 So that was a very interesting just experience like feeling the anatomical markers and then like actually making my incision, taking my clamps, clamping my chest tube, putting it and pushing it and feeling the actual pop of the tissue and the chest tube going in. All of that stuff is like it's amazing. What's up you guys? It's Adana. Welcome back to my channel. If you are new, go ahead and subscribe right now. Kind of browse on my channel. See if you like what you see and if you do, definitely stay a while. Join this journey on with me. And you can also go to my Instagram at AdanaThePA on Instagram and follow me on there as well because I like to post different things on Instagram that I do on YouTube. All right, now with that being said, this video is going to be about my experience, just a more detailed experience on my trauma rotation. I recently did a video about just kind of summing up what I've done so far in my trauma rotation and I have completed that rotation, but I saw that you all wanted more details on what exactly goes into the trauma rotation. So that's what this video is going to be about. With respect to the types of trauma that I see, I was at a level two trauma hospital. So, I mean, if there's something that's really, really, really extremely serious that we cannot handle at our level two trauma center, then we will send them to the level one trauma center. That is a local trauma center in our area. But my particular hospital, we still got a lot of like your typical MVCs, which are your motor vehicle collisions, your MCC, so your motorcycle collisions. We got a lot of falls from standing. There's usually like someone that is older and they had a stroke or like an MI or something that went into a cardiac arrest and then they were standing and they fell. So it's a lot of that kind of stuff where somebody didn't take their hypertension medicine and so now they're very hypotensive and then they fell and they struck their head. And so we'll see a lot of bleeds. We also saw just a lot of assaults because of the area that I was in. There are gang activities in that surrounding area and then just a lot of just nightlife. So drugs and prostitution and things of that nature where people get into fights and those fights can turn deadly. That's obviously like the end-end game but they come in with very, very serious injuries. So when a patient comes through the trauma bay, you're either a level one or level two or level three trauma. So you're level three traumas, there's a criteria for them all, but you're level three traumas can usually be seen in the emergency department just by themselves. Although we are connected, we're technically two separate entities. So if you are a level three trauma, you can be seen in the emergency department. If you're a level two or level one, that is our area. With respect to your level one traumas, level one traumas are your traumas that you think of where it's gunshot wounds, stab wounds, where there's going to be a lot of blood. So you're completely down. So as soon as you hear a page come through and yes, we still use pages where like carrying these pages around and then we'll get the page and you'll hear it called over top head, you know, level one trauma, ETA five minutes or ETA two minutes or level one trauma now. So you'll get your page and you go immediately. It doesn't matter where you're at. I could be up in the call room, logging patients or studying, which I did often or if it's nighttime because I did 24-hour shifts, I could be sleeping and then I get this page on my side. So it's always important to have the page nearby or on your person so that you can get the page, feel the page and then be ready for the trauma. So as you get that page, you go down, level one traumas, you're completely gowned up. You have your mask. You have your caps on. You have your full like gown and gloves and then you have your shoe booties on because you know, it's bloody. It's messy. You don't want to really dirty your clothing and your shoes and stuff. I mean, I wouldn't want to but luckily there is a scrub machine in the hospital and as it is in most so you can always go and like throw in the soil scrubs and then get a new pair but who wants to do that, right? So gown up, protect yourself because you have no idea what's coming in. You don't know if they have contagious illnesses that, you know, don't necessarily want to contract so but you still have to go ahead and help these individuals. So the level ones gown completely up level two. I mean, you just have your gloves on but you're ready with your stethoscope, your shares and as a student, I was just kind of there. So I was there like in the mix but not completely, completely in the mix. So when the trauma comes through, the EMS will bring them on the stretcher and then we have to pull the patient onto our beds. So I helped out with that. I would always be there ready to pull the patient over. If the patient has a C-spine collar on which is to protect their C-spine, their cervical spine so that they can't really turn their heads like that then I was usually the one that was protecting C-spine because we go through a full like very quick and dirty assessment of the patient. So, you know, we do the GCS scale, which is your Glasgow coma scale to kind of tell you how aware the patient is, which it deals with eye movement, their verbal, like are they talking to you or not, and then their motor skills. So are they moving all extremities? Are they not? Are they coming up to you like that? Are they only responding to pain? Those type of things. So that tells me kind of really like how sick is this patient really and do they need to be innovative? Do we need to protect their airway? The saying goes less than eight intubate. So definitely you look at it and you're like, okay, does this person need to be intubated? But I mean they could be not nine on the GCS or sometimes maybe even a 10. And depending on like if they're progressing really quickly, like I had a patient that had severe facial edema and was progressing really quickly, their GCS was a 10, but we had to intubate them because it was like, no, like there's, their airway could be closing in any minute. So things like that, but we out protect the C-spine. So we'll have to turn them. So I hold the C-spine, turn them. They'll walk down their back to make sure that there's no pain there. And immediately when you come in as well, like I'm the one that's taking off all of your clothing. So every trauma that comes through the trauma bay, they are completely undressed. Only their underwear is left. We'll put warm blankets on them and we'll also put a gown. So that's what I'm doing. I'm pulling off all of their clothing, putting warm blankets, putting on a gown. Next thing is we're asking them questions like, hey, how are you doing? How did this happen? What year is it? Who's the president? What's your name? All of those information to see if they're alert and oriented in terms three or times four depending on what they say. We're looking at their eyes, like are their pupils equal, round and reactive to light and accommodation? If they're not, then we document that. We look in their ears depending, you know, that's really important in traumas. Are there any, is there any bleeding or is there any spinal fluid coming out of their ears or their nasal cavities because the fluid will be a little bit less bloody, or clear or a mixture of blood and that clear fluid and you would think, okay, so they have a fracture in one of their, the bones in their skull because that's one of the ways that serial spinal fluid will leak out. So we look at those things, we also go and we'll talk out what are the different injuries that we see. So if there's a last question to the anterior forehead, we'll talk about that. If there is a stablinal laceration to the chest, we'll listen to breath sounds. Are they equal? And my thing, so for me, I listen to breath sounds. Sometimes I would do like pedopulses. Do I feel the pulses? Are they two plus or not? I also took IVs. So I would start an IV on every last one of the patients. After my second shift, which was a 12 hour shift, my first two shifts for 12 hour shifts and every shift after that, I did 24 hours. So after that, I always started IVs. I would take every opportunity that I can to do that because it's not necessarily a skill that I did a lot of in PA school and so I wanted to make sure that I was able to like keep up with that. So you start your IVs and you fill your, you get your blood and you start your IV and you fill your different containers to send out to the lab. So after we've gone through all that, the patients undressed, blankets are on, IV is in. We do either normal saline or lactated ringers depending on if they have a brain injury or not. We would choose the different solutions. Usually it's a leader of that and that's automatic. So after we've started that, gone through all of our systems making sure, hey, do we hear breath sounds? If we don't hear breath sounds, then we put a chest tube in and I was able to put in four chest tubes on my rotation there and it was cool. It's cool seeing bedside chest tubes done because it's different than seeing the chest tube placed in my CT surgery rotation. So that was a very interesting just experience like feeling the anatomical markers and then like actually making my incision, taking my clamps, clamping my chest tube, putting it in, pushing it and feeling the actual pop of the tissue and the chest tube going in. All of that stuff is amazing and it just made me appreciate even more. I'm like, dang, this is amazing. I cannot believe that I'm actually doing this. My hand is in someone's chest cavity. My finger is in there, feeling around, making sure I can break up adhesions and things of that nature. That's also something that we do. If there's breath sounds are not equal and like the patient is desatting then immediately we're putting in a chest tube. There are times when you may not necessarily see that initially and that's when you go to our next step in the trauma, I guess you can say organization. So after we've done all of that, the next thing is to take them straight to CT scan. So depending on their injuries we either can scan them or we choose the specific areas that we're going to scan them at. If they were in a motor vehicle accident or like abrasions to their leg, their hand is swelling then we'll get like a hand, AP of the hand, AP lateral maybe and also of their knee, their leg, whatever the case may be. So we take them to the CT scan and usually stay with them and one thing I have to tell anybody that's going on a rotation or going on these types of rotations always, always, always help your nurses out. As a PA I mean, obviously they'll have they have other things to do so they don't always go to CT but after they've done putting in their orders then they'll come over. But as a student, you know there's nothing else that you have to do. So go ahead, you can watch your PA preceptor put in orders and stuff at a later time go help your nurse be like is there anything that you need me to do push the bed and that's what I always did, I pushed the bed to make sure that things were clean I'd pick up after myself put chucks down when I'm doing different procedures but that's always, that's something important to remember. But we take them to CT scan they get their CT scan then and then we bring them back and at that point if there's a laceration an open laceration and they have blood on their face that they need to clean up that's me, that's where I come in again so I will clean them up I will do these lacerations I got to do so many laceration repairs you guys I'm not I'm not lacerationed out but I was like lacerationed out I was like oh absolutely you need a laceration done oh you need me to repair a finger laceration a hand forearm anything just let me know because I wanted to take this opportunity to get as much experience as I could so a lot of times I used pro lean I had a gentleman that was assaulted he got cut we saw it on his the outer part of his cheek but my preceptor was like you always go ahead and make sure that it doesn't go all the way through so after you numbed him up take your hemostat and push it and see if you can see it on the other side or open his mouth and push it open to see if you can see a hole going through and sure enough the hole was like all the way through so I had to use chromic in his mouth which is what you use in like meekest membrane areas and it's like absorbable and then I use like a pro lean on the outer part of his face because it's nice and it's blue and it's fairly strong and you can see it so when it's time to go and remove those sutures because pro lean is not absorbable then you can just cut in and be fine so and you you have to learn those things but you know in school we learn about the different kind of stitches that you throw but I didn't get that much education on okay absorbable versus non absorbable micro filament or poly filament versus monofilament why choose one over the other that kind of thing obviously you know absorbable and non absorbable in areas that you like are inside of the body you're not going to use a non absorbable suture you know in the deep tissues of the body you're going to use absorbable but so those things are kind of like common sense but just trying to figure out okay am I going to use um vicaril or monocryl or pro lean or chromic like all of these different sutures f con like what f lean like I don't know so I had to look that up and so it's important also to just kind of get um an idea and have like Google on on your like speed dial like as you can say to look up this information but after I would do that I'd suture up or clean up whatever area needed to be clean then my work was essentially done I would um document my procedure notes um so you're not like I would I would help out your as a P.A. student you're not allowed to document which is something I feel like probably should be changed because the med students are able to document the different procedures and things that they're doing and if I'm the one that's doing the procedure which a lot of the times like I'm the one that's doing elastration repair or I'm the one that's removing the staples from you know a patient skull like that they're coming back or whatever the case may be when I'm giving discharge instructions then I should be able to like write the note because I did it so that's something that I think we should probably look into like getting changed somewhere in the future but um I would also I would help out with my note my procedure note or I would type in the information and then they would look at it to make sure that they agreed with everything and it was accurate and yeah and then after that uh if another trauma came through then I was on the other trauma if not uh you kind of just take your time wherever you can to go get something to eat make sure you have a lot of water um because a lot of times what will happen is you'll have a good trauma come through then you're spending like a good 30 or so minutes suturing because there might be like a lot of lacerations that you have to suturing clean up and then another trauma comes in like immediately right after so you're just kind of in the swing of things and you don't realize how long you've been standing for and you're kind of tired and drawn out and like weary and so it's important to just stay hydrated stay fueled um not overeat because a lot of it is overnight as well and what you see at night is very different than what you see during the day but all in all it was a great experience I loved it I hope you guys have a better understanding of exactly what I do um I can just again go through the really really quick points which is immediately the trauma beeps uh I got a beep page on my beeper um a beeper yeah so I get a page coming through and then the trauma comes in immediately I take off all of their clothing we look to see if there are any overt fractures bones coming out of the skin um bruises uh if there are any step uh for like kind of deformities going down the back um or on their shoulders like you know for clavicle injuries those kind of things and then from that um we will start the IV we'll put in the fluids and um also another thing is you start kind of putting in order so if it's like a dirty injury like a motor vehicle accident there's an open wound you know you're obviously gonna give them some type of antibiotic and also managing their pain so it's important to like understand okay am I giving this patient like flexural and like motrin and things of that nature these NSAIDs and muscle relaxants to help with that kind of pain or am I giving them like morphine or dilated um because you really want to like you know you always say about these opioid uh the opioid crisis and um you know and things like when there's like a broken rim stuff those things are painful so like opioid crisis kind of is out the window you're like now I'm gonna give you some dilated or oxy for that pain so it's important in understanding your patient and managing the type of pain that they have um then we'll take them to CT scan see have a report of exactly what is going on with the patient and then you manage the patient from there they come back to the trauma bay you manage them if you have to suture up and and fix these lacerations you go ahead and do that and from that then you kind of just send them off to the floor or you just charge them home depending on how healthy or sick they are so um it was exciting you guys I had a great time this was a very detailed video on that a little bit longer than my videos usually are but I wanted to give you guys a feel of exactly what my day was like uh anyways if you have any other questions please be sure to leave them in the comment section below and um if you like this video go ahead and hit the like button follow me on instagram at adana the pa and I can't wait to talk to you guys next time bye