The Trauma Bay

At my program, the intern takes all of the floor/ED/trauma consults during the day. Regular consults on the floor or in the ED are really not that big of a deal. I go to see the patient, look at the films, read about what I've seen and heard and then report to my chief. The trauma bay is another animal, especially if I have been called for something that requires immediate attention like a disvascular limb, dislocated joint, or open fracture. This call usually occurs after the initial primary survey has been completed but before the patient leaves the trauma bay to go to the CT scanner and get additional plain films. The patient has a portable chest x-ray, an AP pelvis and maybe a couple of other portable films of obvious deformities.

Keep in mind, I am the intern, and the trauma/EM staff, not to mention many upper level residents stop what they are doing and stare at me while I complete my evaluation, ask for things that I need and prepare whatever intervention is necessary. Meanwhile, the trauma chief is asking to take the patient to the CT scanner and the nurses are griping about keeping the patient in the trauma bay for longer than is necessary.

So, I have to balance the excitement of taking care of some blown up limb or reducing a dislocated extremity with not overstepping my bounds as an intern - and get things done in a timely manner so that the trauma team can finish their evaluation. Oh yeah, and there is a person laying on that bed with a life/limb threatening injury. We've had some interesting trauma so far, a couple of really bad open fractures, a blown off foot and a couple of dislocated hips, and I've learned a ton in that setting. Number one, I've learned how to walk into a room where anything can happen and things are changing by the second and keep my cool. When I come into the trauma bay, "I'm just the intern," is not really a great excuse. I'm the "expert" in the room and it's my job to take care of the patient. I had to tell a lady the other day that there is a chance we will have to amputate her leg. Luckily, she still has her leg - but we'll see how things go over the course of the next year, not only for the patient - but also for my education...