We've covered so many services in our Top 10 series, and we're not through yet! Today, we're going to be talking about Trauma. Working in Trauma is exciting for some, and terrifying for others, and generally our trauma teams are there to take care of any trauma cases that come in. However, emergencies happen and accidents occur. You never know when you might find yourself thrown into a trauma situation. If so, here's a beginner list of things you need to know about trauma surgery.
10 Things to Know About Trauma Surgery
1. Always be ready
Traumatic accidents and injuries can happen 24 hours a day, 7 days a week, 365 days a year. They know no time or place , so surgical teams must be ready at all hours of the day to take care of these patients.
2. And be ready for anything
Trauma can occur to any area of the body. You have to be prepared for anything from Ortho to Maxillofacial, to Brain, and/or abdominal injuries. Trauma teams need to understand all surgical specialties to help these patients. Also, while some trauma teams may be designated for a specific specialty, like Ortho Trauma for example, that doesn't mean they won't ever see a different type of trauma, so preparation and readiness are key.
3. Know your massive transfusion protocol and blood product availability
Massive transfusion protocols (MTP) are a set number of red blood cells, platelets, and plasma that are ready to go and aren't type specific. You need to work with your blood bank to ensure MTP is ready to go when a trauma is activated and figure how much product is available in the hospital. Most trauma patients will require some type of blood product transfusion, either in surgery or afterwards.
4. You may have multiple specialties working at the same time
Sometimes patients come with multiple life-threatening traumatic injuries that require several surgical teams to work at once. You may have an ortho surgeon and neurosurgeon working at the same time, for example.
5. Trauma is a team approach
Multiple specialties working at the same time requires additional nursing staff to be available. You may need multiple circulators and scrubs. Anesthesia may need additional assistance. The scrub person might need someone who is available just to focus on items they may need. Taking notes for charting purposes later could be another person’s role. It’s all hands-on deck in trauma surgical cases.
6. Hospitals are typically designated as different level trauma centers
From Level 1 that has all surgical specialties available down to Level 4 with very limited surgical specialties available. But, just because you aren’t a Level 1 Trauma Center doesn't mean you'll never see a trauma patient. Critical patients are taken to the closest medical facility for stabilization before transfer to higher care hospitals. A mass causality incident will require all hospitals to take on patients. So, while you may not get trauma patients all the time, ORs must be ready to go when needed.
7. Support your anesthesia personnel
Anesthesia will need help managing a critical patient. The patient’s airway may be compromised making intubation difficult. Large amounts of blood products, fluids, and medications may need to be given. They will need help administrating these, and getting extra IVs and special lines placed to give it all. They may need to be drawing labs. It is beneficial in trauma if there is dedicated help for anesthesia.
8. Trauma can be major or minor
As you would guess, major trauma involves multiple injuries that are life or limb threatening whereas minor trauma, while traumatic, does not pose a threat to life.
9. The OR may take a field trip to the ER
If a trauma patient comes in who is very unstable and deteriorating, a life-saving procedure may have to be done in the ER to stabilize the patient before they are brought to the OR. It’s helpful if your OR has an emergency travel cart with specific instrumentation and supplies for situations such as these.
10. Be prepared for end of life and post-mortem care
While all efforts are always given in an emergency, sometimes injuries are just incompatible with life, and we lose a patient. Depending on circumstances, you may need to be a part of end of life and post-mortem care by preparing the patient to be presentable for the family. Chaplains are available to help and communicate with the family should this occur. Familiarize yourself with your facility's policies and expectations regarding end of life and post-mortem care as well so that you are prepared if you are called upon to provide this type of care.
The world of trauma surgery demands a level of readiness and adaptability that few other specialties require. Trauma teams find themselves in an environment where emergencies can strike at any time, and the unexpected becomes the norm. But as a team, they consistently work together to give each patient the best possibility of a successful outcome.
This list is only the beginning, and barely skims the surface of what trauma teams needs to know. But if you start here, you'll be able to build on this knowledge and better prepare yourself for any trauma case that may come your way.