Trauma Surgery

[Guest Mimimowmow]

I heard about trauma surgery as a subspecialty after Gen Surg, but for all I tried, I couldn't find any information regarding to this sub-specialty in Royal College's website? Does Canadian system acutally offer a sub-specialty as trauma surger or it's only a US things...??? Any insight would be appreciated. Thanks.

[Guest dddd]

There are some fellowships in Trauma Surgery available after General Surgery and Ortho for sure, and maybe others. There are big differences between here and the US though.

 

As far as I know, in the US, there are many 2 year fellowships that combine trauma and critical care. After that, many people will be employed doing both trauma surgery and running the ICU. I presume these are all General Surgeons doing this.

 

In Canada, trauma and critical care have nothing to do with each other, and as far as I know there are no true combined programs like in the US. Critical care is 2 years, and many different specialists can enter the fellowship, such as Gen Surg, Internal Med, and Anesthesiology. It has nothing to do with surgery, and when finished you can run an ICU.

 

If you want to do trauma, you can do a fellowship of 1 year I think. But a lot of trauma surgeons in Canada don't have formal fellowship training, and instead they have just focussed on trauma during residency and practice. Some focus on trauma surgery without formal training, and also do a fellowship in critical care, allowing them to do both. It would be nice to see a combined program in Canada though.

 

This link has some links to training available.

 

www.trauma.org/resources/...ps.html#TC

[Guest UWOMED2005]

Yeah - almost all of the good trauma fellowships are in the US.

 

The problem with Canada for trauma (which is a great thing if you're not doing trauma) is that we don't shoot or stab each other enough to give adequate training in trauma at most Canadian centers. Even Toronto - the violent crime rate is still not comparable to US centers like baltimore, chicago and Atlanta (some of the best trauma programs, btw.)

[Guest Mimimowmow]

So....does the hospital usually call Gen Surg for most of the trauma cases? Or it is still case dependent with respect to severity and what is involved?

 

Basically, I guess I'm trying to say that if I want to do majority of the trauma cases in Canada, what specialty should I choose? Gen Surg? I assume?

[Guest CaesarCornelius]

I heard that a lot of trauma surgery is Thoracic Surgery (a sub-specialty of gen surg).

 

CC

[Guest UWOMED2005]

Hmm. . . . great question. Complicated explanation, and unfortunately I forget a few details about how the trauma team works here.

 

But basically, all trauma in SW Ontario (except for some specifically within the city of Windsor) is diverted to the 'Trauma Center' at South Street site, Victoria Campus, LHSC.

 

If you're talking about dealing with trauma in smaller rural hospital. . . it's the 'emerg' doc (usually a family or family-EM doc) who deals with it. Their role is strictly to stabilize ABCs and transfer to the trauma center.

 

But if you're talking surgery your interest is bound to be in the trauma center. . .

 

When a case that has been designated 'trauma' arrives at South Street, it arrives in Emerg, but is diverted to the 'Trauma Team' (emerg staff might help out.) To be honest, I can't remember EXACTLY EVERYBODY who is on the traum a team (crackers, Aneliz, mying, or cracked03 might be able to help me out) but the essentials are the 'Trauma Team Leader,' (TTL) the trauma residents, ?the gen surg residents?, and nurses. I can't remember exactly, but there might be consultants other than the TTL who are considered part of the trauma team.

 

Numerous consultants at LHSC serve as the TTL. Their specialties include general surgery, orthopedics, thoracics, and emergency med. The TTL and trauma team are responsible for the initial stabilization of the patient. After that, surgery may be called.

[Guest therealcrackers]

The various trauma team leaders at LHSC are thoracic surgeons, general surgeons, vascular surgeons, orthopedic surgeons, emergency docs, and ICU/intensivist/anaesthesia. Everyone who is a resident or fellow in those subspecialties has the option (in ER it's a requirement) to do a trauma rotation. So when a trauma is called, the trauma team leader (TTL) calls the shots on initial management and disposition of the patient (the attending ER doc is in charge until superseded by the TTL); the patient may die, may go to the OR for a variety of procedures (cardiac, thoracic, vascular, orthopedic, abdominal surgery --- plastics usually gets called later).

[Guest cracked30]

The trauma pagers, ie the pager that lights up, wakes you out of sleep, with the cry "TRAUMA IN EMERG, TRAUMA IN EMERG!" is carried by the TTL and the junior and senior general surgery residents and a dedicated trauma resident.

 

These people are responsible for things like intubation, central lines, chest tubes, diagnostic peritoneal lavage, "cracking" the chest. Other services are called in separately as needed. If someone needs to be rushed to the OR, it is invariable due to intraabdominal injury, other injuries fall below that on the ATLS protocol. If you like that kind of excitement, Gen surg is the place to be.

 

The TTL can be anyone with ATLS training, at South Street it can either be a ER consultant, an ICU consultant, a Gen surg consultant, or thoracics and vascular consultants.

[Guest Future MSFer]

Is there a difference between Emergency medicine and Trauma Surgery? You say that in order to work in the ER room, one should do general surgery. But what if some Med schools have both Emergency Medicine and General surgery (such as McMaster), which one should I take if I wanted to work in the ER and be part of the TT?

[Guest moo]

I think people have a deluded view of what Emergency medicine is. It's the trauma surgeons who deal with the MVCs, the gunshot wounds, and the other traumas that occur in the big city. The ER physician's job is to stabilize and decide whether the patient needs to be admitted or not and whether to call a consult. The ER physician is not a surgeon, but he or she can do minor surgical procedures like stitch up wounds, etc. If a patient comes in with a bowel obstruction, the ER physician's job is to obtain appropriate tests and then call the general surgeon who will decide if the patient needs to be taken to the OR or whether to just be admitted, given an NG tube, fluids, etc.

[Guest UWOMED2005]

Yeah. . . much of the stuff you see them do on ER is not usually done in the emergency deparment. It's done in ORs, and at a much more controlled place.

 

I think if ER featured emerg docs seeing colds, sore throats, abdo pain, and "dizziness NYD" the ratings wouldn't be so hot.