Tuesday, April 30, 2019

Trauma Surgery & Orthopaedic Trauma Surgery

POP QUIZ: What nerve must you watch out for when performing an anterior-approached ORIF of the lateral malleolus? And what would happen if you were to dissect this nerve?

     My 10th rotation (of 12 total) consisted of a mixture of trauma surgery and orthopaedic trauma surgeryDuring our PA school clinical rotations at the University of Kentucky, we get the opportunity to pursue two separate "elective" rotations in fields we are interested in. I spent the first two weeks of the rotation with the trauma surgery team and the second two weeks with the orthopaedic trauma surgery team. I chose these fields due to my background and future interest in orthopaedics, specifically in a trauma setting. I got to be part of both of these teams at a level one trauma center.

     While both fields are related to trauma, they manage very different aspects of the patient. Trauma surgery is a sub-specialty of general surgery while orthopaedic trauma surgery is a sub-specialty of orthopaedics. A trauma surgeon and team manages extensive damage to various body tissues and organ systems while the orthopaedic trauma surgeon and team manages the bones, joints, ligaments and tendons related to the trauma. The trauma team typically consults with the orthopaedic team to manage related musculoskeletal injuries.

     As a part of the trauma surgery team, I was a member of morning conference at 5:45am where we discussed any patients that came during the overnight shift. We then broke into our teams (A, B, C, ICU) and rounded on our patients to see what needed to be done throughout the day.  I was assigned two or three patients each day and was responsible for their care, including notes, orders, consults, and a member of the operating team if necessary. I then presented the patients to my preceptor along with my assessment and plan. Days were typically 12 hours, with 3-day weeks.

     Some interesting things I got to see/do with the trauma surgery team:
  • I was able to participate in a "trauma alert red" (highest level trauma at our facility) where the patient coded. I was 2nd in line to perform chest compressions, and the patient was able to achieve ROSC rather quickly. Their FAST exam was negative and the patient was stable on mechanical ventilation. 
  • I saw a patient follow-up at the clinic s/p surgical debridement from Fournier's gangrene secondary to a perirectal abscess. This was his first follow up and he had extensive skin debridement including portions of his penis and the removal of his entire scrotum... I was not part of his surgery, but that does NOT sound fun.

     I then spent some time with the orthopaedic trauma surgery team which consisted of the operating room three days per week and one day of outpatient clinic. The surgical team consisted of the attending physician, a fellow, and myself. We would arrive around 6:00am to round on patients we consult with. We would then visit pre-op to visit the patient as they prepared for surgery. We then performed the required orthopaedic surgery, and visited with the patient and family post-op once the patient was conscious after sedation wore off. Days ranged from 10 hours to 14 hours, 4 days per week.

     Some interesting things I got to see/do with the orthopaedic trauma surgery team:
  • A patient presented with a fractured humerus due to an MVC. Upon opening her arm for ORIF plate-fixation, we saw what looked to be cancerous bone. We sent samples to pathology, and her fracture was a result of a weakened humerus due to adenocarcinoma that metastasized from her lung.
  • I got to use the mallet and adjust an intermedullary nail. I didn't get to actually hammer in the nail, I simply made some minor adjustments to ensure proper placement. However, that still took some good whacks. Orthopaedics is like wood-working... power drills, screws, nails, plates, it's such a unique and precise surgical field!
     Follow this link to the University of Kentucky Trauma Blog if you have any interest in current trauma care/management: http://uktraumaprotocol.blogspot.com/
     If you have any interest in orthopaedics, I LOVED this resource: https://www.orthobullets.com/

POP QUIZ ANSWER: The superficial peroneal nerve, located just anterior to the lateral malleolus. If dissected, you would lose sensation to the dorsum of the foot. You would NOT lose and eversion due to being past the point of muscular innervation.

Wednesday, January 23, 2019

Motivation

"If you don't work for what you want you will end up with something that you don't want. If you don't work for what you want, you will most likely work for someone who did! Someone you don't want to work for."

     I heard this quote a while back and it continues to stick with me every day! How true this is and how motivating these few lines are. Life is hard and it will knock you down, but it's hard for everyone, so get up and GRIND! (Grindin' ← favorite song*) You have to be willing to put in the extra effort in order to truly be successful. If you don't, someone else is willing to and you will end up not being as successful as the person who was willing to do more. The one willing to sacrifice more, the one willing to study more, willing to lose sleep, the one who didn't go out and party every weekend, didn't binge-watch the next Netflix series, the one who pushed through the challenges and hardships in the pursuit of their dream. What is your dream? Where do you want to be? What do you want to be? Who do you want to be?


     My daily routine for this rotation is being at the clinic from 8:00am until ~5:00pm, I leave the clinic and hit the gym. I finally end up at home around 6:30pm, eat dinner, and then try and study. My days are busy, so it's hard to stay motivated and focused! After each workout session, I love to sit in the steam room for about 10 minutes and just relax/decompress. To sweat out all the toxic thoughts and negative emotions from the day. I put on the "Fearless Motivation" playlist on Spotify and listen to a few speeches while I relax. I use this time to reflect on my day. To examine what I could have and should have done that day along with what I need to get done before day's end. I dissect the reasons I didn't accomplish them, and makes plans/goals on how I can improve tomorrow to reach my goals.

     This approach may not be motivating to you, but there are plenty of other options to help keep your life on track. Prayer & religion, planning & goal-setting, cellphone reminders, etc... The most important thing is to just stay on track, and get done what you need to get done to get where you want to go (Yes, I know that was extremely well-said 😅). "The Road to There" has to end up somewhere, so make it where you'd like to end up. Just like a GPS, you have a destination set and you decide which route you to take. I recommend avoiding the road blocks and u-turns!

     Just realize this... You can't sit at work all day, working for someone else only to come home and not work on yourself. Work each day on something to improve yourself. Whether it be health, fitness, education, business, a new idea, your next investment, or whatever it may be. Don't spend your days only working for someone else, you'll fail to realize your own potential and your own worth!