Upon completion of the Trauma rotation, the neurosurgery resident shall be able to:
- Discuss the principles of ATLS, including primary survey, resuscitation, secondary survey and adjuncts/investigations.
- Identify the clinical setting in which airway obstruction is likely to occur, and recognize the symptoms and signs of airway obstruction when it does occur.
- Outline the various techniques to maintain an airway in a trauma patient, including endotracheal intubation and cricothyroidotomy, and have a working knowledge of when these techniques should be applied.
- Define shock and have a working classification of shock.
- Discuss the symptoms and signs in patients presenting with various etiologies of shock, including: hypovolemic, septic, cardiogenic and neurogenic.
- Outline the treatment of hemorrhagic shock, and list the clinical indicators of response to therapy.
- Outline the symptoms and signs, and initiate treatment for the following injuries: airway obstruction, pulmonary contusion, simple/tension/open pneumothorax, flail chest, simple/massive hemothorax, and cardiac tamponade.
- Recognize the signs suggestive of intraperitoneal, retroperitoneal and pelvic injury, including: guarding, rebound, flank hematoma, perineal hematoma, etc.
- Discuss the indications for and be able to interpret the results of DPL, ultrasound and trauma CT scans.
- Outline the principles of initial management of musculoskeletal trauma, including: immobilization, assess neurovascular integrity, etc.
- Outline the recommendations for tetanus prophylaxis in the trauma patient.
- Perform the following skills:
- Insert an oropharyngeal/nasopharyngeal airway.
- Perform a cricothyroidotomy, tracheal puncture and tracheostomy.
- Obtain vascular access, including peripheral venous access, central venous access (femoral, subclavian, internal jugular), and venous cut down.
- Develop rapport, trust, and ethical therapeutic relationships with patients and families, be able to review/update day to day care with patients.
- Conduct, document and present pertinent history and physical exam in context of trauma; with particular attention to conditions seen in context of head and spine injury.
- With appropriate supervision discuss relevant information with patients and family in a compassionate way and be able to obtain consent for common procedures.
- Share and present information with other health care providers, with attention to communicating information to when organizing diagnostic tests and procedures.
- Work/collaborate effectively in an interdisciplinary team, and coordinate patient care in a complex trauma patient which may include other services including orthopaedics, neurosurgery, ICU.
- Consult other services when appropriate in context of a complicated vascular patient with multiple medical comorbidities – nephrolology/internal medicine/endocrinology/ geriatrics/ICU
- Take part in all educational activities and teaching afforded by the service during the rotation.
- Be able to share workload and duties appropriately with other residents and medical students
- Be able to teach medical students, other residents and patients.
- Describe the surgeon’s roles and responsibilities to other professionals; Describe the elements of a good consultation
- Work with other health professionals effectively to prevent, negotiate, and resolve conflict
- Effectively utilize and allocate finite resources, prioritize tests and OR emergency cases.
- While on a busy surgical service manage own time, education and personal life for a balanced lifestyle.
- Work effectively and efficiently
- Triage patients being able to identify trauma emergencies that require prompt and immediate management such as airway control, circulation/management and control.
- Demonstrate an understanding of the influences that affect the workings of the health care system at various levels
- Participate in discharge planning of a complex surgical patient
- Recognize and council patients on determinants of health in patients, especially with respect to surgical risks such as smoking, DM and bmi.
- Contribute to overall patient well-being and outcome, though appropriate pre and post-operative care.
- Promote lifestyle which improves surgical risks and reduces accidental trauma.
- Facilitate return of patient to community/alternate care and help put care/support in place to reduce return to hospital for surgical care.
- Ensure consults and tests are done in an appropriate timely manner.
- Participate in rounds and educational activities provided by the trauma surgery service.
- Identify and seek out personal learning needs, especially with conditions relevant to also to neurosurgical patients such as head/spine injury, carotid injury, dvt prophylaxis in the contest of injury, electrolyte management – in the context of a multi trauma patient.
- Apply principles of critical appraisal to medical information.
- Participate in patient, student and peer learning
- Contribute to development of new knowledge and be involved in appropriate research projects as available.
- Demonstrate a commitment to their patients, profession, and society through ethical practice
- Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, respect and altruism
- Maintain appropriate relations with patients and other health care providers.
- Show appropriate respect for opinions of other health care providers
- Be able to appraise and identify own limits with respect to knowledge and patient care, and when to ask for assistance and consult effectively