Trauma Medical Students
Welcome to Trauma/Acute Care Surgery. We round weekdays at 6 a.m. starting in the SICU. Come there on your first
day and meet the team.
1. We are a busy team. You will be expected to pre-round every day on your patients and present them on work
rounds. Ask your interns/residents how to do this. Initially you will have one or two patients, but as you get
more familiar with what we want, you could pick up as many as 5. We have p.m. teaching rounds and a variety
of conferences including Critical Care Conf on Monday at noon in Burnett Womack 4050 (if you aren’t otherwise
busy), Tuesday conference at noon (same place) alternates between M and M and Trauma/Acute Care
Conference. Wed at 5 in the OR classroom is big M and M. Thursday at 830 is multidisciplinary rounds (BW
4050).
2. For the first week, I would like you to write at least one daily progress note on one of your patients and send it
to me as a generic note produced in webcis and forwarded to me. Use the SOAP format. NO cutting and
pasting. Include all data that you think are relevant and no data that you think are extraneous. (What is MCHC
anyway, and does anyone care?). We will go over them the first week.
3. Write 2 H and P’s during the first and second weeks of the clerkship. These must be on patients newly
presenting to us, e.g. they can be patients you saw in the ER as consults or admitted through the ER when you
were on call. They could also be consults already in the hospital on the medical service (new to us though not
new to the hospital). They can be new traumas, new clinic patients. They cannot be people you picked up the
morning AFTER their trauma or people you picked up on POD (post op day) 37. Write the H and P’s as word
documents and send them to my email at unc which is elizabeth_dreesen@med.unc.edu. Pls include pt initials
and MR #. I’d like them by Sunday night so we can go over them early in the subsequent week. When I read
them, I look to see that you asked relevant questions, that you included relevant data, and that you came up
with a problem list that includes a brief but inclusive list of what your plans are for dealing with the problem.
The problem list can be simply “problems” (e.g., in a young healthy guy with appendicitis, the problem list might
have one problem: RLQ pain with appendicitis by CT. Plan would be 1) NPO 2) IV fluid 3) antibiotics (and which
one) 4) consent for _______. Problem lists in complex patients can be done by organ system or, in trauma
patients, by injury. In a multiply injured person, it might include 1) neuro – GCS 12 with nl head CT and positive
tox for alcohol – admit to SICU for serial neuro exams. Repeat head CT in 48 hrs if no change. 2) c-v – stable BP
but tachycardic. Plan to monitor CVP and urine output and serial Hct to ensure adequate volume resuscitation.
Suspect tachycardia due to agitation. 3) pulmonary – multiple rib fx and contusions on chest CT. Careful
attention to pain control and incentive spirometry with supplemental O2 , sat monitor, as patient is at risk for
pneumonia, etc….. A surgery problem list and plan is REALLY different than the ones you did for ICM or
medicine. We often don’t include things like “smoking” for example.
4. Please write a set of admission orders. Do this as a word document and email to me. ADCVAANDIML. You can
do them for one of your h and p’s or for someone else. Pls include pt initials and MR #.
5. You can do a creative project instead of one of the H and P’s. It can be ANYTHING creative
6. Please do a discharge summary for the third week of the clerkship. This also as a word document. Use this
format: Date of admission. Date of discharge. Admission diagnosis (principle). Secondary diagnosis (their
diabetes, their UTI that they got from their foley, etc). Principle procedures with dates. Hospital course.
Discharge instructions including location they are being discharged to, meds, wound care, activity, diet, follow
up.
7. Look at x-rays on PACS. Choose the x-ray of someone you saw/followed to present to your fellow students and
me during each of the last two weeks of the clerkship.
8. One of you should be designated as the “consult” student, let the resident carrying the consult pager know
which one of you it is, what your beeper number is and go with them to see new consults. The resident may
even send you ahead to recon the consult before they see them. I had to give up my first born child to get you
beepers. Please use them to stay connected with the team and to come to traumas, especially the red traumas.
Largely, you will be standing at the foot of the bed in the trauma bay observing and not doing things.
WATCHING IS A LEARNING EXPERIENCE.
9. You should decide the night before who is scrubbing which cases. (look under schedule on WEBCIS). You should
make EVERY EFFORT to see the patient before the case (even if it means just visiting them in preop holding).
READ about the case the night before so you can be familiar with the indications for the procedure, the major
parts of the procedure, and the anatomy. The Health Sciences Library website has some procedure atlases
under E books (e.g. Mastery of Surgery which has good pics and descriptions or Khatri’s book which is called
something like operative surgery. You can also use the traditional Schwartz and Sabiston texts, but these have
more on physiology and pathophysiology and less on actual operations)
10. If you are proactive about asking, you will do more procedures. ASK to put the patient’s foley catheter in in the
OR (nobody expects you to know how, but anyone will be happy to teach you.) ASK to sew up lacerations on
trauma pts. If a pt is getting a PICC line, ASK if you can watch the PICC team place it. ASK to do wound-vac
changes, change trach tubes. Take advantage of the ancillary personel: ASK speech if you can watch them do a
cognitive eval or a swallowing study. Go with PT and OT at least once to see their initial consult on our patients.
If you come to our multidisciplinary conference on Thursdays at 830 in Burnett Womack 4050 (don’t stop and
get coffee after you’re a.m. lecture), you will meet all these folks.
11. Trauma is a team sport! One of the critical parts of keeping 30 injured patients straight in our minds is
maintaining the list which includes an updated list of injuries and problems, operations, procedures, antibiotics,
medications. The students are primarily responsible for this and it is IMPORTANT. It is paperwork, and from one
perspective, it is scut, but as you look around you, you will see EVERYONE doing scut from the attendings on
down. No one EVER rises above scut in clinical medicine.
Trauma Medical Student Checklist
____ Cognitive eval with speech (beeper forthcoming)
____ PT or OT eval in trauma patient (PT Maire 123-2843) (OT Kari 123-7789)
____ Do an AOD consult (Janet Scovill, “cricket”, 347-1005)
____ See a central line placed
____ See a trach and a PEG
____ See a CABG
____ Sit with anesthesia during one of our cases
____ Go to VIR and see a procedure (IVC filter placement)
____ Do a tertiary survey with NP Lissy Olivencia-Simmons
____ Do a C spine clearance
____ Place an NG or corpak
____ Place a foley
____ Participate in a wound vac change
____ See a consult by yourself