Busy Lots of variety Chance to do Procedures Mix of didactics and practical experience Amount of practical experience is up to you Trauma and General

Transcription

1

2 Busy Lots of variety Chance to do Procedures Mix of didactics and practical experience Amount of practical experience is up to you Trauma and General Surgery Trauma bay, ICU, OR, floor, clinic

3 In your handbook Goals PGY level specific ACGME competency specific Knowledge and skills WHAT YOU LEARN WILL BE DETERMINED BY YOUR EFFORT!!!!! You are never alone Seniors PA Chiefs Attendings Read each day

4 Attending PGY 4 General Surgery resident PGY 2 General Surgery resident Interns Physician Assistants Pharmacy Trauma Nurse Clinicians Students Medical, PA, Pharmacy Social Services Nutrition

5 Get check out from night call See all patients Complete 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 sheet Call consults before noon Check out in pm with Chief and on call resident

6 Attended by all Bring WHITE TRAUMA ACTIVITY BOOK Discuss General Surgery Patients New admissions and work ups Post Call resident s patients Potential Discharge patients Problems overnight Complex ICU patients

7 Attend resuscitation Do procedures Get results of films List ALL injuries Route History and Physical to ON SERVICE ATTENDING- unless otherwise requested (ie on call attending is there) 17 and older adult trauma service 16 and younger peds trauma, put on ped surg list

8 Tertiary exam: head to toe, image anything that hurts Check/decrease IVF Diet? Lovenox? GI proph? Final reads on films INCIDENTAL FINDINGS Tell patient or family Incidental form to Trauma office

9 Use incidental findings form Inform patient Avoid shorthand, abbreviations, Jargon that may not be understood by the patient Write legibly Give to TRUDY in TRAUMA OFFICE

10 Call 75398, request bed, discuss case, patient handoff All outside and ED lines changed in 24 hr Update problem list Wound care Tertiary exam Refer to ICU admission criteria in Handbook

11 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

12 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

13 Stay with that attending You are welcome in OR Review each day at morning report Can use general surgery history and physical form Be sure chief knows of any problems We will be covering ED general surgery consults for half the days of the month, check the schedule

14 Pre-set criteria by faculty Appendicitis, Diverticulitis, Cholecystitis, Bowel obstruction You should get called from the ED that patient meets criteria Put in basic admit orders at that time You can see pt. On the floor or if you have time and can go to the ED right then BE SURE YOU NOTIFIY CHIEF AND ATTENDING

15 Level of careadmission Rib fracture protocol Geriatric trauma Level of careadmission Spinal Cord pathway Level of careadmission Reversal of preinjury anticoagulation Aortic injury Pelvis fracture TBI Criteria for ED discharge Level of careadmission DC from ED

16 List all injuries List consult service and attending: i.e. Ortho spine: Dr. France Ensure meds are correct Ensure appropriate follow up appointmentseveryone is offered trauma follow up Adequate pain meds Think about lovenox/coumadin A DISCHARGE SUMMARY (see handbook template) IS REQUIRED FOR ALL DISCHARGE including deaths and ED

17 Every Tuesday: starts at 12:00 Route to attending who sees pt with you No elective cases during this time Clinic Notes done within 24 hours If seen by resident, Make dot BLUE.

18 Sign in on trauma nurse flow sheet Name and time of arrival Team Leader: Trauma Chief Identify all roles before pt arrives Blood for all P1 ABG for P1, VBG for P2 Order sets: Part A- nursing, Part B- us: order fluids, CT, additional Xrays Click: Notify attending

19 CXR, Pelvis- if blunt torso trauma If Pelvic fracture FOLEY!!! If hematuria GU work up (CT cysto usually) Blunt Chest trauma: 12 lead EKG!!! FAST exam History and Physical Procedure Notes: Bedside

20 Morning Report Trauma Conference: Thurs 12 noon Departmental 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

21 All are welcome Chiefs: 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

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

23 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

24 Transfer note required for all patients leaving the ICU to the SDU/floor Call on call intern to ensure they are aware of patient transfer. Update problem list Merlin Excel list

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

26 Learn Read Work Have fun Great experience Save a life READ YOUR HANDBOOK