It is January 10, 2011. Today I started a new rotation which I am fairly excited about, but it will be a difficult rotation. The rotation is trauma. Some people might ask; “isn't everything you do trauma?” and that's a good question. Trauma is its own sub-specialty within emergency medicine and within surgery. Many hospitals are Level 1 trauma centers. That means that they are equipped and have the personnel to handle any kind of trauma, the most severe trauma and there are trauma Level 2 centers which do not handle all of the major traumas, but can still handle fairly significant trauma and then it drops off from there to trauma Level 3, etc., on to minor. What is a Level 1 trauma center? Well, that means you have a trauma service that is there on call 24 hours a day, you have neurosurgery available 24 hours a day, and you have an emergency department with a trauma center and it can handle and treat blunt force trauma, penetrating trauma, gunshot wounds, fire burns, and the sickest of sick trauma patients. The Level 1 centers will also have a surgical ICU (SICU) where the patient can be treated and managed following the trauma and the surgery required to fix the trauma.
I am at a Level 1 trauma center in an urban setting. As you can imagine we get some very severe trauma cases on a daily basis. Today I started my rotation by showing up on the surgical floor at 4:30 in the morning to meet the trauma team and I was assigned four patients who were already admitted to manage. So in addition to that taking care of trauma patients who are recovering in the SICU, I also have the responsibilities is to respond to all the Code Greens in the hospital. Code Green is an announcement that there is a trauma case that is coming to the hospital or already at the hospital. “Attention, will the trauma team please report to the trauma bay” is the announcement made throughout the hospital. The announcement is heard by everyone through the overhead paging systems. Each of the members of the trauma team also receive a text page through their pagers. I will go along with the rest of the trauma team down to the emergency department to wait for a trauma that's coming in and help treat the patient once they do get there.
Today was a particularly busy day. We had I think eight Code Greens. Several were pedestrian versus automobile, so someone was hit by a car and you can imagine that the injuries are severe, the car always wins, and so it was an interesting day and plus I had a gunshot wound to the leg and someone who fell and fractured their skull. There's all kinds of trauma patients that come in. So once we go down to the emergency room and manage the patient. Basically that entails securing the airway, if they need intubation I'll intubate them, doing an ultrasound FAST exam to check for any internal bleeding. We fully inspect the patient, cut their clothes off and look for any wounds or deformed extremities or cuts, lacerations, and do a general assessment of what's wrong with the patient. Then do all the imaging, X‑rays, CT, whatever's required to look for any fractures, particularly spinal injuries, and then we also repair any lacerations. Then if the patient has the kind of wounds that would require immediate surgery they are whisked off to the operating room where whatever the necessary surgery is to be done. So they either go into surgery or if surgery's not required then they go to the trauma surgery service floor where we continue to manage them as a trauma team until they are better, go home, or transferred to another service for whatever reason. So right now we have 15‑plus patients on our service plus whatever comes in overnight tonight, so it's very busy and tomorrow I'm on call, so that will be a long day but certainly an interesting day. I'm sure I'll learn a lot. So I'll be on this service for the next month and I take call every third night so the hours will be extraordinarily long. It should be fun though and I imagine I will learn a lot and it is a good adrenalin rush to treat the trauma patient.