Trauma Surgery

[YellowJacket!]

Well, the rotation I feared the most has started - Trauma Surgery.

I have been working 16 hour night shifts at the University of Tennessee Medical Center, a level I trauma center and regional "magnet" hospital.  Its been very exciting and as a PA student, I thought I would not get to do much but I was wrong.  I have been doing almost everything a regular trauma surg resident does.  Apparently I've done pretty well becasue the attendings and residents have been letting me do a lot on my own, but with their supervision.

Being at a level I center, I see everything and unfortunately, a lot of that is motorcycle wrecks, MCC for short.  Since I am at a magnet center, we receive the worst of the worst from a large radius.  One of my patients was stopped at a traffic light and hit from behind by a pickup truck that never stepped on its brakes.  The MC rider and his bike were driven under the SUV in front of him and he was crushed.  He suffered severe head trauma in spite of having a full helmet on which was crushed.

Last night I took care of a guy that was on a 1-off custom bike built by some well known TV celebs.  It was a single vehicle wreck and his bike was totaled.  He told me that he paid over $150k for the bike and the wheels alone were $15k each.  I told him I only paid a dollar for my bike.  He laughed a little but he had three fractured ribs...  Fortunately for him, his pride and pocketbook were hurt more than his body.

I have also worked several stabbings and GSW's and was asked by the cheif trauma surgeon to "scrub in" and first assist on a man who was stabbed in the abdomen.  There were three other residents on the service that night that could have been asked but he picked me which was awesome.

It's emotionally draining and physically tiring but it has been the best experience I have had so far during school.... of which I have only 5 months left!

More to come....

David

[Rikugun]

Yikes, the next time you decide to write about MCC's give a spoiler alert up front so I can avoid it. That PU truck/SUV sandwich story was a serious bummer. I'm sorry you have to endure that as part of your job. That's enough to give one pause about riding.

[Re-Vision]

If I was needing help at something such as trauma surgery or motorcycle stuff, don't think I would hesitate to call on the fellow who built Yellowjacket. Know we miss hearing from you and hope you can find time to post more often.  Hope you never see any of us in an emergency room.   BDC

[Rick G]

I always keep an eye on the mirror when I'm stopped at a light or stop sign. I have left early to avoid being tail ended, of coarse you have to watch traffic from the left and right too!  I don't trust anyone in a cage.

[The Prophet of Doom]

$150K for one of those TV bikes that are built in how long? a week?  I'm in the wrong game.

[YellowJacket!]

Well, I finished a very successful trauma surgery rotation and got to see and do much much more than I ever expected.  Apparently I was pretty good at what I was able to do in the OR as many of the attendings picked me over a resident as their first assist.  It was a great feeling to have that happen and an experience I'll never forget.

On a more disturbing note, since the facility I was at (The University of Tennessee Regional Medical Center) is a "magnet center" for trauma, it receives the worst of the worst for the region within a 300 mile radius.  Unfortunately, I "worked" an awful lot of motorcycle wrecks which gave me pause to think about my future and riding a motorcycle.  Many of the cases I was involved in were "MCC vs MV" and in almost every case, the MV driver was responsible.  One in particular that was very difficult was a rider that was stopped at a traffic light behind a pickup truck.  He was struck from behind by a person who wasn't paying attention and hit him so hard that it forced him and his bike completely under the truck in front of him.  The driver panicked and reversed direction causing the truck to come down completely on the biker.

He was wearing full gear and a good helmet but was literally shredded and just about every bone in his body was broken.   We worked furiously on him in the trauma bay and then the OR and pumped 42 units of blood in addition to the 3L of "cell saver" recovered blood but could never get his pressure up.  In addition to the severe damage to almost every internal organ he suffered a very acute traumatic brain injury which the neurosurgeon felt was not survivable.

Finally at the request of his family 3 days after the collision, he was removed from life support and died.  The teenager who hit him, who was also very severely injured, was charged with vehicular homicide as they were intoxicated AND texting while driving.  Great, just great.

I also got to work several cases involving "The Dragon", one of which a 400lb female rider lost control of her scooter (yep, scooter) and went over the embankment at mile #6 and down 250 feet.  According to EMS, it was a memorable extraction.  She survived, but I got to put in  a chest tube to reinflate her lung as a result of numerous rib fractures.

Another, and thanks to the biker for the humor... was a guy that "wanted to become one with the road" and decided to take on a sweeping turn that was beyond his skill level and way beond the ability of his shorts, t-shirt and flip flops to protect the thin layer of shin that was on his body.  Probably the worst case of road rash I've ever seen and I spent several hours debreiding and cleaning his wounds.

Above and beyond the number of any cases though were the ATV wrecks.  We would get 2 to 3 a day, and they were usually very serious.  Several broken necks and severe brain injuries.  One couple was out riding and the boyfriend had the dog on the ATV's tank.  He got spooked and the guy lost control and went over a cliff.  His girlfriend was blindly following him and unknowingly drove right over after him.  The dog survived without injury.  A surgeon described it as "they went over the cliff like a herd of lemmings"....

So, that and much more prepared me very well for my next rotation.... Family Practice, which I feel will not be as exciting.

David

[vadasz1]

So you think family practice will be boring.  Then I hope that you get a kid with a marble stuck up his nose like in the movie ONE FINE DAY.   ;)

[admin]

David, you're a better man than I.

those are some crazy stories. both disturbing and crazy.
how do you do it ? I would be cowering in the corner for sure.
small cuts and bruises are no big deal for me but wow, I can't begin to express my appreciation
for the kinds of things you guys have to deal with. Amen.


-Ron

Well, I finished a very successful trauma surgery rotation and got to see and do much much more than I ever expected.  Apparently I was pretty good at what I was able to do in the OR as many of the attendings picked me over a resident as their first assist.  It was a great feeling to have that happen and an experience I'll never forget.

On a more disturbing note, since the facility I was at (The University of Tennessee Regional Medical Center) is a "magnet center" for trauma, it receives the worst of the worst for the region within a 300 mile radius.  Unfortunately, I "worked" an awful lot of motorcycle wrecks which gave me pause to think about my future and riding a motorcycle.  Many of the cases I was involved in were "MCC vs MV" and in almost every case, the MV driver was responsible.  One in particular that was very difficult was a rider that was stopped at a traffic light behind a pickup truck.  He was struck from behind by a person who wasn't paying attention and hit him so hard that it forced him and his bike completely under the truck in front of him.  The driver panicked and reversed direction causing the truck to come down completely on the biker.

He was wearing full gear and a good helmet but was literally shredded and just about every bone in his body was broken.   We worked furiously on him in the trauma bay and then the OR and pumped 42 units of blood in addition to the 3L of "cell saver" recovered blood but could never get his pressure up.  In addition to the severe damage to almost every internal organ he suffered a very acute traumatic brain injury which the neurosurgeon felt was not survivable.

Finally at the request of his family 3 days after the collision, he was removed from life support and died.  The teenager who hit him, who was also very severely injured, was charged with vehicular homicide as they were intoxicated AND texting while driving.  Great, just great.

I also got to work several cases involving "The Dragon", one of which a 400lb female rider lost control of her scooter (yep, scooter) and went over the embankment at mile #6 and down 250 feet.  According to EMS, it was a memorable extraction.  She survived, but I got to put in  a chest tube to reinflate her lung as a result of numerous rib fractures.

Another, and thanks to the biker for the humor... was a guy that "wanted to become one with the road" and decided to take on a sweeping turn that was beyond his skill level and way beond the ability of his shorts, t-shirt and flip flops to protect the thin layer of shin that was on his body.  Probably the worst case of road rash I've ever seen and I spent several hours debreiding and cleaning his wounds.

Above and beyond the number of any cases though were the ATV wrecks.  We would get 2 to 3 a day, and they were usually very serious.  Several broken necks and severe brain injuries.  One couple was out riding and the boyfriend had the dog on the ATV's tank.  He got spooked and the guy lost control and went over a cliff.  His girlfriend was blindly following him and unknowingly drove right over after him.  The dog survived without injury.  A surgeon described it as "they went over the cliff like a herd of lemmings"....

So, that and much more prepared me very well for my next rotation.... Family Practice, which I feel will not be as exciting.

David

[Rick G]

The Pastor of a local Lutheran church was walking his dog one morning,a year ago, when a 16 year old girl in a Ford Exploder, ran over top of him killing him instantly. She was texting at the time . The judge arranged it so that she will not get a licence , until shes 25 and will be on probation for 10 additional years.  Life is dangerous , no one gets out alive. Enjoy it while your here!
My uncle got me good , when I visited Montreal in 1964, He had Ostomylitis and had a large hole in his leg . He dropped his pants and showed it to me and I nearly fainted!
30 years later on my last trip to Canada, he had had his leg amputated . He asked me to help him undress for bed and lift him in. In doing so I didn't lift him quite high enough and his "under carrage " dragged and he sat on them. I think he was disappointed that his stump didn't bother me , But a lot of water had gone under the bridge in those 30 years and I was not bothered by the sight at all. he was being a bit of a rascal , when he asked me to lift him into bed , thinking I would  pass out.  I still get a kick out of the look on his face  when i put him into the bed ! ;D ;D

[Rikugun]

David, you're a better man than I.

those are some crazy stories. both disturbing and crazy.
how do you do it ? I would be cowering in the corner for sure.
small cuts and bruises are no big deal for me but wow, I can't begin to express my appreciation
for the kinds of things you guys have to deal with. Amen.

Couldn't agree more. The rest of us would be in trouble if it weren't for the Yellowjackets of the world.  ;D

[fret not]

David, congratulations on your progress.  You might not save the world but for each person you treat you definitely will make a big difference to them.  You da Man! ;)

[Drikk14]

 I agree I couldn't do this myself and am glad people are out there that can. Hope your time as a Family Practitioner goes smoother.