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Wed, 10 Jul 2002 15:49:49 -0700 (PDT)

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Dear Heather Kadinger,

This is the very first e-mail digest I get from Trauma.org and I am glad to see someone who is a beginner like me. Now about the difference between a thoracotomy in the ER vs OR, in my humble opinion, it doesn't matter where you do it, all what matters is why are you doing it. In some trauma centers they may have the facilities to perform trauma surgery in a 'trauma bay' (a small OR) affiliated with the ER. In the majority of other centers, they perform surgery in the OR, beacuse clearly, the conditions and facilities there are better for operations. [Anyone reading this can comment on where trauma operations are done at their hospital].

Remember, a thoracotomy is by definition an opening into the thoracic cavity, and that can be done for a variety of clinical situations, not necessarily trauma conditions - ask a thoracic surgeon in your hospital and s/he'll tell you how many thoracotomies they do everyday and why do they do them. As for the patient's symptoms, they differ and vary according to the patient's disease and when that disease is diagnosed and decided to be operated upon, it is the thoracic surgeons who decides which incision to choose to best access the organ they want to operate on. In clinical surgery, insicions and operations are based on the diagnosis of the disease and not the patient's symptoms directly - the diagnosis is ofcourse based on the patient's signs and symptoms and most importantly the history of their disease. It kinda briefly goes like this... history, clinical examination, investigations, diagnosis, decide to operate, operative details (type of insicion, instruments used etc.), post-operative care and, in the case of trauma patients, rehabilitation. A thoracotomy, or any other insicion for that matter, is just a way of access to organs to be operated on.

It is the Committee of Trauma of the American College of Surgeons (ACS) <www.facs.org> which decides which trauma center gets to be a Level 1 or Level 2 center. I've never heard of Level 3 centers, tell me if you know any. I've gone through many trauma center web-sites and I never really found any published criteria about what makes their center Level 1, or 2 etc., neither does the ACS web-site has any criteria too. However, from what I have read, I can presume that a Level 1 center is designated as such according to the number of trauma patients admitted per year, the ratio of blunt to penetrating trauma seen in that center and the availability of a SICU (surgical intensive care unit) run by general surgeons who have an added qualification in surgical critical care (SCC). There must be other criteria that I don't know of, this is just my impression from what I have read. You can access those web-sites through trauma.org and they are listed under Level 1, Level 2 etc. Examples of famous Level 1 centers in the US include my favourite LAC+USC (of the University of Southern California) in Los Angeles, CA and Grady Hospital (of Emory University) in Atlanta, GA and many more. Outside the US, there's the amazing Johannesburg Hospital Trauma Unit (of the University of Witwatersrand) in South Africa.

Regarding careers, that is one big story, but to make things short, you have to first graduate medical school to do any of the following specialties. You also have to make a distinction between "Emergency Medicine" and "Trauma Surgery and Surgical Critical Care". Training in emergency medicine takes 3-4 years after medical school graduation, while training in trauma and SCC takes 1-2 years after a 5-year residency in general surgery. Why is there such a distinction? I don't know, I personally wish there wasn't any. I have no information about the training of trauma nurses and EMT personnel, why not check out <www.phtls.org> . 

Good luck in your studies and I hope I was useful.
Mido.

Mohammed Gaber, Year 5
Faculty of Medicine, Suez Canal University, Egypt.

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Dear Heather Kadinger,<BR><BR>This is the very first e-mail digest I get from Trauma.org and I&nbsp;am glad to see someone who is a beginner like me. Now about the difference between a thoracotomy in the ER vs OR, in my humble opinion, it doesn't matter where you do it, all what matters is why are you doing it. In some trauma centers they may have the facilities to perform trauma surgery in a 'trauma bay' (a small OR) affiliated with the ER. In the majority of other centers, they perform&nbsp;surgery in the OR, beacuse clearly, the conditions and facilities there are better for operations. [Anyone reading this&nbsp;can comment on where trauma operations are done at their hospital].<BR><BR>Remember, a thoracotomy is by definition an opening into the thoracic cavity, and that can be done for a variety of clinical situations, not necessarily trauma conditions - ask a thoracic surgeon in your hospital and s/he'll tell you how many thoracotomies they do everyday and why do they do them.&nbsp;As for the patient's symptoms, they differ and vary according to the patient's disease and when that disease is diagnosed and decided to be operated upon, it is the thoracic surgeons who decides which incision to choose to best access the organ they want to operate on. In clinical surgery, insicions and operations are based on the diagnosis of the disease and not the patient's symptoms directly - the diagnosis is ofcourse based on the patient's signs and symptoms and most importantly the history of their disease. It kinda briefly goes like this... history, clinical examination, investigations, diagnosis, decide to operate, operative details (type of insicion, instruments used etc.), post-operative care&nbsp;and, in the case of trauma patients, rehabilitation. A thoracotomy, or any other insicion for that matter, is just a way of access to organs to be operated on.<BR><BR>It is the Committee of Trauma of the American College of Surgeons (ACS)&nbsp;&lt;<A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-July/"http://www.facs.org">www.facs.org</A>&gt; which decides which trauma center gets to be a Level 1 or Level 2 center. I've never heard of Level 3 centers, tell me if you know any. I've gone through many trauma center web-sites and I never really found any published criteria about what makes their center Level 1, or 2 etc., neither does the ACS web-site has any criteria too. However, from what I have read, I can presume that a Level 1 center is designated as such according to the number of trauma patients admitted per year, the ratio of blunt to penetrating trauma seen in that center and the availability&nbsp;of&nbsp;a SICU (surgical intensive care unit) run by general surgeons who have an added qualification in&nbsp;surgical critical care (SCC). There must be other criteria that I don't know of, this is just my impression from what I have read. You can access those web-sites through trauma.org and they are listed&nbsp;under&nbsp;Level 1, Level 2 etc.&nbsp;Examples of famous Level 1 centers in the US include my favourite LAC+USC (of the University of Southern California) in Los Angeles, CA&nbsp;and Grady Hospital (of Emory University) in Atlanta, GA and many more. Outside the US, there's the amazing Johannesburg Hospital Trauma Unit&nbsp;(of the University of Witwatersrand) in South Africa.<BR><BR>Regarding careers, that is one big story, but to make things short, you have to first graduate medical school to do any of the following specialties. You also have to make a distinction between "Emergency Medicine" and "Trauma Surgery and Surgical Critical Care". Training in emergency medicine takes 3-4 years after medical school graduation, while training in trauma and SCC takes 1-2 years after a 5-year residency in general surgery. Why is there such a distinction? I don't know, I personally wish there wasn't any. I have no information about the training of trauma nurses and EMT personnel, why not check out&nbsp;&lt;<A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-July/"http://www.phtls.org">www.phtls.org</A>&gt; . <BR><BR>Good luck in your studies and I hope I was useful.<BR>Mido.<BR><BR><BR>Mohammed Gaber, Year 5<BR>Faculty of Medicine, Suez Canal University, Egypt.<BR><BR><p><br><hr size=1><b>Do You Yahoo!?</b><br>
New! <a href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-July/"http://pa.yahoo.com/*http://rd.yahoo.com/sbcyahoo/consumer/evt=640/*http://sbc.yahoo.com" target="_blank">SBC Yahoo! Dial</a> - 1st Month Free &amp; unlimited access
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