I have left the wonderful world of small people for my rotation as chief resident on surgical critical care and trauma. This month so far, has been one of the most stressful because my patients have been very, very sick with loads of complicated problems.
I am responsible for taking care of patients in the Surgical Intensive Care Unit. I am also the “go-to” girl on the Code Team. I am the definitive person to get the patient tubed and the central line in place. It can make for a very hectic day sometimes.
I have done a couple of bedside trachs over the past month. Both went very well. My attending is scrubbed with me so I have felt very comfortable with these procedures. I am also in charge of the nutrition for my patients. This usually entails making nutritional calculations and adjusting up or down according to nitrogen balance and catabolic state.
My ABSITE exam is next Saturday so I am reading and studying in between my ICU chores. Since I study most of the year, I go into my review mode in the last week or so before the test. We have a pre-ABSITE party scheduled this and all of the surgical residents are off duty beginning at 1pm on Friday until 1pm on Saturday. After 1pm, I go on call for covering the ICU.
The worst part of this rotation is that I do very little operating. Since most of my trauma is blunt, I do loads of babysitting and do not spend much time in the OR. Babysitting males with the “Saturday-night syndrome” which is, inebriated, bellicose and grandiose is not much fun. They are usually between the ages of 25 and 35, single and drive into trees and poles. (Hmm, I wonder why the trees and poles jump out in front of them?)Alcohol use is very high in this city along with cigarette smoking. These folks burn up loads of healthcare dollars for something that is preventable. (What is it about not drinking and driving that you do not understand?)
Anyway, I have loads of interesting cases that I will write about later.
What city are you in?
Note the location under my avatar.
We have similiar problems but primarily with snowmobiles. Amazing what darkness, alcohol, trees, and a vehicle that can go 70 mph, but offers no protection, can do to a body. Throw in a little hypothermia from lying in the snow waiting for help for sometimes several hours.
I also wonder what possesses people to put a child or teen, who cannot legally drive, on a vehicle that can reach these speeds. I’m on trauma call this weekend, but thankfully the snow is melting to slush, so there shouldn’t be too much snowmobiling going on today-- and it’s spring break, so the kids are getting drunk elsewhere.
I am back to being Trauma chief again. So far, it has been fairly light duty as I discharged my last patient from the hospital on Thursday evening.
The Memorial Day holiday brought some trauma on Saturday before the Monday holiday because many folks started drinkning alcohol and driving early. By 1pm we were up to our neck in trauma alerts. Most of these folks turned out to be less seriously injured than first thought.
Again, I was able to discharge the last of my Memorial Day trauma patients to rehab and settle into the first week of June. I have no doubt that the numbers will start to climb as the weather get warmer.
Here in Cleveland, alcohol, guns, automobiles and motorcycles make for a lethal mix. We have a huge drinking and drugging population that will wind up in my trauma bay. We also have police, just as in most places, that are quick to shoot and ask questions later. The criminals are painting their handguns to look like toy guns so that the police end up shot in the face. I cannot fault them for defending themselves but the last facial gunshot woond that I took care of was 10 hours worth of surgery.
I hated to leave my Vascular service but I will go through this one for a portion of the month. I am just not much of a Trauma surgeon as most trauma is blunt these days. If a surgeon does not operate, there is not much fun. Much of what I do as Trauma chief is disposition i.e. to rehab, to home etc.
Thanks for the updates, Natalie. I’m very interested in learning more about surgery, and in particular trauma. You’re not the first I’ve heard say that trauma surgery is changing - less surgery, and more rehab, occupational, etc. Would you be able to elaborate more on that, and what a “typical” (if such a thing exists) day for you would be like?
Thanks! I look forward to hearing you in DC
My typical day: If I am not on call, I get to the hosptal at 5:30AM. The first thing I do is get report from the overnight team as to whether they have admitted any patients to my service and what the status of those patients. In general,if a patient has been addmitted, I need to know the results of the primary and first secondary survey; what consultants have seen the patients (ortho, neurosurgery, ENT, Oral-maxillo facial, plastics) and when the repeat secondary survey needs to be done. If the patient is in the ICU, they are my reponsibility. If they are on the floor, the intern will follow up on all studie, and report to me. Together, we will set the plan for the patient, I will round with the intern and see the patient and then it will be up to the intern to get the plans carried out.
If the patient is in the ICU, I review all studies, speak with all consultants and plan the care myself. If there is surgery to be done,I will do it.
If there are no new patients, we do the same things for our established patients. Round, write notes, plan for discharge and studies, make sure plans are done. I then speak with my trauma attendings letting them know the status of their patients and the plans. I also work with the critical care attendings to make sure that the critical care patients are taken care of.
If I am on call, I cover the ICU and traumas only. If not, I leave the hospital after signing out at 5pm and finishing my duties. I do not sign out anything except to late lab checks or radiograph checks. If I am on call, I am the first to see all trauma patients or trauma consults (the patient fell and are not serious enough for a trauma alert). During the day, it is up to me or another senior resident to make sure that all trauma patients are taken care of during trauma alerts. This means evaluation and emergency treatment. The ED docs usually assist us but running the trauma belongs to us and the trauma surgeon.
Most trauma today is blunt or non-operative. The split at most places is about 80% blunt and 20% operative (could be ortho or neuro). In urban area, the percentage of penetrating trauma is a bit higher but not significantly so. If there is a burn unit, the burn surgeons take care of these patients during the day and trauma service during the night.
Except for the burns, trauma is not that much fun for me.