Acute care (L) surgery ronald Reagan ucla medical Center goals

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Ronald Reagan UCLA Medical Center

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.

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.
Directory: workfiles -> General Surgery Residency -> Objectives
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General Surgery Residency -> A couple of tips on how to do well on this rotation

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