of the patient....prior to patient arriving lab/xray are waiting..if ortho is needed/paged stat/neuro needed paged stat/etc.this runs smooth as a baby's butt....very organized/quiet/no panic/no running around wasting time.🙂

If I was the guy that was always stuck at the feet... how do you ever get to be the attending shouting out commands if you never get to train in that spot?

I agree that residents often slow things down and make things slightly inefficient... however, I feel that is an opportunity cost that we as society need to probably take on...


Here, on activated trauams, its and odd/even thing as far as which sr resident gets to control things. However, what I have noted is that there is so much major medical or more minor trauma that rolls in, a resident gets more than a fair share of stuff. EM ALWAYS gets the airway (EM2s).

 

[Bring It On]

of course residents rotate....and chief gets to stand in at the attending's spot...always rotating....learning....really magic to see this work....so quiet and organized...it is almost surreal....but it works!