Trauma Surgeon REACTS TO: So you Want to be a Trauma Surgeon - Med School Insiders

hi my name is dr rich hilsden and you're watching my channel knife skills today i'm going to do a reaction video to med school insiders so you want to be a trauma surgeon actually this video was inspired by a comment in one of my other videos so i really appreciate anyone who makes a comment i love reading them i love the engagement and you do give me ideas to make some videos so the med school insider series on so you want to be is an awesome i think series of videos to really give you a sense as to these different careers in a nice little nutshell if you're a resident or a med student trying to figure out what you want to do for your career obviously you need to explore it in more depth but this gives you kind of a sense is hey well what are these different specialties like so i'm going to put my headphones on we're going to dive right into it and we're going to check out med school insiders so you want to be a trauma surgeon so you want to be a trauma surgeon you've come to the right place in this episode of so you want to be let's talk about what it means to do trauma surgery the training process and some of the lesser known upsides and downsides of being a trauma surgeon trauma surgery is a sub-specialty of surgery primarily dealing with patients who have undergone a physical injury often in an acute setting not all trauma requires surgery and depending on the specific injury these patients may also need further treatment from neurologists internal medicine doctors and more okay so this is a really good place to take a quick pause on this video and i would say absolutely this is really one of the most fundamental things you'd understand about becoming a trauma surgeon is that trauma surgeons will be dealing with patients that both need surgery and don't need surgery in fact trauma surgery really evolved out of general surgery and the whole field of trauma has been in my mind led by surgeons but as time goes on and research has improved we really understand that more and more injuries are best managed non-operatively many many injuries can be treated with adjuncts to surgery like embolization optimization of medications medications that we've introduced into trauma like transitamic acid you can see that in one of my videos uh as well so really surgery and trauma although they're intimately length they go hand in hand if you're going to be a trauma surgeon you need to be aware that a lot of the patients that you're going to treat are going to be non-operative and so that's an important concept to understand the majority of injuries addressed by trauma surgery include those of the neck chest abdomen and extremities in europe trauma surgeons treat most of the musculoskeletal trauma whereas neurosurgeons handle injuries to the central nervous system in the united states and uk however skeletal injuries are primarily handled by orthopedic surgeons and facial injuries are often treated by plastic surgeons or maxillofacial surgeons neurosurgeons typically manage injuries to the cns in these countries too okay so i'm going to pause this right here as well so this is a great breakdown the european approach more or less obviously the uk follows the american style a little bit more is exactly that oftentimes trauma surgeons really are orthopedic surgeons and they've added in the general surgical skills to take care of some of the life-threatening issues like having to do a laparotomy or thoracotomy those type of things or even some cases some neurosurgical cases in north america really trauma surgery is a branch of general surgery and that focuses on the neck the chest the abdomen the pelvis those types of things a little less on the extremities although we do get trained in vascular surgery as well so the scope between what you're doing in north america versus in europe is going to be a little bit different the focus really of trauma surgery is those life-saving urgent operations trauma surgeons must be familiar with a variety of general surgical thoracic and vascular procedures trauma conditions can be described as blunt or penetrating blunt would include injuries from a motor vehicle accident falls atv rollovers and assaults penetrating injuries include gunshot wounds stab wounds and the like additionally they're dealing with high acuity situations often with little time and incomplete information with a patient in front of them who is rapidly decompensating okay so this breakdown between blunt and penetrating is extremely important so the approach to handling problems does differ quite a bit between blunt and penetrating penetrating injuries are far more likely to require surgery than blunt injuries they're far more likely to need a major operation to repair whereas blunt injuries are much more likely to be managed non-operatively at least in that acute setting at least in that immediate setting so many of the life-saving surgeries that we're trained to do and get competent to do as a trauma surgeon are those life-saving surgeries for those blunt operations like for example the emergency department thoracotomy or the resuscitative thoracotomy that i discussed in a recent video but one thing that is for sure and it's being emphasized here is that regardless of whether the patient's operative or not oftentimes the trauma surgeon is one of the first people to interact with that patient when they arrive at a hospital and need to be prepared to deal with those urgent situations the more traditional trauma surgical interventions often include procedures such as the exploratory laparotomy where the abdomen is opened and the abdominal organs examined for injury or disease thoracotomies open up the chest and tracheostomes are procedures for insertion of a breathing tube through the throat over the past few decades advances in trauma and critical care have led to more non-operative and sometimes minimally invasive treatment modalities this is good for patients as less invasive therapies often have better outcomes to become a trauma surgeon you'll complete medical school and then do five to seven years of general surgery residency depending on whether your residency includes a two-year research block from there most trauma surgeons do a one to two year fellowship in traumatology surgical critical care or emergency surgery for a total of six to nine years of additional training after medical school pediatric trauma surgery is part of regular ped surgery training depending on where the ambulance takes the patient sometimes it gets managed and triaged acutely at the adult hospital but ideally go straight to the pediatric trauma center so this is actually a really good point trauma surgery is a long path in north america again the typical approach is you do five years of general surgery residue training that can be a little longer depending on what type of research or electives or your goals and then you move on to doing a fellowship so the fellowships that you can choose typically are either trauma surgery surgical critical care or acute care surgery i did a trauma surgical fellowship but the trend is in 2022 when i'm reviewing this video is more and more people who are interested in trauma surging are doing that emergency general surgery or acute care surgery fellowships and if i were advising a new med student or resident who is interested in trauma as their career i'd actually direct them to emergency general surgery or acute care surgery as their fellowship because those programs very typically involve a lot more trauma than you would have had in your general surgical training but they also emphasize more advanced difficult emergency cases they're a little less of an emphasis on the surgical critical care part and i think that the trend at least is where people are going and how the hospital and medical systems are changing that skill of the emergency general surgeon is becoming more of a subspecialty on itself and is becoming more and more valuable and as a surgical specialty your general surgery residency and trauma surgery fellowship will be incredibly taxing and long with often unpredictable hours rather than telling you what it's like to be a trauma surgeon i'm gonna hand it over to my friend dr david hinden we joke around sometimes that trauma surgery is kind of like general surgery on steroids all of the regular principles that we have in general surgery are still there and many of the procedures and maneuvers are the same too in trauma surgery you might find yourself removing and reconnecting different portions of the small bowel and colon you might find yourself removing a portion of the lung or repairing a hole in the diaphragm and you might find yourself deep in the abdomen exposing the retroperitoneum to repair a vascular injury all of these are techniques and maneuvers and procedures that we might do in other areas of general surgery but the difference in trauma is the urgency and often the speed at which we have to do this work and just as trauma surgeons may have to perform surgery in a much more urgent time frame these surgeons also must make decisions about patient management and take action often with limited information sometimes even in the blink of an eye so i think dr hinden's comment there is perfect probably one of the biggest challenges of being a trauma surgeon is not necessarily even the technical aspects although we do get special training in that and with our experience certainly we bring a unique skill set to the table i think what really makes a trauma surgeon special is that ability to make decisions with limited information we live in a world where ct scans and ultrasounds and tests are guiding our management to the point where surgeons are only operating when they have an absolute certainty of a particular indication that's not possible in trauma surgery in trauma surgery you need to look at the patient the vital signs the physical exam the mechanism of injury the trajectory of a bullet or a stab wound and make the decision based on that information alone and oftentimes it's not enough there are times where we go to the operating room and the surgery may have been unnecessary we talk we use the term a negative laparotomy for example um other times we operate and there was maybe the compartment we opened we went to the chest when the injuries in the abdomen for example there are times when we do make the wrong call and you have to be comfortable with that as a trauma surgeon you have to be biased towards taking action as a trauma surgeon that's critically important there's a lot to love about trauma surgery it's a specialty that's fast-paced and exciting and more than any other area in surgery trauma is an environment where you can have an immediate and lasting influence in someone's health with actions that play out in seconds to minutes after all what could have a larger impact than saving someone's life trauma surgery also tends to attract surgeons who like to perform what we'd call big operations many of these procedures involve making large incisions creating major exposures of vascular structures and performing large-scale repairs of significant injuries throughout the body one of the most common procedures we do in trauma surgery is called an exploratory laparotomy in this surgery a long incision is made from the top of your abdomen just below the ribs straight down the midline to below the belly button once the abdomen is entered surgeons are able to quickly run the bowel meaning that they examine your entire intestines from end to end this type of procedure is typically carried out very quickly so that surgeons can quickly locate injuries for instance from a bullet or a knife wound and then determine the next best steps to stabilize the patient control any bleeding and repair the injury and at the same time they're inspecting the intestines they're also looking at solid organs within the abdomen and different zones where your major vascular structures lie like your aorta to see what other injuries might need to be addressed so this exploratory laparotomy is probably the core procedure for trauma certain it is the sort of skill that uh i would say we're most dependent on we pride ourselves in performing and has probably the biggest impact overall in our careers when it comes to patient outcomes there are other procedures we'll be talking about the thoracotomy in a minute for example that are also big operations that are quite effective but that exploratory laparotomy again is the cornerstone we have access to a lot of different organs and it's really our area of expertise cardiothoracic uh vascular those specialties are great but they don't have the same amount of time and investment into the abdominal cavity and therefore are less comfortable and less of an expert in this area so uh most trauma surgeons would say that exploratory laparotomy is one of their favorite operations it's a little bit like a box of chocolates you're not sure exactly what you're gonna get and that's what makes it exciting one of the best parts of being a trauma surgeon is operating based on your clinical acumen alone and the exploratory laparotomy is the procedure another trauma procedure that's unfortunately somewhat common in urban areas with a large amount of crime and violence is called an e-d thor economy or a crash thorough economy this is a procedure that's typically carried out in a portion of the emergency room called the trauma bay and it's done for patients who come in without a heartbeat after a form of penetrating trauma in this procedure over the course of a few minutes a large incision is carried out across the left chest the heart is released from the pericardium and a cross clamp is placed on the aorta to help reduce the amount of blood loss visible injuries to the heart and lung may also quickly be controlled with a clamp to help achieve hemostasis and stop bleeding at this point the surgeon then performs what's called open cardiac massage which means squeezing the heart between one's hands to try to restore a heartbeat like a kind of internal cpr i did a video recently on the trauma thoracotomy i called it crack the chest so take a look at that video i described really how it's done indications and really go into some good detail on that procedure again it's probably one of the most exciting and i would say high stakes procedure that we do in general surgery and in trauma and so you can take a look at that as you can probably tell even though most specialties within surgery these days require a surgeon to specialize and commit to operating in one part of the body a trauma surgeon could find him or herself removing a portion of the lung repairing a bleeding cardiac injury removing a damaged spleen and repairing a hole in the intestines all in the same day and maybe all on the same patient another thing to love about trauma surgery is the mix of critical care medicine that's involved most trauma surgeons balance their time operating with helping to manage icu patients this requires a more intellectual side of surgery that can often be a really nice balance to the more intense operative side of things also trauma surgery typically runs on a shift-like schedule this means that while you might be incredibly busy while you're at the hospital once your shift is over one of your partners takes over your responsibilities and typically your time outside the hospital is then completely yours to contrast some surgeons within other specialties might be on call 24 7 for their patients there's also a flip side to all of that excitement the high intensity action-packed moments of trauma surgery can also come with their toll it can be exhausting and draining both physically and emotionally having critically ill badly injured patients often means that unfortunately there will be many patients who arrive in your trauma bay that you just can't save having to break bad news to loved ones of patients on a regular basis is an emotional weight that can be hard to overemphasize this is an incredible burden that trauma surgeons have to carry this is probably one of the most important points of this whole video is without a doubt as a trauma surgeon you're going to have patients that die patients that might die on your table may die on the trombay or may not survive coming into the hospital and i still have a few encounters that i can remember i can remember one mother of a 19 year old that died who basically you know crying in front of me said i can't believe you couldn't save my daughter said that to say that to me and that situation was a situation i don't think any surgeon could have helped it was a devastating awful injury and yet it was hard because you know i felt that i like i failed and i had to share that with the with the mothers so those moments even to this day i remember i remember the loved ones who've suffered from having to be told that their daughter partner has died those are the things i remember actually more than oftentimes even the great saves i don't think very often about the big wins i think about the people who have been left behind by the loved ones that i couldn't save and that's extremely heavy and so i i commend them from bringing that up in this video because i think that's something that can't be really overstated and because traumas can occur at any time of the day trauma surgeons also have to be available 24 hours a day too that means that when you're on call at the hospital there's no guarantee what your day or night might be like things can be quiet all morning afternoon and evening and then trauma patients can suddenly start pouring in needing multiple operating rooms to open up to take care of the sudden volume shifts like this can be exhausting for surgeons and for some people they really do take a toll the unpredictability can also be a source of stress in itself also by the very nature of what trauma surgeons do it's one of the areas of surgery where you're unlikely to have patients seek you out to be their surgeon after all trauma patients aren't expecting to be having an emergency but along those lines it's good to know that most trauma surgeons also have an office practice of general surgery so these surgeons may be seeing patients who come to them for elective surgeries like hernia repair gallbladder surgery and other procedures okay this is another point that's worthwhile interrupting very few trauma surgeons in 2022 at least starting their career are only doing trauma surgery i think the idea of just being a pure trauma surgeon endless shifts being almost an emergency doctor with a scalpel is going away most of us augment our trauma surgery schedules with emergency general surgery so we're doing things like hernias gallbladders uh bowel resections for colon cancer emergently those types of things in addition to our trauma surgery call schedule and um as well many of us will have a private or a independent general surgery practice again with all the regular general surgical uh skills so that could be things like endoscopy or could be things like proctology and certainly my general surgical practice is quite broad in addition to my trauma surgery practice and i'm grateful for that because that creates a great balance there are some times when i'm ready for a more intense trauma surgery schedule and that comes and there's times when i'm like interested in a little bit more of a regular pace and more of a relaxed general surgical pace then i have that as well an incredibly meaningful and rewarding surgical specialty people who should go into trauma surgery are those who thrive within fast-paced high-intensity environments people who like making a decision putting together a plan and executing it quickly and without hesitation if you're someone who prefers to mull over a decision trauma may not be the field for you drama surgery is also ideal for people who thrive in working on teams everything we do requires close coordination with our colleagues in surgery nursing anesthesia and more and trauma surgery is also ideal for doctors and surgeons who like critical care medicine too surgeons who enjoy running in icu and managing patients in intensive care finally trauma surgery is also ideal for people who like to have a shift work type schedule in their life so that when you're off you're truly off from the hospital and free of responsibilities this type of schedule and trauma makes the specialty really ideal for people who have other passions in life and wish to balance their surgical career with other time commitments outside of their surgical practice awesome so that's my analysis of med school insiders so you want to be a trauma surgeon i think they really did accurately describe it quite well there are various different experiences that different types of trauma surgeons will have and your career will be different depending on the hospital you work with depending on the fellowship that you choose to go into and really how much balance you want between trauma surgery and general surgery i have a bunch of other videos on my channel discussing some of the procedures that we do in trauma surgery some trauma surgical issues especially some of my older content so i'd love for you to go and take a look at that if you have any other video ideas please make a comment below this video was exactly that inspired by one of your comments and i absolutely appreciate everyone and your engagement it really is why i am here thanks for watching

Channel: Knife Skills

Views: 13,629

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Id: GuZQFhNYJeE

Length: 21min 48sec (1308 seconds)

Published: Thu Feb 24 2022