Friday, January 18, 2013

Shock Trauma, ETA 2 minutes

The Ambulance Bay. Photocredit: M. Ramirez

Welcome to January... And yes, I do realize it's half way through the month already.

This month I found myself back at the trauma center. My program is well known for its trauma -- it's one of the busiest Level 1 Trauma centers in the nation. Which means that it's always a full house, of patients and residents. As the second year I'm basically in charge of running the trauma assessment area. The CCA (or critical care assessment) is where I live every 3rd day for 24 hours -- this area is basically an ER room just for trauma; it's actually completely separated from the level 1 (or medicine) ER, which is located done the hall from us (and about 500 feet away from the ER ambulance bay, whereas they can just roll into "my" ER).

My job is to see, evaluate, and "dispo" all the patients that arrive by ambulance or through triage. And then help run the shock traumas that arrive, with the rest of team. Basically, the second year resident functions as an ER doc for traumatic chief complaints (i.e. "I fell off a ladder and now my ankle hurts" to the "Some dude just shot me in the leg, doc"). What's really good about this rotation is the amount of autonomy... I have a chief resident who is a phone call away should I need help or advice, and I run every patient by the attending (in person or on the phone) before sending them home or admitting them, but for the most part, it's a time for the second year resident to get a lot of experience triaging patients and honing their skills at assessment and treatment.

I was last in the CCA in July -- in fact, I was the resident who got lucky enough to be on call July 1st and 4th... For those of you familiar with the new ACGME duty hour rules, it means that July 1st, as a newly minted second year resident, it was the first day any of the kids in my class could take the 24 hour call. I was there for 7 weeks, and in those 7 weeks I saw and learned a lot.

July is busy, especially in the trauma center. There's a few reasons, but the main reason is that it's warm. And like I said when I lived in Detroit, "It's a lot easier to shot someone in the summer and get away on your bike, then in December, when there's snow on the ground." Down in the south, it may not snow, but people just don't go outside when it's cold. In July, during a 24 hour period, I would see and assess, work up, and dispo about 50 to 60 people. In January, it's about 30-40 people.

That being said, there's a certain air of electricity at any time of the year in the trauma center. You don't stop. Even if there's nothing to do, you find something that needs to be done (even if it means squeezing in a few extra minutes of studying).

Trauma is exciting -- you never know what's going to come through the door. There could be 1 person in the CCA one minute, and 2 minutes later there's 4 s/p MVAs (just had a car accident), a GSW to the LLE (gun shot wound to the leg), a person that has a pneumothorax in need of a chest tube (air outside their lung but inside the chest, causing collapse of the lung) and a shock trauma that's unstable arriving to the shock trauma room.  You are always on alert... it's what makes shows like, Trauma: Life in the ER, popular. Trauma is "sexy" to the general public. But not necessarily when you're the one living it -- then it's just exhausting.

That being said, it's not too bad... and can be a lot of fun.


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