Second day of ATLS was not as thrilling – no pigs in sight – but we’re all relieved to have the test out of the way. The residents teaching the course were fairly laid back, but the surgery attendings of course had very high standards when we were practicing the stations. You have to state that you’re wearing gloves, that you’re starting an iv, that you’re telephoning a proper report to the referral hospital, and so on. Everyone complained about the unrealisticness of this, but how else can you test? They can’t take our word for it that we’ve had experience and know how to work with a trauma team.

 The class is most oriented towards physicians who will be working in rural areas and understaffed ERs, where the goal is to stabilize the patient and transfer them to a trauma center. So to us interns, “brought up” in academic tertiary care centers, where we are the receiving end of all referrals, and especially to the surgery interns, who will be the definitive treatment for these patients, discussions of when to transfer, and how to stabilize for transfer seemed pointless.

The experience did highlight for me again how much we depend on nurses and other staff. We’re not used to saying, Start two large-bore peripheral ivs, start oxygen, get the patient on a monitor, because the nurses and techs do that faster than you could say it. And so on for the rest of the proceedings. Even if I wanted to, I doubt that I could examine a patient’s back without c-spine precautions – too many nurses keeping an eye on their patient!

The written test was actually difficult, but by sticking to the ABCs I got through it ok. That’s another thing I appreciate about this class. It really drummed in the ABCDE protocol for assessing a patient (airway, breathing, circulation, disability/deformity, exposure/environment). With this thoroughly in place, I feel much more prepared to go evaluate patients on the floor in the hospital. Even if I have no idea what’s wrong with them, this framework should help me to catch the biggest problems and not miss too many horrible things.

 Tomorrow will be a long day: all the incoming interns and fellows having orientation to the hospital, and then several more hours in the evening with the other surgery residents, finding out our responsibilities for Sunday. But in a way, that will be good too, to know exactly what to expect – or at least what’s expected of us.