ROTATION DETAILS PGY-2 

Emergency Medicine Emergency Medical Service PICU Community ED Rotation Trauma

 

 Trauma

 

OBJECTIVES

1.      To learn ATLS protocols and practice them (Practice-based learning and improvement, medical knowledge, patient care).

2.      To learn the evaluation, diagnostic and treatment modalities of the critically ill trauma patient with blunt and penetrating injuries (Practice-based learning, patient care).

3.      To understand airway management techniques in the traumatically ill (Practice-based learning, patient care).

4.      To understand the diagnosis management of increased intracranial pressure (Medical knowledge, patient care).

5.      To understand the causes of life-threatening occult problems that can occur (Practice-based learning, patient care).

6.      To understand the diagnostic benefits of Ultrasonography in trauma (Practice-based learning, patient care, system-based practice).

7.      To know when arteriography is indicated (Patient care, practice-based learning).

8.      To know when emergent open thoracotomy is indicated and to learn the basic components of performing this procedure (Practice-based learning, patient care).

9.      To perform procedures such as central line placement, tube thoracostomy and tracheostomy (Practice-based learning, patient care).

10.  To manage the critical care needs of trauma patients after admission (Practice-based learning). The resident will help coordinate total care of the trauma patient. Familiarity with the entities below is expected of the resident: prehospital trauma care; triage; initial resuscitation/stabilization; gunshot wounds/ballistics; skull fractures; intracranial hemorrhage/hematomas; penetrating cranial trauma; spinal cord injuries; peripheral nerve injury; spine fractures; spine dislocations/subluxations; facial fractures; dental injury; ophthalmologic trauma; otologic trauma; anterior neck injuries (vascular, laryngotracheal, and esophageal); penetrating neck trauma; rib, sternal fractures; flail chest; aortic rupture; myocardial/pulmonary contusion; pericardial tamponade; vascular injuries; penumo/hemothorax; bronchial avulsions; penetrating chest trauma; solid/hollow viscus injury; diaphragmatic rupture; bladder rupture; renal injuries; urethral injury; penetrating abdominal trauma; extremity fracture or neurovascular injury; trauma in pregnancy; genital trauma; and burns (Medical knowledge, practice-based learning, System-based care).

11.  To understand how triage of trauma patients is done by EMS and within the institution (System-based practice).

12.  To learn how to deliver bad news to patients and families (Communication skills, practice-based learning).

13.  To understand the ethical/legal issues involved in Trauma cases (Professionalism, system-based care).

 

DESCRIPTION OF CLINICAL EXPERIENCE

·         Each resident will spend 6 weeks on the trauma service functioning as the junior resident of the trauma team. The resident will respond to all trauma consultations and resuscitations when on call (no more than every third twenty-four hour period) under the auspices of a PGY-4 or PGY-5 surgical resident, an Emergency Medicine Attending Physician and ultimately the Trauma faculty. The resident will be able to go to the OR and will have a broad procedural exposure.

 

DESCRIPTION OF DIDACTIC EXPERIENCE

·         All major trauma resuscitations are filmed. These films are reviewed weekly at the noon combined Trauma-Emergency Medicine Conference. Trauma has morning report seven days a week.

 

EVALUATION PROCESS

·         Written feedback from the Trauma faculty with input from the Trauma team’s Chief Resident.

 

FEEDBACK MECHANISM

·         Direct feedback from residents, EM faculty and Trauma faculty at the bedside, feedback on performance during trauma conference, written, formatted rotation evaluations.

 

This rotation has been agreed to and approved by the Chief of the Trauma Service. Resident are given copies of all rotation summaries at the beginning of their PGY-1 year. Prior to taking Trauma, second year EM residents complete an Advanced Trauma Life Support Course (ATLS) with the second year surgical residents. All residents receive Vanderbilt's current trauma protocols just prior to their trauma rotation. Residents should use rotation summaries, formatted written rotation evaluations, and their performance on the In-service Examination to assess the rotation’s effectiveness.