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Updates in Trauma Surgery
John Kim, DO. MPH, FACS, discusses new developments and trends in trauma surgery as well as updates for other providers on the latest advances in emergency surgical care.
Featuring:
Learn more about John Kim, DO
John Kim, DO, MPH
John Kim, DO works in Urbana, IL and specializes in Family Medicine. He is affiliated with Carle Foundation Hospital.Learn more about John Kim, DO
Transcription:
Melanie Cole (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episode’s post test.
Welcome, our topic is updates in trauma surgery and my guest is Dr. John Kim. He’s a trauma and general surgeon at the Carle Foundation Hospital. Dr. Kim, explain a little bit about trauma surgery. What’s been the general standard of care? What has been happening in the past 20 years or so and what do you see that’s changing or different now?
Dr. John Kim (Guest): Trauma care in the United States revolves around getting our critically ill patients to a trauma center located regionally depending on where you live. We do have designation as a level I trauma center, which means that we have significant capacity to treat critically injured patients whether it be through blunt trauma, penetrative trauma and those would come in the form of gunshot wounds or stab wounds or motor vehicle collisions and we are set in Central Illinois where we have a fairly large catching area and we provide those services through our level I trauma center to provide the best trauma care that we can here. Currently we are staffed with five or six trauma surgeons, several critical care, pulmonary critical care, as well as a small sampling of general surgeons that do trauma care as well, so we are very expertly poised and equipped to treat all of the critically injured in our area. The trauma surgery has evolved significantly in the past 20 years I think. From the military experience going down all the way down to – going back all the way down to the Korean War to the current conflicts has really proven to push the boundaries of where trauma surgery is being evolved and we are right at the cusp of keeping up with all those different protocols and algorithms and we try to provide the best care that we can.
Melanie: How important is action planning for your field Dr. Kim? As you say gunshot wounds, stab wounds, you can’t necessarily plan for those things but you can plan for what you will do if you encounter them, so tell us a little bit about how you go about doing that?
Dr. Kim: Yeah that’s a good question. Trauma is not something that we plan for. It is a very stressful event especially for the injured patients and their families, but we do recognize a pattern when it comes to trauma. So for example in the winter months, we do get a significant amount of elderly populations who fall and they are on anticoagulations and they tend to come in with injuries to their brains due to intracranial hemorrhage and so forth. The summer months are a little bit seasonal with the hotter days and the people getting all upset and shooting themselves so the summer months are a bit more of the penetrating kind of variety and smattered throughout the year obviously as we live so close to the major highways, we do get a lot of motor vehicle collisions. We do see a pattern in trauma. Sometimes it’s seasonal, sometimes there is an uptick of certain types of injury. The majority of what we see here at Carle Foundation Hospital is the blunt trauma associated with falls and motor vehicle collisions so we are well equipped to have a master plan regarding those specific injury patterns, but we are able to also handle the mangled extremities and penetrating trauma that has been actually a bit of an uptick in percentage over the past few years.
Melanie: How important are imaging decisions on trauma and what role do they plan for the physician in preoperative evaluation?
Dr. Kim: Well imaging is always helpful. We don’t base our decision making on whether a patient needs an operation urgently based on that, so what I mean to say is when a patient comes in and is critically unstable from a blunt injury, the patient will often times not get any imaging studies. They will probably go to the operating room and get explored and have an operative means of controlling the hemorrhage in that way. Imaging really comes into play when the patient is rather stable and we are trying to rule out or rule in injuries that potentially could be missed. So patient comes in with a blunt abdominal trauma and the patient has abdominal tenderness but is otherwise hemodynamically stable, we do acquire the CT scans fairly readily to make sure that we don’t miss a solid organ injury like liver laceration or splenic laceration or sometimes a hollow viscus injury like small intestine perforation due to intraabdominal pressure from the seatbelt. So imaging has a very big role in how we manage the stable patient, usually not so much in the nonoperative patient – nonstable patient, they usually go to the operating room to get explored.
Melanie: What about surgeon satisfaction? Is there a general feel in your field that technology is keeping up with the needs that you’re seeing, Dr. Kim?
Dr. Kim: You know that’s a good question. As far as technology keeping up with the needs, I think what we’re seeing here at Carle Foundation Hospital, as we become more electronic in our medical record keeping and so forth is that it does help with to track patients better and to even get the communication piece to be more clear and articulated as we’re not typing and dictating everything now, back in the day when we used to write notes and could barely read what we the surgeon wrote. Those days are no longer here. But it is important for trauma surgeons to keep up to date on the latest technologies and what’s really come to focus in the past couple years has been the use of ultrasound because it’s low tech, it’s rather user friendly, and it’s fairly accessible at bedside so doing an ultrasound for a focused sonogram exam on the abdomen and even extend that to the chest to diagnose and rule out pneumothoraxes have been a pretty big push in the last recent years.
Melanie: Where does disaster management and emergency preparedness fit into this updates in trauma surgery?
Dr. Kim: Yeah we do live in a world where we have to unfortunately think about that. When we have mass shootings that have become altogether more commonplace. We have to think about how we are as a facility going to sustain a volume of patients that get injured through penetrating trauma such as massive shooting or chemical burns in a big factory or multiple rollovers, so we just never know when it’s coming and hopefully it’ll never come, but we do have in place at Carle Foundation Hospital, a mass casualty plan where surgeons who are on call or not even on call will get an alert and they will show up at the hospital at a designated place and we will be triaging patients as they come through the door. So we do prepare for that annually in hopes that we’ll never have to use that resource.
Melanie: Certainly very good point. So as we wrap up the segment, do you feel that mentoring in trauma surgery is a good way for new technology and new physicians to come together to practice some of the latest advances and what do you see on the horizon whether it is technology based or electronic monitoring and records, where do you see it headed Dr. Kim?
Dr. Kim: Well I’m not sure about how the technology piece works into the mentoring aspect of it when you talk about peer to peer but at Carle Foundation Hospital we do have a general surgery residency so we are training youngsters every day and we are very involved in the mentoring piece of it and we do use technology to groom them for their future careers. So we do have a simulation lab here. We do try to keep up on how to use the latest technologies in their future practice going forward. So for me the mentoring piece as it relates to technology really is more geared toward the residents that have to go through this training.
Melanie: And in summary, what would you like other providers to know about updates in trauma surgery and what’s going on today that’s exciting for you?
Dr. Kim: Trauma surgery is always exciting. You never know what’s coming through the door and that’s what keeps me involved in trauma surgery. It’s not mundane. It’s not routine. Every time that alert goes off on my pager I do get a rush of adrenaline. Trauma surgery is also evolving. We’re trying to make everything as streamlined as possible so that the acutely injured can get to us as quick as possible and so that we can diagnose and treat also in an expeditious way. And I would say, the only thing, constantly traumas change. There are always different algorithms being written for specific trauma pathologies. So the updates are coming frequently, but it is an exciting field and I try to be a part of that here.
Melanie: Thank you so much for being on with us today and explaining and sharing your expertise in some updates in trauma surgery. You’re listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com, that’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole, thanks so much for listening.
Melanie Cole (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please click on the link and complete the episode’s post test.
Welcome, our topic is updates in trauma surgery and my guest is Dr. John Kim. He’s a trauma and general surgeon at the Carle Foundation Hospital. Dr. Kim, explain a little bit about trauma surgery. What’s been the general standard of care? What has been happening in the past 20 years or so and what do you see that’s changing or different now?
Dr. John Kim (Guest): Trauma care in the United States revolves around getting our critically ill patients to a trauma center located regionally depending on where you live. We do have designation as a level I trauma center, which means that we have significant capacity to treat critically injured patients whether it be through blunt trauma, penetrative trauma and those would come in the form of gunshot wounds or stab wounds or motor vehicle collisions and we are set in Central Illinois where we have a fairly large catching area and we provide those services through our level I trauma center to provide the best trauma care that we can here. Currently we are staffed with five or six trauma surgeons, several critical care, pulmonary critical care, as well as a small sampling of general surgeons that do trauma care as well, so we are very expertly poised and equipped to treat all of the critically injured in our area. The trauma surgery has evolved significantly in the past 20 years I think. From the military experience going down all the way down to – going back all the way down to the Korean War to the current conflicts has really proven to push the boundaries of where trauma surgery is being evolved and we are right at the cusp of keeping up with all those different protocols and algorithms and we try to provide the best care that we can.
Melanie: How important is action planning for your field Dr. Kim? As you say gunshot wounds, stab wounds, you can’t necessarily plan for those things but you can plan for what you will do if you encounter them, so tell us a little bit about how you go about doing that?
Dr. Kim: Yeah that’s a good question. Trauma is not something that we plan for. It is a very stressful event especially for the injured patients and their families, but we do recognize a pattern when it comes to trauma. So for example in the winter months, we do get a significant amount of elderly populations who fall and they are on anticoagulations and they tend to come in with injuries to their brains due to intracranial hemorrhage and so forth. The summer months are a little bit seasonal with the hotter days and the people getting all upset and shooting themselves so the summer months are a bit more of the penetrating kind of variety and smattered throughout the year obviously as we live so close to the major highways, we do get a lot of motor vehicle collisions. We do see a pattern in trauma. Sometimes it’s seasonal, sometimes there is an uptick of certain types of injury. The majority of what we see here at Carle Foundation Hospital is the blunt trauma associated with falls and motor vehicle collisions so we are well equipped to have a master plan regarding those specific injury patterns, but we are able to also handle the mangled extremities and penetrating trauma that has been actually a bit of an uptick in percentage over the past few years.
Melanie: How important are imaging decisions on trauma and what role do they plan for the physician in preoperative evaluation?
Dr. Kim: Well imaging is always helpful. We don’t base our decision making on whether a patient needs an operation urgently based on that, so what I mean to say is when a patient comes in and is critically unstable from a blunt injury, the patient will often times not get any imaging studies. They will probably go to the operating room and get explored and have an operative means of controlling the hemorrhage in that way. Imaging really comes into play when the patient is rather stable and we are trying to rule out or rule in injuries that potentially could be missed. So patient comes in with a blunt abdominal trauma and the patient has abdominal tenderness but is otherwise hemodynamically stable, we do acquire the CT scans fairly readily to make sure that we don’t miss a solid organ injury like liver laceration or splenic laceration or sometimes a hollow viscus injury like small intestine perforation due to intraabdominal pressure from the seatbelt. So imaging has a very big role in how we manage the stable patient, usually not so much in the nonoperative patient – nonstable patient, they usually go to the operating room to get explored.
Melanie: What about surgeon satisfaction? Is there a general feel in your field that technology is keeping up with the needs that you’re seeing, Dr. Kim?
Dr. Kim: You know that’s a good question. As far as technology keeping up with the needs, I think what we’re seeing here at Carle Foundation Hospital, as we become more electronic in our medical record keeping and so forth is that it does help with to track patients better and to even get the communication piece to be more clear and articulated as we’re not typing and dictating everything now, back in the day when we used to write notes and could barely read what we the surgeon wrote. Those days are no longer here. But it is important for trauma surgeons to keep up to date on the latest technologies and what’s really come to focus in the past couple years has been the use of ultrasound because it’s low tech, it’s rather user friendly, and it’s fairly accessible at bedside so doing an ultrasound for a focused sonogram exam on the abdomen and even extend that to the chest to diagnose and rule out pneumothoraxes have been a pretty big push in the last recent years.
Melanie: Where does disaster management and emergency preparedness fit into this updates in trauma surgery?
Dr. Kim: Yeah we do live in a world where we have to unfortunately think about that. When we have mass shootings that have become altogether more commonplace. We have to think about how we are as a facility going to sustain a volume of patients that get injured through penetrating trauma such as massive shooting or chemical burns in a big factory or multiple rollovers, so we just never know when it’s coming and hopefully it’ll never come, but we do have in place at Carle Foundation Hospital, a mass casualty plan where surgeons who are on call or not even on call will get an alert and they will show up at the hospital at a designated place and we will be triaging patients as they come through the door. So we do prepare for that annually in hopes that we’ll never have to use that resource.
Melanie: Certainly very good point. So as we wrap up the segment, do you feel that mentoring in trauma surgery is a good way for new technology and new physicians to come together to practice some of the latest advances and what do you see on the horizon whether it is technology based or electronic monitoring and records, where do you see it headed Dr. Kim?
Dr. Kim: Well I’m not sure about how the technology piece works into the mentoring aspect of it when you talk about peer to peer but at Carle Foundation Hospital we do have a general surgery residency so we are training youngsters every day and we are very involved in the mentoring piece of it and we do use technology to groom them for their future careers. So we do have a simulation lab here. We do try to keep up on how to use the latest technologies in their future practice going forward. So for me the mentoring piece as it relates to technology really is more geared toward the residents that have to go through this training.
Melanie: And in summary, what would you like other providers to know about updates in trauma surgery and what’s going on today that’s exciting for you?
Dr. Kim: Trauma surgery is always exciting. You never know what’s coming through the door and that’s what keeps me involved in trauma surgery. It’s not mundane. It’s not routine. Every time that alert goes off on my pager I do get a rush of adrenaline. Trauma surgery is also evolving. We’re trying to make everything as streamlined as possible so that the acutely injured can get to us as quick as possible and so that we can diagnose and treat also in an expeditious way. And I would say, the only thing, constantly traumas change. There are always different algorithms being written for specific trauma pathologies. So the updates are coming frequently, but it is an exciting field and I try to be a part of that here.
Melanie: Thank you so much for being on with us today and explaining and sharing your expertise in some updates in trauma surgery. You’re listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com, that’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole, thanks so much for listening.