Trauma Shadowing

When I googled "trauma" this was the first image that came up. I'm pretty sure it's not real, but it is funny.

Last Friday night I was at the hospital from 7pm - 7am doing "trauma shadowing." The Emergency Medicine Interest Group arranged for two first year students to follow around the second year resident for a 12 hour night shift to start learning what trauma, surgery and emergency medicine are all about. We carried a beeper all night and in addition to going to see the post-surgical patients the resident was taking care of (to remove tubes, draw blood or prescribe pain killers), we met down in the trauma bay whenever someone was on their way to the hospital in an ambulance.

First of all, it is really hard to stay up all night. Thankfully the "sleeping rooms" have very comfortable beds (but no pillows), personal bathrooms, and allow for naps between traumas.

Our first case was a "chest stabbing" that the other student and I decided to demote to a "chest poking." The man was "minding his own business" ("one of the most dangerous things to do in Baltimore," in the words of one of his nurses) and didn't know who or what stabbed him. After a chest x-ray and CT scan he got 3 staples to hold the wound together and was released.

The second case was a man who tried to commit suicide and had a very deep rope burn around his neck. He had a history of psychiatric disorders and came in to the emergency room on his own actually. A CT scan showed no soft tissue damage and the blood vessels in his neck were not torn. I believe he was taken to another area of the hospital after it was determined he would be ok.

Our final patient was brought in around 2:30am (the bars close at 2am) after he got in a bar fight. He was in rough shape and the attending physician wanted to get a CT scan to make sure he didn't have any head or brain injuries. Unfortunately, an hour later the we still had no scan to look at because the man kept climbing out of the CT machine. He was NOT happy to be in the hospital (which he referred to as the bar several times, while asking for his boys) and did not want an IV in his arm (which he ripped out twice).

Overall, it was interesting to see the approach to taking care of a patient with possible trauma. Lots of people were completing many tasks - and I was able to identify who was doing what and why they were doing it. Getting a history, age, drug and alcohol use, and allergies. Hooking up the finger pulse oximeter and blood pressure cuff to monitor vital signs. Understanding when to get a chest x-ray and CT scan. Then as the situation gets under control, people start to thin out and the patient is given the care and support necessary for his specific situation. Which makes sense :)