Trauma surgery

This article needs more primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. Find sources: "Trauma surgery" – news · newspapers · books · scholar · JSTOR (February 2022)

Trauma surgery is a

Most United States trauma surgeons practice in larger centers and complete a 1- to 2-year trauma-surgery fellowship, which often includes a surgical critical-care fellowship. They may therefore sit for the American Board of Surgery (ABS) certifying examination in surgical critical care. National surgical boards usually supervise European training programs; they also certify for subspecialization in trauma surgery. An official European trauma surgical examination exists.^{[citation needed]}

Training for trauma surgeons is sometimes difficult to obtain. In the US, the Advanced Trauma Operative Management (ATOM) course and the Advanced Surgical Skills for Exposure in Trauma (ASSET) provide operative trauma training to surgeons and surgeons in training. The Advanced Trauma Life Support course (ATLS) is what most US practitioners who take care of trauma patients are required to take (emergency medicine, surgery, and trauma attending physicians, physician extenders, as well as trainees).

Responsibilities

The broad scope of their surgical critical care training enables trauma surgeons to address most injuries to the neck, chest, abdomen, and extremities. In large parts of Europe, trauma surgeons treat most of the musculoskeletal trauma, whereas injuries to the central nervous system are generally treated by

Most patients presenting to trauma centers have multiple injuries involving different organ systems, so the care of such patients often requires a significant number of diagnostic studies and operative procedures. The trauma surgeon is responsible for prioritizing such procedures and for designing the overall treatment plan. This process starts as soon as the patient arrives in the emergency department and continues to the operating room, intensive care unit, and hospital floor. In most settings, patients are evaluated according to a set of predetermined protocols (triage) designed to detect and treat life-threatening conditions as soon as possible. After such conditions have been addressed (or ruled out), nonlife-threatening injuries are addressed.

Acute care surgery

Over the last few decades, a large number of advances in trauma and critical care have led to an increasing frequency of non-operative care for injuries to the neck, chest, and abdomen. Most injuries requiring operative treatment are musculoskeletal. For this reason, part of US trauma surgeons devote at least some of their practice to general surgery. In most American university hospitals and medical centers, a significant portion of the emergency general surgery calls are taken by trauma surgeons. The field combining trauma surgery and emergency general surgery is often called acute care surgery.^{[citation needed]}

History

Dr. George E. Goodfellow is credited as the United States' first civilian trauma surgeon.^[4] He opened a medical practice in the silver boom town of Tombstone, Arizona Territory, in November 1880, where he practiced for the next 11 years.

On July 2, 1881, U.S. President

Goodfellow once traveled to Bisbee, 30 miles (48 km) from Tombstone, to treat an abdominal gunshot wound. He operated on the patient stretched out on a billiard table. Goodfellow removed a .45-caliber bullet, washed out the cavity with hot water, folded the intestines back into position, stitched the wound closed with silk thread, and ordered the patient to take it to a hard bed for recovery. He wrote about the operation: "I was entirely alone having no skilled assistant of any sort, therefore was compelled to depend for aid upon willing friends who were present—these consisting mostly of hard-handed miners just from their work on account of the fight. The anesthetic was administered by a barber, lamps held, hot water brought, and other assistance rendered by others."^[8]

Goodfellow pioneered the use of sterile techniques in treating gunshot wounds,^[14] washing the patient's wound and his hands with lye soap or whisky.^[8] He became America's leading authority on gunshot wounds^[15] and was widely recognized for his skill as a surgeon.

By the late 1950s, mandatory laparotomy had become the standard of care for managing patients with abdominal penetrating trauma.^[16] A laparotomy is still the standard procedure for treating abdominal gunshot wounds today.^[16]

In the United Kingdom

In the United Kingdom, trauma surgery is now generally considered a subspeciality of

Courses in the UK for aspiring trauma surgeons include the advanced trauma life support and Definitive Surgical Trauma Skills courses, both provided by the Royal College of Surgeons.

See also

• Transmediastinal gunshot wound
• Eastern Association for the Surgery of Trauma, is a major association of trauma surgeons in the US.

References