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  • 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.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to the next installment of our So You Want to Be series, where we highlight

  • a specific specialty within medicine, and help you decide if it's a good fit for you.

  • You can find the entire list on our So You Want to Be playlist. If you want to help us

  • decide which specialty or healthcare professional to cover next, drop a comment down below with

  • your request.

  • If you'd like to see what being a trauma surgeon looks like, check out my second channel,

  • Kevin Jubbal, M.D., where I do a second series in parallel titled a Day in the Life.

  • Trauma surgery is a subspecialty 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. 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 central nervous system in these countries, too.

  • 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 crash, 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.

  • The more traditional trauma surgical interventions often include procedures such as exploratory

  • laparotomy, where the abdomen is opened and the abdominal organs examined for injury or

  • disease. Thoracotomies open up the chest, and tracheostomies 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 5-7 years of general

  • surgery residency, depending on whether your residency includes a two-year research block.

  • From there, most trauma surgeons do a 1-2 year fellowship in traumatology, surgical

  • critical care, or emergency surgery, for a total of 6-9 years of additional training

  • after medical school.

  • Pediatric trauma surgery is part of regular peds surgery training. Depending where the

  • ambulance takes the patient, sometimes it gets managed and triaged acutely at the adult

  • hospital, but ideally goes straight to the pediatric trauma center.

  • If you're interested in more specific types of trauma, there are other specialties to

  • consider. For example, orthopedic trauma focuses on surgical intervention of traumatic injuries

  • related to bones. If you want to deal with spine and cranial trauma, neurosurgery would

  • be your specialty.

  • General surgery residency is middle of the road in terms of competitiveness, with an

  • average matriculant Step 1 score of 234, with the national average at 230. As with most

  • surgical specialties, trauma surgery is male dominated, although not as much as some other

  • surgical specialties like neurosurgery or orthopedics.

  • As a surgical specialty, your general surgery residency and trauma surgery fellowship will

  • be incredibly taxing with long and often unpredictable hours.

  • Rather than telling you what it's like to be a trauma surgeon, I'm going to hand it

  • over to my friend, Dr. David Hindin. Not only does he have an awesome YouTube channel that

  • you should definitely check out, but he's also a general surgeon with extensive trauma

  • experience from his surgical residency at Temple University Hospital in Philadelphia.

  • Without further ado, here is Dr. Hindin.

  • 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 timeframe, these

  • surgeons also must make decisions about patient management, and take action, often with limited

  • information, in the blink of an eye. But more on that in a few minutes.

  • 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 on 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 callBIG

  • operations. Many of these procedures involve making long 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 quicklyrun 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 may need to be addressed.

  • Another trauma procedure that's unfortunately somewhat common in urban areas with a large

  • amount of crime and violence is called anED thoracotomy,” or a “crash thoracotomy.”

  • 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,

  • or stop bleeding. At this point, the surgeon 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.

  • 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 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-type 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 your time outside the hospital is completely yours.

  • To contrast, some surgeons within other specialties are on call 24/7 for their patients.

  • But there's also a flip-side to all of the 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 over-emphasize. This is an incredible burden that trauma surgeons have

  • to carry.

  • And - because traumas can occur at any time in 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) will 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 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 often see patients who come to them for elective surgeries like hernia

  • repair, gallbladder surgery, and other procedures.

  • At the end of the day, trauma surgery is an incredibly meaningful and rewarding surgical

  • specialty.

  • People who should go into trauma surgery are those who thrive within fast paced, high-intensity

  • environmentspeople 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 every decision,

  • trauma may not be the field for you.

  • Trauma 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 an 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 in 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.logic

  • Massive thanks to Dr. Hindin for sharing his expertise in general and trauma surgery. He

  • has a super interesting story as a surgeon and medical technology innovator, so be sure

  • to check out his channel, David Hindin, M.D . Link below. Which specialty should we cover

  • next in our So You Want to Be series? Let me know with a comment down below. Thank you

  • all so much for watching, and I will see you guys in that next one.

So you want to be a trauma surgeon. You've come to the right place. In this episode of

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So You Want to Be a TRAUMA SURGEON [Ep. 8]

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    Summer posted on 2020/06/08
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