THIRD YEAR STUDENT ROTATION
ACUTE CARE (L) SURGERY
Ronald Reagan UCLA Medical Center
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)
Postoperative complications 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) and initial 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:
http://www.surgery.ucla.edu/resident/
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
1. Blunt Trauma:
2. Penetrating Trauma:
3. Simple Laceration:
4. Complex Laceration
Observe operation
_______
_______
_______
_______
Observe in ICU
_______
_______
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.