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Mon Dec 15 20:48:47 GMT 2008

"I would argue, however, that some patient conditions mandate constant surgeon vigilance and care"

EXACTLY - which is why I am praying that we succeed in succession...and can cover our own unit!   :-)

Ron
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of moore677 at aol.com
Sent: Monday, December 15, 2008 3:45 PM
To: trauma-list at trauma.org
Subject: Re: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

Thanks Dr. Gross for the stat's.? Many of us argue/proclaim that trauma is a surgical disease, yet when it comes to the postoperative or post-traumatic ICU care of the patient, it is no longer our problem.? And for a lot of what we see, any intensivist will do.? I would argue, however, that some patient conditions mandate constant surgeon vigilance and care.? For instance, I operated on a patient with a GSW to the abdomen early yesterday AM.? He sustained a Grade V burst injury (central extending thru to the right lateral segments) of the liver.? Fortunately, he responded to?a second round of packing, factor VIIA, and a host of blood products.? In our institution, it would be acceptable, if not expected, that the medical intensivist now manage this patient.? And while I readily acknowledge that?my medical colleagues are smarter, in my opinion, this patient should only be managed by a surgeon/surgical intensivist.??I seriously doubt that there would be any surgeon that would d
 isagree with this statement.? I fully also acknowledge that there is a shortage of intensivists, and that there are intangible benefits from a multidisciplinary approach.

Dell...................?

-----Original Message-----
From: Gross, Ronald <Ronald.Gross at bhs.org>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Mon, 15 Dec 2008 7:29 am
Subject: RE: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

Dell,

We are a Level I  Trauma Center with around 1700 trauma admissions/year.  We
have a (woefully undersized) 24 bed Med-Surg ICU that is staffed by surgical,
and medical intensivists, as well as a smattering of anesthesiologists, all of
whom rotate from the medical to the surgical side.  Some of the medical folks
are pulmonologists.  All of this might be changing, however, as we look to
change the structure to a medical AND surgical ICU, with the medical side under
the direction of a pulmonologist, and the surgical side directed by one of our
trauma/critical care surgeons.

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On
Behalf Of moore677 at aol.com
Sent: Saturday, December 13, 2008 4:16 PM
To: SSherry at LHS.ORG; trauma-list at trauma.org
Subject: Re: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

 Are there other trauma surgeons out there willing to share with me the make up
of their trauma/surgical ICU.? PLease tell me how many surgeons,
anesthesiologists, ED, and pulm/med intensivists make up your staff coverage.?
This info would also be greatly beneficial.? Please tell me how many trauma
admissions you have as well as whether you are a level I or II.

Dell................

-----Original Message-----
From: Sherry, Scott :LPH Trauma <SSherry at LHS.ORG>
To: moore677 at aol.com
Sent: Sat, 13 Dec 2008 1:45 pm
Subject: RE: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

OHSU - portland oregon. has trauma cc trained intensivists for the trauma icu.
there is one EM/IM/CC and one Anesthesia CC ICU intensivist in the rotation.

Legacy emanuel protland oregon?- 8 ICU trauma intensivists rotate through trauma
er, icu, ward.

From: trauma-list-bounces at trauma.org on behalf of moore677 at aol.com
Sent: Thu 12/11/2008 3:40 PM
To: trauma-list at trauma.org
Subject: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

Are there any U.S. Level I trauma centers that still have the medical
intensivists contribute a significant amount of care to your p
atients?? If so,
and what is their role exactly and how much time do they spend in the ICU?
We are a high volume ACS Level I (4000 trauma service admissions) with a new
general surgery residency and 8 trauma surgeons.? Two of the eight are surgical
intensivists and do their own critical care.? Over 90% of the care of our ICU
patient's?are currently?done by the medical intensivists.? We are trying to
develop a?SCC service?whereby we as surgeons can do the majority of the teaching
and rounding, but I fear we would need to take on at least 2-3 more surgical
intensivists.? Monies are not available for this.

Suggestions?

Forrest "Dell" Moore, MD
Trauma Critical Care Surgery
St. Joseph's Hospital and Medical Center
Phoenix, AZ
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