Trauma Surgery: Day 16

6a-5p today. Another busy day in the trauma life! The head of surgery was our attending for today, so we got another good lecture from his after our rounds. He is a definite asset to the medical school; he values education and medical students very much, and always makes me feel like I am really a part of the physician-team. We talked about Acute Pancreatitis, which is the condition that one of our patient's is suffering from. He is doing better, remarkably. Hopefully his labs continue to improve and he will come out on top of this. When he came into the SICU yesterday, the mortality was something like 30%...today I calculated it to be around 5%. As long as his condition continues to improve, he will be able to go home. The pancreas is probably non-functional, though, so he will be on strict insulin and pancreatic enzyme replacement therapy for the rest of his life. Many other complications can occur, such as malnutrition, GI obstruction, and transverse colon ischemia. It is a really serious illness.

The motorcycle trauma I spoke of yesterday is being excessively monitored for any changes in the condition. I am becoming more competent in reading radiologic studies, but there is a long way for me to go before I feel comfortable. I'm getting the hang of reading chest x-rays. The CT of this patient's head and neck is truly impressive. With the technological advances in imaging, we are now able to take the 2-D images from the CT scan and, using a clever software program, we can obtain a 3-D image that we can manipulate in many ways, like moving it in any direction, visualizing blood vessels, bones, tissue, skin, air, blood, and many others. It is really cool to be able to see things from so many different perspectives, it makes it easier to catch all of the little problems going on in a really injured patient.

Here are the CT images of the head from this frontal bone fracture. The brain was actually visualized through the bi-frontal bone fracture upon physical examination...

If there is any lesson to be learned here, please! please! if you're going to ride a motorcycle or dirtbike or four-wheeler or ATV, please! please! wear a helmet!!!!

Trauma Surgery: Day 15

woah, day 15 already?! Time is just flying by! Was in today from 6a-7p. Did a bit of pre-rounding paperwork before our M&M (Morbidity and Mortality) and Grand Rounds conference, which was from 7-9:30. It is sooooo hard to stay awake in a dark room with soft-speaking lecturers talking about the details of a particular case. The lecture was on Deep Brain Stimulation, a topic which I love. It is used most notably for Parkinson's patients that no longer react to medications or suffer moderately to severely from the side effects of the medications. We were taught in med school that you place the electrode into the Globus Pallidus Interna, but you can actually place it into the substantia nigra as well...If you understand the pathways, this therapy is intuitive. I won't bore you with those silly neurology pathways! ;) They are actually making progress in the utilization of Deep Brain Stimulation to treat refractory depression, Obsessive Compulsive Disorder, Obesity, and Addiction. You just place the electrode into different specific locations within the brain, make it stimulatory via electrical currents, and watch the patient improve. It is truly one of the most impressive treatments in medicine. A man that shakes and shakes is in the operating room while an electrode is placed into the proper location, at which time he stops shaking and regains fine and gross motor control. It brings tears to my eyes every time I see a video of it happening, it is really amazing what we can do to improve a person's quality (and quantity) of life. On an important side note, DBS actually is more cost-effective long-term in comparison to the long list of medications that a patient must take in order to achieve similar effect (plus drugs inherently have adverse effects!).

This man has Essential Tremor (but the effects are similar to Parkinson's): http://www.youtube.com/watch?v=lUG8iFxukig

2 Traumas today, but motorcycle accidents. The first one had a horrible head fracture. I actually saw the brain through the facial fractures...it was a very impressive site. The patient will be in the OR and then we will follow on our service. With brain injuries, all we can do is support the patient (keep the intracranial pressure low, the cerebral perfusion adequate, the blood pressure optimal, etc), but we can't fix what's broken, so to speak. The brain is too complex to just stitch back together again, like a bone or skin...we do everything we can to give the patient the best chance of making a full recovery, but the end results are, ultimately, out of our control. The patient has to do the rest. It's a slow and difficult process, but it feels so good when they pull through better than you could expect.  I know this is not always the case...    The other MCA was relatively minor, as far as we could tell by the preliminary reading of the X-Ray and CT scans.

A man came in with acute pancreatitis. He has familial hyperlipidemia, which predisposed him to acute pancreatitis (lipase, an enzyme secreted by the pancreas, helps to breakdown fats... and a person with hyperlipidemia has a lot of fat, stored as triglycerides, in the arteries). His prognosis is poor, and we can only support the patient until his eventual and inevitable decline, during which time we will actively resuscitate him with fluids and replacements, and possibly go in to the OR to repair the peritonitis and clean up the pancreatic enzymes as best we can. I need to read up on this...the presentation was a lot like we learned it to be in medical school (excrutiating pain that radiates from the epigastrium to the back; grey-turner's sign; acute onset). So I will end the day with a few loose ends about this particular patient, but I will be sure to fill you in on all of the exciting details tomorrow!