Floor work

• Rounds are 6 AM outside of the ICU/D2 workroom
• Print the combined Gen surg + Trauma list, by gravity (make sure you have the Room/Bed column, not Bed, or else the ED patients will be scattered in random order)
• Notate which patients are on gen surg
• On weekdays you will round and manage gen surg patients only; the trauma NPs round separately with the chief
• Take the general surgery and trauma pagers in the AM; the NPs will take the 
• You do not round on/write notes on ICU patients
• If you admit a trauma early in the day, reasonable to sign them out to the NPs after orders done/imaging followed up on
• On weekends you round on gen surg + trauma (still no ICU) pts unless there is a trauma NP working (usually every other Saturday)

• 	M	T	W	Th	F
  Conference	7-8 AM: M&M 8-9 AM: Trauma Conference (in Alway M121 - across the way from where M&M is)	7-8 AM: Grand rounds	~ 8-1230: ED intern at teaching
  OR	OR?			OR?	Bronk OR

   

OR

• You usually do Friday cases with Bronk (open hernias, lumpectomies, etc).
• Can go to other cases if free...

Clinic

• You don't have to go to any clinic! Hooray!
• Sometimes you can go to procedure clinic (lipoma excisions, etc)

Discharges

• All traumas get referred to trauma/general surgery clinic for follow-up in ~ 2 weeks
• Uncomplicated lap appys, uncomplicated non-op SBOs, etc - don't need follow up unless there's an issue

Traumas

• You will have a personal trauma pager; you can either leave it on all the time and mute your SpokMobile when you're off, or ask the page operator to activate/deactivate it
• Pages are formatted: "TRAUMA ADULT xx: n-t ETA"
• xx = 95: don't need to go to these; ED takes care of it
• xx = 97: minor trauma
• T97/minor: The intern runs the minor traumas
• xx = 99: major trauma (hypotensive, airway compromise, GCS < 9, penetrating trauma)
• T99/major: Usually the R2 runs the majors but you will run it if they are not available
• n: # of patients arriving in this trauma
• t: minutes until arrival
• Notes:
• Trauma H&P - "H&P", .traumahp - this will autopopulate the survey findings that the nurse charts as you call them out - clutch! Just review it to make sure everything's right.
• Tertiaries - "Tertiary Survey", .tertiarynew - use this template. Make sure to fill out the CAGE (alcohol abuse) questionnaire
• Complete within 24 hrs of admission
• Helpful app - 'Trauma Guide', developed by former resident William Kethman
• When to get scans

• CXR
  Pelvic XR	Usually don't need if pt ambulated on scene
  CT Head (noncon)	If had LOC or GCS < 15, generally (see Canadian head CT rules)
  CT C spine	Can clinically clear if NONE of the following (Nexus criteria): Midline tenderness Intoxication Distracting injury Focal neuro deficit Altered mental status If CT C spine negative but still c/o neck pain, generally get MRI to rule out ligamentous injury
  CT T/L spine	Can clear if nontender and no concern for injury. If tender but scan is negative, can clear based on CT (unlike C spine)
  CTA chest
  CT A/P

• Consults

• Spine	Ortho vs Neuro	Isolated TP fx - prob don't need to call
  Ortho
  NSGY	Batphone -  6506835399	Brain bleeds

• Dispo
• ICU vs. floor vs. ED dispo (no injuries)
• ≥ 4 rib fx in pts < 45 yo, or ≥ 2 rib fx in pts > 65 yo -> ICU for pain control
• Isolated ortho/NSG injury - can generally transfer to their service after your tertiary is complete and negative

Phone numbers for trauma radiology:

• Pt station-go to MRN/or go to ED list-click on them (can save as favorite by right clicking)
• right click treatment team, type in trauma, add tt acute care surgery trauma as primary team, should show up on list after this
• for all trauma pts, write good summary line, injuries, write trauma note (co-sign by attending, can go to smartpage to find, search group name trauma and trauma attending on call admitting, shifts end at 4), follow-up on imging
• dotphrase for h&P is .traumahp, quick and dirty AMPLE (allergy, meds, PMH, last meal, event) GCS major injuries, etc
• after running trauma, in order of importance first write orders (nurses usually take care of this) call consults if emergent (ie epidural and NSG), follow-up on imaging, can go to reading room and stands over shoulder for "wet read"
• for all MVC: LOC, restrained, ambulate on scene
• after finishing primary and secnodary, sumarrize all info, tell evryone which studies youd like, ask of anyone else has anything theyd like to add
• copy 'jeg list' to change columns on top when printing list, click vascular surgery rounding report