BusyLots of varietyChance to do ProceduresMix of didactics and practical experienceAmount of practical experience is up to youTrauma and General SurgeryTrauma bay, ICU, OR, floor, clinic

In your handbookGoals PGY level specificACGME competency specificKnowledge and skillsWHAT YOU LEARN WILL BE DETERMINED BY YOUR EFFORT!!!!!

You are never alone◦

Seniors◦

PA◦

Chiefs◦

Attendings

Read each day

AttendingPGY – 4 General Surgery residentPGY – 2 General Surgery residentInternsPhysician AssistantsPharmacyTrauma Nurse Clinicians

Students – Medical, PA, PharmacySocial ServicesNutrition

Get check out from night callSee all patientsComplete notes◦

Route trauma to service attending◦

Route gen surg to admitting/operating attending

Daily morning report: 8am trauma office◦

9:30 on Wed◦

Sat/Sun: ask attending

Update problem list/excel sheetCall consults before noonCheck out in pm with Chief and on call resident

Attended by allBring WHITE TRAUMA ACTIVITY BOOKDiscuss ◦

General Surgery Patients◦

New admissions and work ups◦

Post Call resident’s patients◦

Potential Discharge patients◦

Problems overnight◦

Complex ICU patients

Attend resuscitationDo proceduresGet results of filmsList ALL injuriesRoute History and Physical to ON SERVICE ATTENDING- unless otherwise requested (ie on call attending is there)17 and older adult trauma service16 and younger peds trauma, put on ped surg list

Tertiary exam: head to toe, image anything that hurtsCheck/decrease IVFDiet?Lovenox?GI proph?Final reads on filmsINCIDENTAL FINDINGS◦

Tell patient or family◦

Incidental form to Trauma office

Use incidental findings formInform patientAvoid shorthand, abbreviations, Jargon that may not be understood by the patientWrite legiblyGive to TRUDY in TRAUMA OFFICE

Call 75398, request bed, discuss case, patient handoffAll outside and ED lines changed in 24 hrUpdate problem listWound careTertiary examRefer to ICU admission criteria in Handbook

When SICU is full or if patient is less than 21, they may be assigned a PICU bed.If ED nurse or bed coordinator tells you this, do the following:◦

Notify chief◦

The most senior person who knows pt should call PICU attending, review case, and ask if they will accept◦

PICU will be the critical care team◦

Do handoff with PICU resident

Cervical Spine◦

No fractures, no tenderness, awake, full ROM◦

Must have completed a full month on trauma◦

Must be monitored by chief, PA or attending x3

Thoracic and lumbar spine◦

If NO FRACTURE on CT, Change to HOB up 30 degrees or activity order

Stay with that attendingYou are welcome in ORReview each day at morning reportCan use general surgery history and physical formBe sure chief knows of any problemsWe will be covering ED general surgery consults for half the days of the month, check the schedule

Pre-set criteria by facultyAppendicitis, Diverticulitis, Cholecystitis, Bowel obstructionYou should get called from the ED that patient meets criteriaPut in basic admit orders at that timeYou can see pt. On the floor or if you have time and can go to the ED right thenBE SURE YOU NOTIFIY CHIEF AND ATTENDING

Level of care-admissionRib fracture protocolGeriatric traumaLevel of care-admissionSpinal Cord pathwayLevel of care-admission

Reversal of pre-injury anti-coagulationAortic injuryPelvis fractureTBICriteria for ED dischargeLevel of care-admissionDC from ED

List all injuriesList consult service and attending:◦

i.e. Ortho spine: Dr. France

Ensure meds are correctEnsure appropriate follow up appointments-everyone is offered trauma follow upAdequate pain medsThink about lovenox/coumadinA DISCHARGE SUMMARY (see handbook template) IS REQUIRED FOR ALL DISCHARGE including deaths and ED

Every Tuesday: starts at 12:00Route to attending who sees pt with youNo elective cases during this timeClinic Notes done within 24 hoursIf seen by resident, Make dot BLUE.

Sign in on trauma nurse flow sheet◦

Name and time of arrival

Team Leader: Trauma ChiefIdentify all roles before pt arrivesBlood for all P1ABG for P1, VBG for P2Order sets: Part A- nursing, Part B- us: order fluids, CT, additional XraysClick: Notify attending

CXR, Pelvis- if blunt torso traumaIf Pelvic fracture→FOLEY!!!◦

If hematuria→GU work up (CT cysto usually)

Blunt Chest trauma: 12 lead EKG!!!FAST examHistory and PhysicalProcedure Notes: Bedside

Morning ReportTrauma Conference: Thurs 12 noonDepartmental Conferences◦

Surgery: Wed◦

ED: Thurs◦

Others: be sure staff know you are gone

SICU Conferences: Tues/Thurs 1:30◦

SICU Journal club and GR, M&M-

see calendar

All are welcomeChiefs: Discuss with Service attending◦

Faculty will cover P2 when you are in OR as often as possible◦

Your job to discuss/arrange ahead of time◦

Notify covering attending when starting and finishing◦

Clarify dictation responsibilities

Must be under 80 hours, 10 hour breaks, have 1 day off/7Schedule at the beginning of the monthLog hours!!!!!!Check out/ communicate

PGY- 1, 2, 4 -Turn in Trauma Op case log and Non-op trauma case log every Friday.PGY-2 - Turn in ICU management case log every Friday

Chiefs: You MUST turn in a copy of your logged Trauma Admits to Dr. Wilson each Friday

Transfer note required for all patients leaving the ICU to the SDU/floorCall on call intern to ensure they are aware of patient transfer.Update problem list◦

Merlin◦

Excel list

The M.E. must be called for ALL DEATHS of ALL THE PATIENTS ON THE TRAUMA SERIVCE.

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