Trauma Rotation

Upon completion of the Trauma rotation, the neurosurgery resident shall be able to:

  1. Discuss the principles of ATLS, including primary survey, resuscitation, secondary survey and adjuncts/investigations.
  2. 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.
  3. 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.
  4. Define shock and have a working classification of shock.
  5. Discuss the symptoms and signs in patients presenting with various etiologies of shock, including: hypovolemic, septic, cardiogenic and neurogenic.
  6. Outline the treatment of hemorrhagic shock, and list the clinical indicators of response to therapy.
  7. 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.
  8. Recognize the signs suggestive of intraperitoneal, retroperitoneal and pelvic injury, including: guarding, rebound, flank hematoma, perineal hematoma, etc.
  9. Discuss the indications for and be able to interpret the results of DPL, ultrasound and trauma CT scans.
  10. Outline the principles of initial management of musculoskeletal trauma, including: immobilization, assess neurovascular integrity, etc.
  11. Outline the recommendations for tetanus prophylaxis in the trauma patient.
  12. 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.
    • Thoracostomy

During the rotation, all residents should fulfill the Royal College’s CanMEDS Competencies.

COMMUNICATOR:

  1. Develop rapport, trust, and ethical therapeutic relationships with patients and families, be able to review/update day to day care with patients.
  2. 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.
  3. With appropriate supervision discuss relevant information with patients and family in a compassionate way and be able to obtain consent for common procedures.
  4. Share and present information with other health care providers, with attention to communicating information to when organizing diagnostic tests and procedures.

COLLABORATOR:

  1. 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.
  2. Consult other services when appropriate in context of a complicated vascular patient with multiple medical comorbidities – nephrolology/internal medicine/endocrinology/ geriatrics/ICU
  3. Take part in all educational activities and teaching afforded by the service during the rotation.
  4. Be able to share workload and duties appropriately with other residents and medical students
  5. Be able to teach medical students, other residents and patients.
  6. Describe the surgeon’s roles and responsibilities to other professionals; Describe the elements of a good consultation
  7. Work with other health professionals effectively to prevent, negotiate, and resolve conflict

MANAGER:

  1. Effectively utilize and allocate finite resources, prioritize tests and OR emergency cases.
  2. While on a busy surgical service manage own time, education and personal life for a balanced lifestyle.
  3. Work effectively and efficiently
  4. Triage patients being able to identify trauma emergencies that require prompt and immediate management such as airway control, circulation/management and control.
  5. Demonstrate an understanding of the influences that affect the workings of the health care system at various levels
  6. Participate in discharge planning of a complex surgical patient

HEALTH ADVOCATE:

  1. Recognize and council patients on determinants of health in patients, especially with respect to surgical risks such as smoking, DM and bmi.
  2. Contribute to overall patient well-being and outcome, though appropriate pre and post-operative care.
  3. Promote lifestyle which improves surgical risks and reduces accidental trauma.
  4. Facilitate return of patient to community/alternate care and help put care/support in place to reduce return to hospital for surgical care.
  5. Ensure consults and tests are done in an appropriate timely manner.

SCHOLAR:

  1. Participate in rounds and educational activities provided by the trauma surgery service.
  2. 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.
  3. Apply principles of critical appraisal to medical information.
  4. Participate in patient, student and peer learning
  5. Contribute to development of new knowledge and be involved in appropriate research projects as available.

PROFESSIONAL:

  1. Demonstrate a commitment to their patients, profession, and society through ethical practice
  2. Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, respect and altruism
  3. Maintain appropriate relations with patients and other health care providers.
  4. Show appropriate respect for opinions of other health care providers
  5. Be able to appraise and identify own limits with respect to knowledge and patient care, and when to ask for assistance and consult effectively