THIRD YEAR STUDENT ROTATION
ACUTE CARE (L) SURGERY
RonaldReaganUCLAMedicalCenter
GOALS
The overall goal of this rotation is to introduce you to principles of patient evaluation and management, with a special focus on trauma and critical care. In general, you will be participating in most of the activities with the residents on the L Service.
Fund of knowledge (Knowledge base)
Acute Traumatic Disease
Penetrating trauma
Blunt trauma
Assessment of abdominal injury
Assessment of thoracic injury
Head injury
Pelvic and extremity fractures
Perioperative patient care
Preoerative assessment / preparation for emergent surgery
Fluid, electrolyte and nutritional management
Management of patients with common surgical emergencies (acute appendicitis, diverticulitis and bowel obstruction)
Postoperative systemic failure (MI, ARF, Resp Fail / ARDS, Sepsis)
Postoperativecomplications and emergencies (PE, hemorrhage, perforation, infection)
Patient Evaluation (Clinical Skills)
A.Comprehensive evaluation of the trauma patient .
This includes skill in performing an asssesment of airway, breathing and circulation (primary survey) andinitial survey of injuries followed by a comprehensive head-to-toe examination (secondary survey), reviewing radiological and laboratory testing and formulating a critical appraisal of presentig condition as well as plan for treatment. You will be expected to carry out a problem-specific ER History and Physical, and to write an appropriate progress note.
C.Acute Surgical diagnosis.
By the end of the rotation, you should become familiar with methods of testing -- non invasive, radiologic, serologic, invasive -- how tests are performed and interpreted on the Trauma service.
D.Treatment of Acute Surgical disease.
You should learn the basic principles of conservative management and gain an understanding of the common operations performed for acute surgical problems, including indications, risks, and frequency of complications.
Requirements:
1.At least one comprehensive H & P’s to be performed per week and copies turned in to the chief resident or attending for feedback and discussion.
2.Attendance to weekly Trauma Clinic
3. Attendance to weekly Trauma Conference.
4.Attendance to observe at least one Trauma Code.
5.Required reading: Chapters 3, 7,8,9,10,11,13, and 14, Peter Lawrence, ed. These chapters should be read before your first day on the service.
6.Because of the great importance of knowledge of anatomy in the evaluation and treatment of patients on the Trauma Service, you should learn the names and the anatomy of the upper airway, topographical anatomy of the chest and abdomen, and skeletal anatomy of the pelvis and torso.
7.Complete the Summary Sheet and turn it in to Iris Mau (Room 72-215 CHS) at the end of the rotation.
Students should page the intern on the L service before they begin the rotation to find out where and when to meet. The name of the intern and pager can be found on the R1 General Surgery rotation schedule located at the Surgery website:
Summary Sheet
Third Year Student Rotation -- Trauma Surgery (L Service) -- CHS
Student Name: ______
Dates on Service: ______
Complete workups -- History and Physical Examination (patient name, diagnosis, date of H&P)
1. ______
2. ______
3. ______
Clinic Patient Notes:
1. ______
2. ______
3. ______
Trauma Surgery clinical activities (these are OBLIGATORY, fill in date).
______1. Attend trauma Code in Emergency Room
______2. Examine abdomen with Attending or Resident supervision
______3. Pass NG tube in Operating Room, ICU or Resuscitation Suite
______4. Place Foley catheter in Operating Room, ICU, or Resuscitation Suite
______5. Close skin of surgical wound or simple traumatic laceration
We would like you to observe the following index cases. We recognize that it may not always be possible. Check off if you were able to do the following.
Index Cases to See Observe operation Observe in ICU
1. Blunt Trauma: ______
2. Penetrating Trauma:______
3. Simple Laceration:______
4. Complex Laceration______
We would like you to develop the following clinical skills. We recognize that it may not always be possible. Check off if you were able to do the following.
Trauma Surgical clinical skills (check if completed).
______1. Perform initial supervised primary survey (A,B,C,D, E)
______2. Palpate pelvis for fracture
______3. Palpate prostate for dislocation
______4. Palpate pulses for presence / quality
______4. Review Trauma pelvic X-ray / KUB
______5. Review Trauma or ICU Chest X-ray
______6. Review Blood Gasses
Attending or Chief Resident signature:
Comments about rotation:
Please turn in this completed form to Iris Mau in Room 72-215 CHS.