1 UW OSSMIG Harborview Trauma Call Guide Ortho Trauma Call Guide 201… · UW OSSMIG Harborview...
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CMP 12/2015 1 UW OSSMIG Harborview Trauma Call Guide Spending a night helping the Orthopaedic Surgery service evaluate, mange and treat patients with injuries in the ED is great chance to get to know the residents, gain real world experience with Orthopaedics, learn musculoskeletal medicine and get involved outside the classroom. Ortho Call at HMC can be very busy with the shear volume of patients that the residents see as the consult resident. Most of these consults require a reduction of a fracture or relocation of a joint, and then splinting and/or pinning to stabilize the limb. Each consult can thus be very labor intensive. In the first half of the year, 4th year medical students come from all over the country to do sub-internships at HMC and help out the person on call to see if this is the kind of program for them. The second half of the year we don't usually have anyone to help us out. This is where you as UW medical students come in. This guide will help you once you’re in the thick of things. Here we attempt to break it down, highlight key things, answer frequently asked questions and help making this whole process bit easier for you. GENERAL INFO • Carry note cards & take notes on important info/pearls/questions/patient/operations • Be prepared to work hard! o It’s guaranteed to be a busy but fun night. Many say it is the most rewarding thing they've done in their preclinical years. • Be enthusiastic with a good attitude. Be yourself as much as possible. • Take as much call as you are comfortable with. o You can come late or leave early. This is for your learning. • Know your anatomy and physical exam. • Constantly Anticipate o “What can I do to make the team more efficient.” § E.g. have tape and dressings ready before the asked § Know which forms to always have on hand • Rotations are a blend of service and education. o Service = being a team player, working hard, etc o Education = learning from residents, patients • Don’t try and show up fellow medical students. Don’t try to show up residents. o That being said, ask question when you have them and answer them when asked • Be nice to ancillary personnel. They know a lot and have been around longer. CALL SIGN UP & SCHEDULING Student scheduling is coordinated via an established Calendar on the OSSMIG Website: http://www.orthop.washington.edu/?q=ossmig/harborview-trauma-call.html Please be considerate to your fellow students and sign up for a maximum of 2 days at one time (this means you can only have 2 future dates at one time). Do not sign up for 2 consecutive days or 2 consecutive weeks on the same day (ie. 2 consecutive Fridays). For 2016, two students can be registered to take call for a given day.
Transcript of 1 UW OSSMIG Harborview Trauma Call Guide Ortho Trauma Call Guide 201… · UW OSSMIG Harborview...
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UWOSSMIGHarborviewTraumaCallGuideSpendinganighthelpingtheOrthopaedicSurgeryserviceevaluate,mangeandtreatpatientswithinjuriesintheEDisgreatchancetogettoknowtheresidents,gainrealworldexperiencewithOrthopaedics,learnmusculoskeletalmedicineandgetinvolvedoutsidetheclassroom.OrthoCallatHMCcanbeverybusywiththeshearvolumeofpatientsthattheresidentsseeastheconsultresident.Mostoftheseconsultsrequireareductionofafractureorrelocationofajoint,andthensplintingand/orpinningtostabilizethelimb.Eachconsultcanthusbeverylaborintensive.Inthefirsthalfoftheyear,4thyearmedicalstudentscomefromalloverthecountrytodosub-internshipsatHMCandhelpoutthepersononcalltoseeifthisisthekindofprogramforthem.Thesecondhalfoftheyearwedon'tusuallyhaveanyonetohelpusout.ThisiswhereyouasUWmedicalstudentscomein.Thisguidewillhelpyouonceyou’reinthethickofthings.Hereweattempttobreakitdown,highlightkeythings,answerfrequentlyaskedquestionsandhelpmakingthiswholeprocessbiteasierforyou.GENERALINFO
• Carrynotecards&takenotesonimportantinfo/pearls/questions/patient/operations• Bepreparedtoworkhard!
o It’sguaranteedtobeabusybutfunnight.Manysayitisthemostrewardingthingthey'vedoneintheirpreclinicalyears.
• Beenthusiasticwithagoodattitude.Beyourselfasmuchaspossible.• Takeasmuchcallasyouarecomfortablewith.
o Youcancomelateorleaveearly.Thisisforyourlearning.• Knowyouranatomyandphysicalexam.• ConstantlyAnticipate
o “WhatcanIdotomaketheteammoreefficient.”§ E.g.havetapeanddressingsreadybeforetheasked§ Knowwhichformstoalwayshaveonhand
• Rotationsareablendofserviceandeducation.o Service=beingateamplayer,workinghard,etco Education=learningfromresidents,patients
• Don’ttryandshowupfellowmedicalstudents.Don’ttrytoshowupresidents.o Thatbeingsaid,askquestionwhenyouhavethemandanswerthemwhenasked
• Benicetoancillarypersonnel.Theyknowalotandhavebeenaroundlonger.CALLSIGNUP&SCHEDULINGStudentschedulingiscoordinatedviaanestablishedCalendarontheOSSMIGWebsite:http://www.orthop.washington.edu/?q=ossmig/harborview-trauma-call.html
Pleasebeconsideratetoyourfellowstudentsandsignupforamaximumof2daysatonetime(thismeansyoucanonlyhave2futuredatesatonetime).Donotsignupfor2consecutivedaysor2consecutiveweeksonthesameday(ie.2consecutiveFridays).For2016,twostudentscanberegisteredtotakecallforagivenday.
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2 Ifyoucannotmakeyourdateanylonger,pleaseemailthelistserv([email protected])atleast1weekpriortoyourscheduleddate/timetoletothersknowofthatavailabilityandremoveyournamefromthecalendar!RememberthatResidentsarecountingontheassistancemedicalstudentsprovide,itisimperativethatyouhonoryourcommitments.Tosignup:1)Loginat:https://depts.washington.edu/orthodev/drupal/?q=ossmig/ossmig-htc-calendar.html
username:htc(alllowercase) password:htc@00SMIG(thosearezeros)
Afteryou'reloggedinToaddadate:
1) Clickonthe"Add+"linkatthetopofthecalendar.2) Enteryournameandclassandthedateyou'resigningupfor.3) Click"Save".Yournameshouldappearinthecalendaronyourscheduleddate.Donotchangeany
oftheothersettings.
Toeditordeleteadate:1) Clickontheeventtitlelink(shouldbeyourname).2) Thiswillopenanewwindow.Clickonthe"more"link.3) Clickthe"Edit"tab.4) Todelete,click"Edit",then"Delete".Itwillaskifyouaresureyouwanttodelete.Click"Delete"
again.Ifyouhaveproblemslogginginoraddingadate:Fortechnicalsupport,pleasecontacttheWebmasteratosmweb@uw.edu.BASICSEQUENCEOFEVENTSHowdoIpreparethedaybefore?Eatwellandgetplentyofsleepthenightbefore.Residentsreallyappreciateitifthemedicalstudentsplannedtotake12(weekday)or24hour(weekend)shifts.Thisallowsthemtospendmoretimeteachinginsteadoforienting,andshouldprovidethebestexperienceforeveryone.Anotherkeypieceofadvicetomakeitthroughalongeveningistostayhydrated.It'seasytoforgettodrinkwhenthere'salotgoingon,butit'saloteasiertostayawakeandfunctionalwhenyou'rehydrated.WhatshouldIreadaboutbeforehand?Themostcommonconsultsareanklefracturesandboxer's/distalradiusfractures.Prioritizereadingaboutthemechanism,presentation,diagnosis,andtreatmentofthesemostcommonfracturesaheadoftimesoyouwillhaveageneralideawhatisgoingon.Therealityisyoumayseejustaboutanything,fromfemurandtibiafracturestopelvicandacetabularinjuries,tospineinjuries.Youwillbeabletopickupinformationregardingtheseconditionsonthefly.Feelfreetoaskquestionsandpursuesuggestedreadingarticles.Ifthere'ssomethingthattheResidentmaynotknowaswellastheywouldlike,sometimesthemosthelpfulthingisforyoutoassistinlookingitup.
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3 WheredoIgowhenIarrive?WhenyouarriveatHarborview,thebestplacetoenteristheEmergencyDepartment.Youcanheadtothefrontdesk,andaskthemtousethephonetopagetheOrthoresidentoncall,orpagetheresidentfromyourcellphone(instructionsinthenextsection).Ultimately,theresidentwilltellyouwheretogo(The“On-Call”roomor“FishBowl”)afteryouhavegottenincontactwiththem.WhenshouldIarriveandwhatshouldIdowhenIgetthere?Onweekdaysyoushouldplanonshowingupbetween6and7pm.Onweekendspleasearrivearound6:45am(NOlaterthan6:55am),assign-outoccursat7am.Sign-outcanbeanexcellentlearningexperience,asResidentswillgoovercasesinthemorningthatwillbehandedofftotheoncomingteam.ThesediscussionsoftenrevolvearoundERworkup,management,andindicationsforsurgery,etc.TopagetheOrthoresident,dial4-3000(or744-3000fromanoutsideline)andasktheoperatortopagetheorthopedicconsultresidenttowhatevernumberyouareat.TellthemyouareaUWmedicalstudentwhoissigneduptofollowthemaround.Whoeverisoncallcandirectyouandgiveyouaquickorientation.Ifitisbusy,theymayhavetheinterndothosethings.Ifyouwanttomakeyourliveseasier,pickupscrubsanddropyourstuffoffinthesixthfloorOrthoResidentroombeforehand(see“GoodPlacestoKnow”sectionfordirections).WhataretheexpectationsandwhatwillIbedoing?Residentsreallyneedyourhelp.Sometimesthatmeanshavingyouscribewhiletheyperformahistoryandphysicalexam,andsometimesthatwillmeanhelpingholdalegand/orgettingsplint/localanestheticmaterialready.Anythingthatyoucandotoexpeditetheteamsabilitytoseepatientsmakesyouinvaluable.Justbeawarethatdifferentresidentswillhavedifferentcomfortlevelswithhavingyoudothings.Themoreyouworkwithusandthemoreyouseemtoknow,however,thenthemorecomfortabletheywillfeelgivingyousomelevelofresponsibility/autonomy.IMPORTANTRESOURCES
• HandbookofFractures(Koval)o “Thebook”fororthopedictrauma.Greatprepforfractureconference.
• Netter’sOrthopaedicAnatomyo Greatresourcetobrushuponyouranatomy.
• Hoppenfeld’sSurgicalExposureinOrthopaedicso AmustforORpreparation.Programshouldhavesomelayingaround
• Miller’sReviewofOrthopaedicso Goodoverview.Probablyabittoomuchforbutcouldbehelpful
• JAAOS“YellowJournal”Articles• OtherResources:
o WheelessOnlineOrtho–http://www.wheelessonline.com/o Yoursmartphone-Goodorthoapps&easytosearchforquestions.
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4 GOODPLACESTOKNOWATHMC
• HarborviewOrthopedicsResidentRoomo CentralHospital,6thflooro Code:198419
• OrthopedicsLibraryo Easthospital6thfloor,downcentralhallonright.Roomxxx
§ Meetherebeforeroundsandforsignout§ Code:1234
• HarborviewEmergencyRoomo Easthospital,1stfloor
• Cafeteriao Easthospital,Basement
§ Bestiftakecentralelevators(backofER)downtoB.TheORwillbeoneway,thecafeteriatheother.
• OperatingRoomso Easthospital,Basement
§ Bestiftakecentralelevators(backofER)downtoB.TheORwillbeoneway,thecafeteriatheother.
§ LockerRooms-Ask.Theyaregenderspecific.• ScrubSupply
o Canborrowfromlockerrooms(1WnearERforwomen,orGfloorbelowERformen).Alsoeasilylocatedon9Einunlockedsupplycloset.
EMERGENCYROOMDETAILSWhat is the Harborview ER like? HarborviewERislikenootheremergencyroom.YoucanseemorehereinanightthanmanyotherERsseeinamonth.TheERisbuiltinsections(Medicine[blue],Triage[green],andTrauma).Radiologyisinthemiddleofitall.YouwillspendmostofyourtimeontheTraumaSideoftheER.ThetraumasideismadeupofRooms:Med(bed1&2),Resus1(beds1&2),Resus2(beds1-4)&Resus3(beds1-4).Thereisafrontdeskwherelabsaresent.Theycananswermostofyourquestions.The‘fishbowl’istheworkareawheretheERresidents,attendings,andmedstudentswork.TheOrthoconsultandSurgeryconsultalsohaveastationhere.WhatformsandprocessesshouldIhaveknowledgeof?Aftertransitioningtoanall-electronichealthrecordsystem,Harborviewhasdoneawaywithmost,butnotallforms.YouwillbeallowedtoseeandassesspatientswhoneedanOrthoconsult.Residentswilllikelyinitiallyassignyoupatients,butasyougainexperienceyoumaybeinvitedtopreemptivelygoseepatientsandstarttheworkupandassessment.Withthatsaid,youwillinteractwiththefollowing:
• AllpatientsneedanOrthoH&Psheet–fillingtheseoutreallyhelpstheResidents.Theyaremadeupofthefollowing:
o GeneralOrthoConsultSheet–usedformosttraumas
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5 o SpineConsultSheet–usedforspinepatients
§ Spinecallissharedwithneurosurgery&thusOrthowillnotalwaysbeconsultedo HandConsultSheet–usedforhandpatientso ConsentForms
§ Neededfortractionpinandforthosewhowillgotosurgery§ Listallpossibleprocedures(noabbreviations).§ Listallpossiblesurgeons§ Mustbesignedandconsentedbyresident
• WhenthereisabreakandtheResidentisrunningtheirlistofConsults.SeeiftheyneedhelpaddingtheconsultstoCORES.
o Youwillbeshownhowtodoitthe1sttime.InORCAgotoCORES,findthelistfortheteamthatisonthatnight(Red,Blue,Green),orSpine,Hand,etc.Addpatientfrommenu,addfromEDcensusandmake1’or2’dependingontheconsultandadmittingteam.
WhereisstufflocatedandhowdoIgetit?CollectingandpreparingresourcesforResidentswhenneededisaprimaryroleformedicalstudentsparticipatinginTraumaCall.Withexperience,youwillhopefullydeveloptheabilitytoanticipateneedbepreparedbeforecalledupon.Alwayshavethefollowinginyourpockets:
Ø GlovesØ ShearsØ PaperTapeØ LidocaineØ X-Ray,H&P&ConsentFormsØ Notebook/Notecardstowritedowninfo/questions
Necessaryresourcescanbefoundinthefollowingsupplylocations:
• OrthoERSupplyRoom:Locatedatendofhallonleftbeforeelevators.Code:7-3-1-7-3-1o Splintingtubs:Volunteersshouldhaveplentymadeup.Very
helpfulifrunninglowandERislowtoanticipateandhelpprepareafewifyou’rebored.
§ Plaster• Youknowwhatthisis.Getwetandithardens.
Warmerwater=fasterhardening§ Webril
• Cushioning.Wraparoundextremitybeforeapplyingplaster.Extraaroundanybonyprominences
§ Bias• Tanwrapforwrappingsplintandmakingit
lookgoodandcomfortable.o OtherSupplies:Slings,Crutches,etc.CamBootslocated
underPTdesk.
• ERSupplyRoom#1:LocatedinthebackbetweenEDBlue&Green.o SuppliesnotlocatedinEDSupplyCartsorSupplyRoom#2o Mediporetape,crutches,etc…
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6 • ERSupplyRoom#2:LocatedinthebackcornernearradiologyMRI–1WH408.
o SuppliesnotlocatedinEDSupplyCartsorSupplyRoom#1o Nonstickdressing,kerlex,etc…
• ERSupplyCarts:LocatedaroundER&ateveryResusbaybed.
o Holdsmostcommonlyusedsupplies.Labelsondrawerso Needles,sterilegloves,waternozzles,suturingset,stapler,etc.
• Warmerator:LocatedinhallwaybetweenResus2&3.
o Warm1LSalinebottlesfoundhere.§ Willuseplentyforirrigatingwounds.§ Usenozzlesorpuncturemulti-holesintopwithan18gneedle.
• MedRoom:LocatedoncornerjustdownfromOrthoSupplyRoom.Codeiswrittenon
whiteboardcornerinsideo Stockuponlidocaineinyourpocketforusewithsuturingorpinplacement.o Food&drinkforpatientsalongbackofwall.
• UtilityRoom:LocatedoncorneracrossfromMedRoom.
o Placeusedtoolsandpinsetsinthebinsontheleft.o PlasterwatercanONLYbedumpedintothesinkinthisroom.
Othercommonlyusedsuppliesnotfoundintheabovelocationsare:
• SteinmannPinSet:o LocatedinResus2onbottomofbackLeftwallo Usedforplacingdistalfemoralorproximaltibialtractionpins
• Sutures:
o LocatedonshelvesabovesinksinResusroomso Alsoinsupplycartbackinhallnearsocialwork
• LargeClamps:
o LocatedonbackleftwallofResus2o Inbinonwall,commonlyhiddenunderSteinmannPinPetsinbino Usedforsheetingpelvis
• MiniC-Arm:
o Locatedinhallbacknearsocialworko Plugin,turnon(greenswitch),andlogin(password=x-ray).Fillinanythingforrequired
forandproceedtoperformevaluation.Seton‘continuous’.o Usedforassessmentandreductionoffractures.
• TractionCart:
o Locatedinhallbacknearsocialworko Usedtosetuptractionandhangweights
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• Stickers:o Locatedbyeachpatient,ondesk,orattachedtoclipboardo Alwayshaveafewextrainyourpockettouseo GiveonetotheResidentifyouarepresentingpatientyousaw.
§ Cutitdowntofitintheirlogsheetifyouwanttobequietlyhelpfulo PrintStickers–theymayrunoutofstickerswhenyouneedabunchtoorderX-Rays.Goto
thoseseatedatcomputersatthewallbehindthebackERdeskandaskthentoprintupstickersforthepatient.Grabsomeandreturnthemtothebedside.
• BoxSplints:
o LocatedintheOrthoSupplyRoom.o PriortoproceduresandbeforeX-Rayevaluationslikelyfracturedorknownfractured
extremitiesarealwaysplacedinaboxsplintoncethepatient’sprimarysurveyiscompletedbythetraumasurgeryEDteam.Helpbytakingdowntheclothingandremovingcurrentsplints/supportsandplacingthemintoboxsplints.
o Placetowelinthemforpatientcomforto Tapethemintoplace
HowcanIhelpprepareforcommonprocedures?ThisisanothergreatopportunitytoanticipateandhelpmaketheResidents’liveseasier.WhiletheResidentisbusyrunningaroundtakingcareofbusiness,alwaysaskyourselfifthereisapatientthatwillsoonneedareduction/splint/tractionpin/suturing.Ifso,looklikeanallstarandstartsettingupeverythingsotheResidentandyoucanjustjumpinandperformtheprocedurewheneveryoneisready.Regardlessoftheprocedurebeginbygettingconsentformsprepared,stickered,andworkonH&P.After,youcanbeginprocedurespecificpreparations:SuturingOrthoResidentsarenotcommonlyneededforthis.TheERresidenttakingprimarycareofthepatientcandothis,butifsplintingisdelayedthenwecommonlyhelpoutanddoit.Ifyouknowhowtodothis,youcanwithResidentpermission.Candothisyourselfafterthesmallwoundsareirrigated.Checkwiththeresident.Especiallylocatedwitharesplintwillsoonbeapplied.Need:
• Sutures,suturingset,gauze,etc.(Seeabovewherethisstuffis)o OverheadlightsareateachResusbed.Knobtoturnonishiddenonbackwall.
DistalFemoralTractionPinNeed:
• SteinmannPinSeto Setupsterilesetonstand
• SterileGloves(forresident&you)• 4x4tubwithbetadine• Lidocainedrawnupwith18g.Label&getnew22gneedle.• TractionCart
o Willneedtosetupatendofbedoncepinplaced.2vertical,onecrossbar,(+/-)extensionpiece,pully,weight(10-15lbs),rope
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• C-Arm(ifreductionneeded)• Tubwithwarmwater.Placeontowelstomakecleanupeasier• Shears• Mediporepapertape(4”usually,though2”forUEsometimes)• SplintingSupplies(differsdependingoninjury)
o TheTUBSforShortLegSplintsalreadymadeupinOrthoSupplyRoomo MakeownTUBoraddtothemdependingonwhatsplintyou’remakingo UpperExtremitySplints
§ 4”wideplasterused-cornersofplasterroundedorbendin§ ShortArmSplint
• 4”x15”plaster.7-8piecesthickx2(1anterior&1posterior)• 3”&4”webril• Bias&tape
§ LongArmSplint• Sameasshortarm+2more7-8thickplasterslabs(4slabstotal)• Extrawebril&bias
o LowerExtremitySplints§ 5”wideplasterused.30”and2extra15”orlongleg§ ShortLegSplint
• 4”x30”plaster.5piecethickslabsx2(sides)+10thick(posterior)• 4”&6”webril• 3layerdwebrilslabswithedgestorn• 6”Bias&tape
§ LongLegSplint• Sameasshortleg+2extra5”x15”5-8thickplasterslabs(sidesoflongleg)• Extrawebril&bias
HowcanIhelpafterprocedures?Splintingandpinningcangetmessy.Afteryoufinishitiseasytohelpcleanupthearea.Towelsandsheetsgointothewhitesquarelaundrybins.Bloodyandsoileditemsintothebiowasteredcontainers.Scrapsoftrashintothegarbagecans.Tractionpinsuppliesareplacedintheutilityroombins.Plasterwaterintotheutilityroomsink.TractioncartorC-armreturnedtothehallway.IsthereanythingelseIcando?BEHEALTHY-Getsomeexerciseortakeawalk.Usethestairswhengoingonlyafewfloorsinsteadoftheelevator.Mostimportantlystayhydratedwhenoncall.You’llbesurprisedhowyouforgettoeatanddrinkovernightwhenyouaresuperbusyintheER.Takeaquickbreakandgrabsomewaterthroughoutthenight.DuringabreakorwhenwaitingforapatienttogetX-Raystelltheresidentyou’reheadingdowntothecafeteriaandgrabaquickbite.
