4 3 neither the el paso medical society its members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor [Music] hello and good evening it's been a hectic day thus far and we're having a good time here in the studio i'm katherine berg and we're going to talk this evening about the dynamics of trauma surgery we talk often about all kinds of different specialized surgery but sometimes you don't know what's coming your way and the doctor that we have with us this evening specializes in trauma surgery and so we're going to get to that in just a few moments if you have any questions during the program that you're interested in calling us for it's a live program it's eight eight one zero zero one three you can also catch us on youtube.com you can go to youtube.com and then search for el paso physician live and we're gonna be airing there as well we want to say a huge thank you to the el paso county medical society but also we have a student here today with the paula foster school of medicine who is going to be manning our phones and that is emily rick and emily rick and i were joking back and forth we had one doctor that we are missing so i said emily you're a medical student you can come join us but she chickened out so she's hanging over there um but anyway we're going to concentrate again on trauma surgery the dynamics of what happens in that emergency room and surgically in that realm again live questions 881-0013 this is the 25th anniversary of the el paso position and a huge shout out to the el paso county medical society for bringing this program to you i'm katharine berg and you're watching the el paso physician it's interesting cause i'll have some of these doctors on the show and yeah they're doctors but i've known them for 20 years we've been doing this show for 20 years you know he talks about farts and he talks about diarrhea and he talks about all kinds of things that nobody wants to talk about and that's what's great about the show because you get to hear those things on the show and go i'm not the only one it's great see el paso physician [Music] trauma care what does that mean it's not something we ever want to be in but every now and again there is a car crash that happens there is someone that falls out of a tree when they're cutting branches there's all kinds of things that go on and we have a surgeon with us this evening dr grace ing who is going to be talking about some of the gruesome things that you've seen but more importantly how is it that you help put people back together at the end of the day so i want to say thank you so much for being here i know that we talked about your special being trauma surgery you also said that you do a lot in critical care and that you are an intensivist and i just love that words i know that we were joking a couple months ago about there's hospitalists now and you're an intensivist um so along with trauma surgery what is it that that your specialty is and i'd love for you to kind of define what intensivist is it's hard to say that intensiveness sure absolutely thank you for having me today so essentially i'm trained in trauma surgery and surgical critical care um and as an intensivist we work in an intensive care unit and so there's medical intensive care units and there's surgical intensive care units and so we specialize in patients that have surgical issues or that have traumatic issues okay and so to say traumatic injuries oh i know it's a whole big book to say that but what are the most common surgeries that you perform as a trauma surgeon so personally as a trauma surgeon a lot of what we do involves getting into the abdomen or the chest those are our major most people that have injuries oftentimes have injuries to the abdomen or the chest and we even do sometimes the neck or any any kind of traumatic injury could be any part of your body so it could be your head which would require a neurosurgeon it could be your bones which would require an orthopedic surgeon so we're a multi-um multifaceted team that work together with numerous surgeons for us to be able to give the best care to our patients that are injured and that's nicely explains i know that originally uh we were looking at neurosurgeon and orthopedic surgeon and then the trauma surgeon and i said of everyone to be able to be here today the trauma surgeon's the one so thank you for that um because and i'm kind of glad that we don't have gruesome pictures because every now and again we'll we'll see something and it's like okay i need to fix that so your realm orthopedics is fixing something mechanical i get it right and then when we're looking at abdomen that's really life-threatening stuff so when you get into that situation and let's let's throw out an idea of a car crash um and often there's injury to the chest you know i'm thinking steering wheel and this is something where just think of some case studies that you've worked on before and traumas that we might be able to discuss here what might happen in a car crash and i'm again i'm thinking person sitting steering wheels here in the old days there the stick shift was a thing there's not that thing anymore so much eyeglasses airbags etc so kind of take it from that front and tell us some of the things that you've seen and you've had to work on sure absolutely so you know in trauma care everything is unexpected so and any part of your body can be injured so if we just take a car crash for example if we go the neurosurgical route they can have a head injury if they hit their head really hard on the steering wheel in a window or if they get ejected from their car they can have a head bleed and it could be severe and it could be life threatening and then we can just kind of march down the body you can have a neck injury from a seat belt seat belts can also cause injury to intra-abdominal organs um if the impact is hard enough you can get rib fractures which could also then damage your lung and bruise your lung if we think about the abdomen as a general we have lots of things in our abdomen and those injuries can be either very straightforward to deal with or they can be very fairly complex if multiple organs intra-abdominally are injured so that could be your liver your gallbladder your spleen your pancreas your intestines so anything on the inside yeah but it's actually one of the most commonly injured organs back there kind of hangs out here on the left-hand side um and so you know then we keep marching down you know your bladder and then you go to all of your bones and really anything can be a life-threatening injury because um you can bleed from bleed from it so bleeding is 100 like number one reason why um trauma patients are so sick is because if you lose your blood you're not providing oxygen nutrients to the rest of your body so the first thing that happens when someone comes in that we have to be acutely aware of is how good is their blood pressure right so on that note too if you're and i'm when you said seatbelt and ribs i'd like to kind of go to that section for a little bit um and the airbags you know that's face i get it that's cranial surgery then you're looking at those kind of bones but um when there's a rib or two broken and and i'm just thinking too you've got stuff you've got the stomach you've got the lungs you've got everything kind of in the way are there two surgeons that would have to go in and operate if there were ribs broken had to get them out of the way then go into the soft tissues is that something you do completely do you have a team how would that work if there's multiple injuries happening in the chest area because there are some bones involved sure but just in general how would that work out yeah so um it depends on the injury of course so a lot of rib fractures end up being non-operative meaning they don't require any kind of intervention and it's time bones will heal the concern that we have with rib fractures is how displaced they are so how you know angulated they are because you're supposed to have a smooth bone and when you break it it of course causes some kind of uh trauma extra trauma because of that so um trauma surgeons actually can do replating as part of their uh skill set tell me what that means rib plating saying that so that's like our inset into some kind of orthopedic trauma because it's the book we're covering it today there's been disclaimers that we've thrown out there and we're doing the best that we can with orthopedics too but it's very fascinating i feel like that's something that it's almost like puzzling things back together right so we essentially realign the ribs so that they become um more normal in ability so you know our there's a lot of anatomy and physiology to how we breathe and so your ribs have to expand for you to take a deep breath in so your chest cavity expands and your bones kind of help you do that and so when your bones are broken every time you breathe it causes a lot of pain and so pain control is one of the biggest issues with people that have multiple rib fractures because your bones are misaligned and so just like any broken bone you would like to be able to realign them if it is the right thing to do at that time so not every rib fracture requires plating or realignment some of them will just heal on their own but in that scenario we do that as trauma surgeons and then inside of the chest cavity so for example if there's a lung injury or something like that we also can take care of that anything more centralized we would have to again it's a multi-disciplinary team so we'll bring in our cardiothoracic surgeons if necessary our vascular surgeons is necessary as well and all of that so i'm always fascinated with the different disciplines and on the operating table and the amount of time because we talk a lot about time in different medical procedures on this program um so we've got the orthopedic surgeon he's getting the bone stuff out of the way you're getting all the admiral stuff and now we have um we have issues with the heart do you literally just move out of the way the cardiologist then comes in and does his stuff or how how does that approach work and i i know everything's different and every situation is different but i'm just trying to think of the different doctors that are operating um at any given time sure so it all depends um and as you said it depends on the situation so we have to treat the most life threat most life threatening thing first so if it means that they have a cardiac injury then that's the first thing that we that we address um and that could be us in conjunction with the cardiothoracic surgeons we take care of that first um things that require immediate that do not allow us to pump blood to the rest of our bodies and provide the oxygen and the blood and the nutrients that we need to heal and to stay alive really um is what we go to first so we control bleeding we we address anything that is life-threatening number one and then then everything else subsequently comes into play okay that makes sense so um this is let's get away from car accidents for a little bit um and in your tenure in doing things is there a certain surgery that sticks out to you in your mind that you thought okay this this is bad and you get in there and there's a way to fix it is there something specific that you've had to deal with you know just during your career that you thought okay i'm not sure how this is going to work out it worked out fine or you know sometimes on the opposite side too but uh just a storytelling type of a thing well there's many scenarios um i probably can think of um a few actually and they're kind of generally you know when people have polytrauma meaning they have many different injuries uh from the same accident um you kind of you know the most satisfying like i said is you go in you see that there's blood in their abdomen and you're like we gotta go in and figure out because you don't always have to search it you have to search for what's happening okay you get a gunshot wound to the abdomen and your patient doesn't have a good blood pressure so you have to go to the operating room and address it you go in there you look for it you find it you either fix the hole in the small intestine or the large intestine you reconnect it or you take it out put it back together stop what's bleeding and then you close the patient and you're done there's you make this sound like it's like a mechanic like you're in there it's like i take this i take that tube and i'm just thinking to myself all the things that are going on in there um and as a surgeon too we had a program a couple of weeks ago on robotic surgery and as a trauma surgeon um there are so many things that the robotic surgery does with just tiny little claps and what have you do you ever get to use a system like that are you hands on all the time and again it's trauma so it's it's fast it's not like i've got weeks and weeks to plan this out um they come into the emergency room and and boom what are some of the procedures that that you're able to use so usually we're kind of maximally invasive in trauma surgery just because um there is no time and you need to get in so we a generalized abdominal injury we do an exploratory laparotomy so they get like a midline incision right here in the middle they just get cut down in the middle okay so we have the best visualization because if you can't see you can't you can't do what you need to do so that's always number one there you know depending on the stability of the patient that can actually kind of determine if we can do some of the more um like laparoscopic or robotic surgery that's kind of coming into play um sort of in the background but it's coming into the forefront and in certain places and in the right patient there's a possibility to use the robot to be able to repair some injuries and the example that i can give is someone who's a stable patient that might have a diaphragm injury and our diaphragms are fairly high and so sometimes if you do open surgery it's actually harder to get up there and with a robot you're able to actually have a fairly good visualization and be able to repair it so i'm going to ask and i and i feel like i didn't prepare you for this but when you're talking about a diaphragm injury in the robot um if you can explain as you said visually our hands and looking in there but if you've got the rollback and the cameras if you can maybe explain to the audience how it is that the robot can see and how you're operating the robot robot so that you can get into you know little crannies was it crooks and crannies as they say sure that you couldn't do with your hands so you can get in there with your hands it's more of a visualization so usually um so we can see our diaphragms from our abdomen so we'll we would so just like laparoscopic robotic surgery in the abdomen um you utilize insufflation so gas to be able to insulate to open up the abdomen and that's how we do all of our other surgeries like if we take a gallbladder out or appendix out it's the same concept except now we're focusing up here so you can look at it as if you're putting in ports in your abdomen you blow it up and you put a camera in and you just look up you're looking up at your diaphragm and you're able to see it and then in that manner that's how we visualize an injury and then potentially put the other ports in place so that it's in the right spot for us to be able to repair it so on any given i have a question here from the audience and i think we talked a little bit about it but sergio is listening and he's asking do they immediately check for internal bleeding in trauma scenarios and i think that you kind of mention that too and what i'd like to do is think of somebody that's coming into the er and what tools are you using immediately to visualize what's happening there's cat scans there's mris resist and that and the other um and again feel free to throw out any case that that you've seen in the past like who would get a cat scan who would get an mri who can you just clinically look at them and say oh this is what's happening we need to fix a b and c sure of course so it's interesting that you bring up a b and c so um we follow trauma surgeons across the country and the world follow what we call it atls which is advanced trauma life support and this is essentially a nation slash worldwide um curriculum that every trauma surgeon every provider that does any kind of emergency care um takes and it and it's in its uh abcde um and that tells you so we go airway which is a breathing and then circulation disability which is how we tell about someone's neurologic status and exposure that's essentially us being able to remove all clothing and anything covering the body so that we could visualize any other injuries that could be covered by clothes by blankets and things of that nature so um we have if there's a system there's a system in place and that's priority so if you can't breathe you're not alive so we can't even take care of you so we have to do that do that deal with that first and then breathing kind of goes right along with it if you have some life-threatening chest injuries that need to be addressed immediately and then we have to take care of that the circulation means blood pressure so let's talk about bleeding right so there are scenarios where a patient does not have a blood pressure and if say for example they had a gunshot wound to the chest and they don't have a blood pressure we would immediately likely have to do what we call a emergency department thoracotomy it's a resuscitative thoracotomy okay slow down the economy in and of itself sounds interesting so what is that so what that is is um you actually have to open the chest to be able to access the aorta which is the big blood vessel that supplies our entire body and um when you say open the chest go in opening the ribs as well correct we get into the chest to be able to access the heart um we'll be able to see it and um it's doing like internal chest compressions so usually when someone um what we say someone dies um and they need cpr we do cpr from the outside so we press on their ribs to try and restart their heart by essentially helping the heart pump so in that scenario if say for example your patient is near dying you have to um open the chest and you actually do internal compressions which means you actually have the heart in your hands and you pump the heart to try to bring blood flow to the rest of the body that sounds so stressful so as you're doing blood flow with your hands is there a certain point where you just feel the heart coming back and then you like how do you know when to let the heart go that sounds so dramatic um but you're in there and and you're feeling it is there a certain amount of beats that you would wait before you backed off i'm just trying to think about how one would do that it's it it's essentially you have to kind of observe and look so what happened what what you need right so we said that the one thing that uh the number one reason why people don't have a blood pressure when they come in is they're probably bleeding so your heart is empty it doesn't have blood to pump to the rest of the body so you feel that as you pump the heart you know when it starts to get full and you're getting stuff out and then you'll see it you'll be able to you can feel it and you can see it it's right in front of you so any small amount of time that you get away from that heart you take a look at it and you hope that there is a normal rhythm of the heartbeat that's going and then there's other algorithms that we we do thereafter to go what's next so i'm thinking too a lot of blood is being lost and this is where maybe this is a shout out to anybody that needs to if you need a volunteer thing to do go give some blood because trauma surgeons need it yes so when they're they're looking at losing blood like you said circulation is not going well and so when is the introduction of blood come in and i and i know these are all these are all specific to the case so i'm just trying to get stories and ideas of uh verbalizing it to where we can create pictures in people's minds so now we're bringing in a couple of is it a leader at a time blood that you're giving in or how does a unit i know it's called a unit but how much is a unit yeah so um there's blood comes in in components so we have whole blood uh so well this kind of gets into two different kind of topics but yes please donate blood need it um and all of our patients definitely um they don't know it but you are saving their lives um at that moment in time so it actually makes a extreme difference in their lives um so at umc thankfully we actually have whole blood which was instituted within this past year and um usually when we think about blood transfusions we think about transfusing what we call in components so we would give prbcs which are just the rbcs the red blood cells and then you get your ffp which is fresh frozen plasma wow look at this okay platelets right and so together combine those make up what our blood is as a whole so um in in history it's kind of come back and forth of whether or not we use each component on its own or we just give you back everything that you lost so because we when we lose blood when we bleed we bleed it as one whole like we don't bleed it out in little components right so um the military has actually been fairly instrumental in kind of bringing this back and they've always used it actually the military has walking walking whole blood unit blood units um within those that are in the military but this has kind of come back into civilian care and so within this year that we've been able to transfuse whole blood so whole blood units are about 500 milliliters of a unit the pr species are usually about 250 each so when we think about blood transfusion if we know that the patient is severely injured and we know that they're bleeding our first go-to is to give it back so i'm embarrassed that i don't know this of all these times we've talked about blood so you said going back and forth let's say we're in 1940 something and there's people that are in war et cetera was it always whole blood at that point etc but for the the general thought process in my head i always thought it's always whole blood unless there's a different reason for it not to be whole blood um so what you're saying if i'm understanding it correctly is that usually it's components but we're trying to get back to the idea of whole blood yes that is correct okay so when when would that have been a thing like when would you just do red blood cells um versus the whole blood and maybe you can look at you know decade ago three decades ago maybe just to kind of explain that process for people who are interested in the history of that i had no idea sure i actually i can't tell you the exact same no just kind of around you know just kind of just kind of curious i believe that it's like i think it's around the in in some of the world war uh world war ii um and is sort of when it was a little bit more well discussed and thought but not out i think it was not outright the the um what what they did in the hospital systems it was more so within wartime because if you think about if you have to separate blood you requires machines and things of that nature which you can't have on the field right exactly so um you know the the nice part about you know getting it as a whole is exactly the thought process of you don't lose it separated you lose it as a complete hole and there's many advantages to the utilization of whole blood there's less anticoagulants in it right so if you're storing blood you blood clots right so we hope that it does it would be normal if your blood would clot and so if you're storing blood um you have to have anticoagulants in the blood itself so when you're giving it back you're also giving back some anticoagulant just by sheer nature of it being a preserved unit and so it with a unit of whole blood since you're essentially getting you get more blood in that the rbcs in that package with less of the anticoagulant in it so it's actually more beneficial in terms of that because every traumatic patient that comes in they are already at risk of having coagulopathy which means that you're more prone to bleed because you've injured some part of your body and that's just our body's natural reaction to being injured that's fascinating i didn't realize that um and so here goes i guess the follow-up question to that is if there's multiple injuries but when i say injuries flesh wounds um that you're bleeding out from so then there there's where the the magic comes in right we have to make sure that breathing is open we got to get that going can't do anything without oxygen blood is flowing and you're also trying to stop the blood so um tourniquets etc etc etc um when someone and i'm gonna go to ems let's say so now there's been a big accident and ems starts something we were talking a couple weeks ago about these mobile hospital rooms and that's kind of what it is taking yourself out of being the trauma surgeon for a moment and maybe put yourself in the headspace of an emt and they have a bad accident and there's a lot of bleeding going on and they have to stop the bleeding before getting to you so that you can actually work on them sure um what is it that they're doing in the ambulance um and again i'm just throwing it out there with whatever scenario you want to throw in there but something that's you know internal bleeding external bleeding etc how are they handling all of that sure um you know we can't do our job without ems and so you know major shout out to all our ems ems crews that come to us and um you know depending on which ems crew we have so some of the flight crews have a little bit more resources um on their plane on their helicopters than maybe just a ground ems does but all of them of course so in terms of stopping bleeding let's just say for example someone has a big cut to their arm we always advocate pressure first just put direct pressure on it whether it's you see it and you just put a finger on it or if you put some gauze on it and you just do direct pressure tourniquets as we know is something that has definitely come back into play and has required extra training because there are appropriate things they're appropriate times to place a tourniquet and sometimes it can do more damage than good but in the setting of being out in the field you you have to deal with what you're given and so if it means that that's the best way for them to stop the bleeding then we just have to be very judicious when the patient arrives for us to be able to remove the tourniquet as soon as possible because you know when you put a tourniquet on you're stopping bleeding which means you're also stopping blood flow to that part of the body which could cause damage it could cause nerve damage it can cause muscular damage and so these are kind of things that um when you're at when you're in the moment you you have to use the resources that you're given and so many there's a stop the bleed campaign that is nationwide and it's advocated by the um american college of surgeons and the committee on trauma and essentially you know if there's a it's a stepwise thing right it's it's how we can save a life potentially if you're a non-medical and you're in a you're in a scenario i love this dr ing so i'm going to ask you um we're all now on a field trip and dr ing is here to teach us how to stop the bleed i love that um so if we could maybe go into how how you would help lay people who are camping or who happen to be you know on a running course or whatever i would love for you to kind of go through that for our audience so they can kind of understand how that works so i want to understand it i feel like i took you know life-saving and lifeguarding all that kind of stuff that was like 35 years ago you know so what's new well i mean it's believe it or not there's nothing extremely advanced about it it's very basic um the the whole point of is is direct pressure is the best way to start so don't be afraid to jump in yeah i think that's one of them too right just exactly jump in because you know you anyone out there could end up helping to save someone's life so if someone is bleeding out from an arm and obviously the person who's injured is not going to be thinking about how they can help themselves because they may not be able to at that time right so as a bystander you know if you see something bleeding the first thing is if there's one thing that's bleeding you put your finger on and just kind of hold hopefully you have something that you can you know guard yourself to be safe so this is another thing is you also have to remember to keep yourself safe so you never know what someone else's blood has but you know in a star so you still have to be able to protect yourself if you have a gauze or some kind of cloth or something of that nature then you can you know make a dressing of sorts to maybe kind of fold it up kind of like a handkerchief and be able to place it on whatever is bleeding and hold pressure um you know everybody anybody has a tendency if they see bleeding you know to just start you know everybody kind of goes a little nuts and that's a normal reaction that's that's not um it's it's not a criticism it's just this is how people react this is being a human being right and so um you know you kind of have to take a breath and then and then step back into just like a second right and be able to kind of think about it that way um you know obviously there are schools should usually have little tourniquet packets that are part of this campaign and essentially you know you place if you need to um and you absolutely can't stop the bleeding you piece place that turner kit on there i mean you mark what time that actually was placed because that's what's essential what is essential is how long have you actually cut that blood supply off and so that's usually like the last resort if you absolutely need to and you cannot get control any other way then you know then you do need to do that to hopefully not let somebody bleed out people kind of talk about makeshift tourniquets if they don't have like an official one and sometimes people come into our trauma bay with belts or sheets tied across whatever extremity that has been injured um and you know certainly as i said you know people do what what they have available and so um for us it's a we have to take tourniquets with a grain of salt because we also we do know that they are potentially life-saving but that they also can cause some injury but as anyone out there is you know start with pressure start with direct pressure um and then you know if you think about something that's bleeding here you might want to hold above and below it just to get control right above and below put pressure above and below and that should be able to help you um to tamp and otter you know stop or slow down the bleeding until somebody of you know whether until ems ems comes and they can take the patient you know i'm sitting here thinking and it just seems so intuitive to us like we'll call 9-1-1 um but every now and again in in the heat of the moment in years everything's just going crazy luckily we all have our phones for the most part on us all the time um and so i'd say the most important thing and and tell me too uh what stories you've heard or what you direct patients to do or i guess again with the with the training when do you stop to call 9-1-1 i mean i'm thinking to myself i've got a hand here i've got a tourniquet here oh shoot my phone's 20 feet away um but that's the most important thing is you need to get help here right right so maybe talk about it was it the stop the bleed campaign um what steps are in there and when do you call i mean immediately if you can immediately if you can and then you just do what you can until somebody that is able that is fully trained can come and help you um you know hopefully there's always somebody else available that can grab your phone or whatnot if your patient if the if the injured person is awake enough perhaps they can help you you know if they have hopefully it's just one extremely that's injured maybe they have the other one that they can help you out with or if you've told pressure for a little bit and it's controlled and the patient who's injured is awake and can talk with you then you know you can try and work together to try and call but that's always a tough situation that despite the fact that we have so much access to being able to communicate with people that potentially in the time that it matters the most it may not be right next to you exactly and i'm thinking too with accidents and trauma i mean usually obviously things like that happen in our home but i'd imagine a good amount of time we're out in public or some kind of public so not be shy and just scream for help yeah um because there are some and again you're thinking about intuitively once you get out of that shock system um of trying to go to it so this is kind of an educational area this evening here too um i have a question here from the audience i'm not quite sure this really goes along with what we're talking about so much but i want to respect the question and for a disclaimer we do the best that we can with the questions that we have it's usually a sentence or two of course um but barbara asks uh that she had a fracture on the bottom of her pelvis and um how long does that usually take to heal what physical therapy would help heal and i know that you are uh you know a trauma surgeon but fracture pelvis i know that we were talking about this being an orthopedic show originally as well um so to the best of your ability uh because you were talking too about everything in the abdomen the pelvis is kind of in the bottom and pelvic fractures are pretty common in accidents so take that and answer it any way you'd like to but also we can go back to the idea of when a pelvis is fractured and you've got the stomach you've got intestines you have all the bladder everything's going on in there again how do you you um navigate that in the operating room sure it depends in this the the actual injury so you know there are injuries that don't require any surgery at all and the orthopedic surgeons will take a look at the skins and they'll say you don't need to do anything about their we don't need to do anything about this they go go to physical therapy try to walk on it and if they're fine then they kind of then they move on and you know bones take weeks to heal as a general hole no matter where it is some some bones take longer or they're harder to heal or they hurt more depending on where they are but so in a setting that a pelvic fracture does not require operative intervention it's mostly physical therapy and just pain control to help the patient be able to kind of get back to as normal as they can if in the more severe cases of pelvic trauma it those can cause a lot of bleeding and so that can then turn into a couple of facets if the if the trauma is severe enough the orthopedic surgeons can do a temporary fixation which keeps the bones in alignment because anytime any broken bone rubs against bone it bleeds some more so in some of these severe cases the orthopedic surgeons can come in and they place an external fixator and it helps to keep it in place until more definitive operations can be done if once the patient is more stable so yeah it is all right in here and it can be a challenge yeah and sometimes we do run into each other depending on when the case is done whether we go do our part first and then they do their part later um and so it's kind of a you know it's a discussion it's a teamwork of of sorts you know we dr adler who we work with very closely with one of our orthopedic surgeons um you know he's called us in where he says hey you know i'm like close to your incision you know so we work together very well and we just talk to each other it's a big team effort trauma is trauma care is multidisciplinary to its core um and it and it's not and we know we talk about the glamorous things of being a trauma surgeon and it's not necessarily glamorous but um that's what people think of the most they're like oh this is cool um but trauma care is totally what i said when you walked in here admit i was like hey nice to meet you it's just it's so much more than that right we require the nurses that take care of the patients at bedside the physical therapists the occupational therapists our speech therapists um our physiatrists are um neural you know everybody that gets involved in the care is really important for any trauma patient to be able to actually recover from whatever accident or injury that they've had so i'm i'm going to ask about the toys that are laying around the emergency room um in the operating room like you were talking about this internal fixator right is that just something that's hanging on the wall it's like you know what we need pelvics broken here we just have to get the fixator what is it that you have at the ready at any er and i'm just in my head i'm thinking is there a closet full of stuff that you might need um and i know everything's got to be sanitized and perfect but just in general and this is where hospitalists come in and this is where other crew members come in so to speak um how is a an er operating room set up in comparison to other general surgeries so the operating room is the same okay um so we when patients first come in they come into our trauma bay and um the trauma bays have um what we call pixis and within the pixis there are a myriad of supplies that we need to take care of our patients and it's it's the most essential things that we need um to be able to care for a patient right in the er so we have like arthur academy sets are in there um we have you know lines for big ivs and um gauze and tape and all kinds of things um we have ultrasound machines that are that help us you kind of mentioned this at the beginning of like what do you have to help you assess um bleeding um internal bleeding as well so we have ultrasound machines that are right outside our trauma bays that are emergency physician colleagues that also play a huge part in trauma care with us they come in and they actually do an ultrasound to be able to check the lungs they check the heart and they check the abdomen for any overt signs of bleeding um and that's something that is extremely helpful and is a huge adjunct to assist us in sometimes diagnosing and sometimes in performing procedures so we have all of those at within the er and then if the patient requires an operation we proceed to our operating room and in the operating room of course all of our supplies that we need are there um and they are in multiple closets i guess you can say secured and sterilized is what and then we just we call for what we need and well dr you are carrying this entire program on your shoulders right now i i am super impressed with you because i'm throwing all these things your way and i kind of don't want to throw the neuro stuff your way i don't want to throw the ortho stuff your way um because i don't think that's fair but at the same time you were talking about really you know the myriad of things but also the myriad of doctors and you threw out some of the disciplines earlier but i'd like for you to maybe describe what some of the disciplinaries are i mean orthopedics i think is self-explanatory um cardiologist obviously is emergency room physicians i mean that in and of itself is kind of like the trauma surgeon right it's like what all does that encompass uh have fun with that question i know it's huge right it just goes all over the place yeah well but that's medicine right yeah we kind of have to we we help each other out we can't be with each we can't be each other without each other so our emergency physician um emergency department physicians are kind of the they're the front line uh people in the hospital you know if someone shows up in the er they're the first ones that they see everybody else gets called in after the fact except for in the setting of a trauma we all show up together so the er physicians they in our trauma bay they help us with they help us with airway so they're this is usually sort of how we um create our team when we take care of trauma patients and so they actually stand at the head of the bed in case there is an airway issue if a patient requires intubation so they need a breathing tube because they can't breathe they actually are the ones that take care of that for us in every single trauma that we do and then they do they help us with the fast exam which is utilizing the ultrasound to be able to help identify other injuries as needed and so they're kind of there are the front lines and then we get called and they tell us hey this patient needs to stay um and so you know it's a it's a big teamwork of people we're orthopedic surgeons we know they do the bones neurosurgeons they take care of the head and the spine and the spine see that's right the brain and neck okay yeah brain neck and back yeah they go all the way so and we have a lot of head trauma and here and so we we are very grateful for our neurosurgeons um and we talked about our cardiothoracic surgeons that help us with the heart and the chest our vascular surgeons that help us deal with i'd love to talk a little bit about vascular surgeons because i'm thinking with all this trauma i know that we were talking about abdomen but now we're looking at not necessarily orthopedics because that's bones but then you also have nerves that get damaged you have muscles you have veins and arteries that are messed up so that too when you're talking about blood flow boom that seems like airway fine blood flow now vascular surgeons uh kind of describe what they do i mean i know it's big and it's all over the body but in the world of trauma yeah so they're pretty they're they're essential um so if they have you know we can kind of go through a couple things so um if we think about the big the big blood vessel the aorta in our bodies um when that is injured we need to watch out we we need them um and um they have and they have different um abilities so there's open surgery and there's endovascular surgery which is more minimally invasive and so previously you know again as time has evolved um more technology has allowed us to be able to provide more interventions that are not as invasive right so we think of open surgery right big incisions and things like that and some things do require that so for example if the femoral artery which is the artery here in your groin gets severed it needs to be repaired and so we call in our colleagues and they come in and help repair that and you restore the blood flow to the rest of the leg if there's an injury to the aorta sometimes it requires an open surgery sometimes they can fix it via endovascular techniques meaning it's minimally invasive they poke the groin in to get catheters and stents up into the aorta and a patient is live is saved from not requiring a very big surgery there was a big surgery but not a big incision and so some of these advances that we've had over the past several years have actually been extremely beneficial to all populations across the board so so i love how you transition that because that would be a natural transition question our advances and i know we talked a little bit about um our friends and you know all the ems folks um just in general though because i'm thinking also somebody severed an artery let's say aorta issue aorta issue um and they're coming to the hospital but it's going to be a while before they get there let's say half an hour with this training again we're talking about stopping the bleeding um and i'm gonna be morbid when i ask this question but how long would it take someone if there was no one to help and and the aorta is severed um bleeding out is a horrible way of saying it but i don't know how else to say that but if there was no help how long would the body be able to and i know it's different situations very long okay if it truly is severed that's almost death it's almost immediate because it just yeah okay i'm getting a couple of questions here from the audience um actually i'm gonna let that one be for a little bit um i would like to talk a little bit about trauma surgery but in adults versus children and i know this is not pediatrics i get that but um i know with orthopedics there's the growth plate and there's you know injuries that you kind of have to pay attention to because until you're 18 you've got growth plates that still kind of move around and what have you but in your experience um the type of traumas that and let's say kids prior to the age of like 16. what type of trauma injuries do they usually have or what are some of the most common i think with adults it's you know car crashes that for some reason that's where my head goes but kids bicycles motorbikes or et cetera you know so in our region atvs are are fairly common and we get fairly severe injuries from atv accidents um and that's you know that's not new to most people but and this is something that uh within our region um has been quite uh it causes quite a few injuries here you know and in kids you know very young children what we're always most concerned about that we don't really like to talk about because it's not a pleasant thing to discuss sometimes but in these younger children it's the non-accidental trauma meaning that child abuse cases and so um you know it's good to bring them to the forefront though this is the place to do that so let's do talk about that sure yeah um and those are the toughest cases right um because you're you're with one of the most vulnerable populations of patients that you're dealing with these kids don't really have a voice and so when they come in and they are severely injured or even if they have one injury that causes suspicion for us it's important for any provider that sees this or has any kind of suspicion that they need to start working up this patient to make sure that they don't have any other injuries on top of it and sometimes it could be a fracture in their femur and that's hard to do sometimes you know kids are very pliable they um you know they're kind of like basketball in a way they're not right no i get it but their skeletons are a lot more flexible than an adult skeleton is and so their injuries are a little bit different so we can talk about that they have more internal injuries potentially without any outward signs of injury so they could maybe have a head bleed without a skull fracture they could have a chest injury like a long injury lung bruising without any rib fractures um and so you know with these with children we have to be we have a high level of suspicion when we see them just to make sure that that they are being cared for as best as they need to be and can be um and so that's something that we have to we advocate fairly heavily for um and within our region um it's now become uh almost under the border rack which covers all the border racks they have been instrumental in ensuring that you know we are advocating for and making sure that we're educating any provider and ers to if there is a suspicion send them to a trauma center so that we can completely work up the child and get everything that's necessary to care for them it's interesting you you talk about border rack um i feel like there's we did a show with them years ago and i was fascinated with everything that border rack does i don't remember what rack stands for regional do you remember what border rack regional bottom line is um so i'd like to give them a plug because without that uh goodness extra arm for trauma in general we'd be in a in a less better place can you explain a little bit what border rack does yeah so essentially they um so these there's these racks are everywhere in the state and essentially so ours of course is confined to our region right and it essentially helps unify the system um you know so you review you review everything the injuries that you see within your region that are special to your region and you essentially try to unify care right so if we all do things differently there's going to be too much variability and grant there's always going to be variability in how we care for patients but there's also a standard of care that comes across all health care so um the one of the purposes of border records there are many um is to be able to help unify that and they've done a lot of work with the non-accidental traumas to ensure that we know you know what are the red flags what should we look out for if we have a suspicion send them to a level one trauma center a traumas level one or two trauma center that can actually take care of these injuries and a border rack how so you said and i i'm not familiar with others other than ours how how and when and you'd have to give a year but when did the emergency system realize that this might be a good thing to do like who may have come up with that um because i think of firemen our firefighters are involved emergency techs are involved you've got city involved county judge involved mayor involved in emergency response systems and i say that i know we had we learned a lot during the august 3rd because that was a massive amount of people at one given time but with border rack how is it that they are in communication with the team the the response team and again going anywhere from county to city to all the different emergency folks so they have representatives from every hospital and the counties that are all participating within it and there's monthly meetings subcommittee meetings so there's you know committees and then there's subcommittees and so um each one is focused on certain aspects of uh healthcare within the region so whether it's and it's not just specific to trauma they do a lot of work with stroke and things of that nature and so um the the monthly meetings the that are the generalized meetings and then the subcommittee meetings are what kind of bring it back together everything comes back to the general meeting to ensure that everybody is doing as unified of care delivery of care as we possibly can so that everyone in this region can get the best healthcare that they can have i love that i remember when we did that program and it was the emergency preparedness program and i i want to say that after 9 11 and we all feel like that's so long ago now um but it really isn't that long ago that there was the idea of okay there is a big thing happening right now what does everybody do and i just remember being impressed with how our border region has it together um so just a just a shout out there another ques actually i'd like to focus a little bit on children here again for a bit because i'm thinking about brain injuries and i know you're not a neurosurgeon but i am fascinated with what happens to the head when the head gets you know atv accident um in general with adults versus children because again there's excuse me the bone is a lot soft or impliable like you said excuse me um even though you're not a neurosurgeon what are the kind of things that that are in play there sure so one of the first things is of course we identify the injury and that's either um you know usually through via imaging um and once we find the injury then we have to define the extent of the injury and so some some of them have a little bruise in their brain and they're just a little toggled they have a concussion um but they're still talking to you and they're doing everything that they should do um and then they can go home you know hopefully in the next couple of days or so others they may blossom over time some of these bleeds get worse and that could be across the board for children or adults and then you know if it's severe enough then they require surgery and the neurosurgeons will also then come into play there of when how and when they decide to operate on a child or an adult or an adult yeah so how does one know for example somebody comes in and you said blossom over time so what would be the tools that are used to see how that happens are they doing several mris how long do you keep them i know every situation is different but in general thinking okay this might be one that we foresee blossoming over time um and i know that's kind of like a game time decision i respect that how does one one how does the team of doctors kind of think okay this is one we need to look at we think that one can go home and why yeah so again it depends on how you present right so if it's um usually we even if it's a small one we will observe these patients overnight um and they usually end up in the intensive care unit and they go there because somebody can check them almost every hour to make sure that they're still doing what they're supposed to so we check them neurologically to make sure that everything is equal their eyes are equal their pupils are equal they can talk normal they they're able to move both sides the same and so we it's very close monitoring um and then usually depending on the bleed likely they'll get a different imaging the next day a repeat imaging so that could be a ct scan which we use more so in the adults and the children population because radiation does have a chance for causing cancer depending on the head injury they may get an mri to be able to evaluate whether or not it is worsened or it's stable and then the neurosurgeons review it and then they we move on from there and you move on from there goodness um i i were about ready to wrap up the program what i'd like to do is i know you've been just fired questions the entire night and again you are a trooper and a half um is there anything that we haven't covered that you'd like to talk about really quick before we wrap up um i feel like we've i've asked you way too many questions okay you're such a trooper like i said um but in general i'm just thinking maybe for audience at home um concussions you mentioned that what to look out for when to bring someone to the er when do they when do they call 9-1-1 maybe that's a good one to throw out there sure um and it's you know if you're if you're able to watch someone fairly closely at home then you know then that's something that you could stay at home and you know but if there's ever any question um go see a physician or go to the er it's you never know and that's the hard part about any kind of traumatic injury is is that you may think that something is very small and it could end up being something more severe so you know it's hard to again it's a case-by-case basis but um if there is ever any question you know definitely talk to any some kind of a qualified healthcare provider and i i know that you're with umc and um very kindly underwriting this program this evening but um in general 911 and whatever the closest when we're talking about trauma whatever the closest places around you would be a good thing to do i feel like i don't have time to ask another question but at the same time we have um i do i do want to actually ask this and we were talking about neurosurgeons i only have one more minute um for the neurosurgeons i'm not going to ask that because it will go into a whole nother thing i will i will do this emily rick i don't know if we're able to put the camera on emily but emily also has been a trooper this evening hi um and we did not put you on camera i feel like i should make you come on over uh but emily is there and she is the one that's been taking our calls this evening and bringing your questions over my way which is really nice and i want to say extra thank you to dr grace ing who's been here and really did a great job tonight umc thank you for underwriting and again a huge shout out to um the el paso community excuse me the el paso county medical society um because they are the ones that really put this together and have been putting this together for 25 years it's not an easy job to get all these doctors here and sometimes doctors schedules are crazy which is what we're witnessing here tonight so i appreciate you being here i'm catherine berg and you've been watching the el paso physician dude i was like i need to like buy you [Music] [Music] you