Im undertaking my first ever over night on call shift tonight.
My department doesnt have night shifts during the week so the onus is on you to get physically called in for urgent cases.
Ie. Go to bed, get called in, do your patient then go back home and the cycle continues!
Which basically limits sleeping time but you can’t stay up all night because if you don’t get called in you still have to work the next day!
Effectively it means that you work during the day and the following day but if you get called in, you get a full 10 hour break before coming back to work.
I’m pretty nervous with it all, especially being completely and utterly on my own.
Wish me luck?
I am proud to report that I will be graduating WITH Honours come graduation in May this year for the class of 2012.
I am officially going to be having BRadMedImg (Hons) on the end of my name.
These were so cool.
This, my friends, is the world of Radiography. From Exposure Factors, to projections, everyone has their own little nack for doing something!
The hardest part for me, is because we switched clinical sites with different technicians having to remember how *they* like me to do certain shots or how the site likes a certain shot done.
I had one tech who wanted everything from the fingertips to just past the carpals on a wrist image. With the centering point still midcarpal : \
I still firmly believe that this is the BEAUTY of our profession.
But I must admit, the variation is both HORRIBLE and AMAZING for students. On one hand, it gives you options to learn and work out what suits you best, but also makes it VERY difficult to keep track of what is expected of you from each practitioner as well as to learn new tricks properly.
Two continuous weeks of night shift and my body clock is well and truly mixed up. I’m so exhausted but its been absolutely fantastic working with total autonomy for a full hour a night and one on one teamwork for the remainder. I really am beginning to feel truly competent and trusting of my own skills.
I have developed and improved my relationships with the emergency dept be it nurses, doctors and interns as well as theatre in general. Most of the techs, nurses, registrars and consultants know me by name and its a nice feeling having a professional interpersonal relationship with people outside of your department.
Working in a regional town with many visiting docs certainly has its perks!
That said, whilst it has been an awesome two months in general radiography, I’m amazed and excited to be embarking towards a new modality at a level that had not previously been heavily afforded to me as a student.
CT was my first introduction to radiography and I’m really excited to properly learn and train in a modality in which ill be expected to take the reins.
I still can’t believe that all this has happened so quickly and I couldn’t be more grateful.
Plus I’m looking forward to working with some awesome colleagues (whilst asking tonnes of silly questions!)
It’s something that gets a newly qualified or Student Radiographer’s heart pumping. A major trauma. Someone’s life is hanging in the balance. The fine line between life and the afterlife is ever shortening. And you’re part of the team that is expected to assist in that patient’s moment of need.
The reality is, unless you’re working in a major regional trauma centre, it’s going to be a fall from height or RTA that doesn’t involve a lot of blood, guts and gore. However this is no reason for you to suspect that there’s nothing wrong with the patient or that the patient is stable. Every trauma patient should be treated the same, regardless of how responsive and how they look when they come through the doors.
Paramedics contact trauma hospital and inform them of the information they have received from the scene of the incident. This usually consists of the age and sex of patient, mechanism of injury, current status (ABC’s). The person receiving the call puts out a trauma call. In most hospitals every person on the trauma team holds a pager (bleep) that will sound and inform them of the ETA of the trauma, adult or paediatric and where it’s going to.
The Trauma Team assemble at the trauma location. In most hospitals this will be the Resuscitation Suite within Accident and Emergency. The Trauma Team consists of:
- Anaesthetic Consultant
- Anaesthetic Assistant (Operating Department Practitioner)
- Accident and Emergency Consultant (Trauma Lead) [and usually an A&E Registrar)
- Orthopaedic Consultant
- Orthopaedic Registrar / Assistant
- Surgical Consultant (General Surgeon)
- Surgical Registrar / Assistant
- Circulating Nurse
- Trauma Nurse
All members of the trauma team are informed of the preliminary information regarding the trauma by the person who received the phone call form the paramedics.
RAD: It is at this point that you should ensure that your mobile x-ray machine is fully functioning. You have three large cassettes and a grid. You have mentally prepared your exposure factors for the adult / paediatric. You need to ensure that every member of the trauma team is wearing lead rubber aprons. [In practice it may be that no one wears lead aprons when the trauma arrives. You do not X-Ray unless everyone is adequately protected from radiation. If protective lead gowns are provided, they need to be worn.]
The Patient will arrive on a spinal board laying supine with a cervical spine neck collar in place. The Trauma Team will collectively, under the supervision of the paramedics, patslide the patient from the ambulance stretcher to the trauma bed.
The Paramedics will then give a full history of the trauma, the trauma scene and the medics will ask questioning relating to the trauma. This may be was there any loss of consciousness (LOC), what the patient’s current Glasgow Coma Score (GCS) etc.
PART TWO: The Team and the Primary Survey
The Layout shown above is the typical locations of the teams. The A&E Consultant (Team Leader) always stands at the feet of the patient, with the Scribe near them. The Anaesthetic Team always stand at the head of the patient. Location of the other members of the team can vary and rotate around the patient as necessary.
The doctors/surgeons will carry out a clinical examination of the patient.
The A&E Consultant is ultimately the head of the trauma and is designated Trauma Team Leader. The Trauma Lead should not have to touch the patient, but should concentrate on the information provided to them by the other members of the team. The Trauma Lead is there to collate all information, advise and supervise the many different medical specialities who are all working at the same time.
The Scribe is an important member of the Trauma Team. They document everything that is going on from the moment the patient arrives until the trauma is complete. Everything, from the GCS on arrival, drugs administered, possible fractures, results from clinical examinations is recorded.
The Anaesthetist is in charge of obtaining a safe airway and managing pain. It is their role to intubate the patient if necessary and insert central lines if needed. The Anaesthetic Assistant (who is usually an ODP or Nurse) is responsible for getting the equipment the Anaesthetist (who can not leave the patient’s head) needs.
The Orthopaedic Consultant is concerned with the musculoskeletal system. This includes checking for bone fractures, the severity of fractures, interpreting the initial Trauma Series X-Rays, checking nerve reflexes and neurological impairments.
The Surgical Consultant is concerned with the patients thoracic and abdominal/pelvic organs. It is their role to assess is there are any thoracic or abdominal injuries. This is usually a general surgeon. If a Vascular issue is present, a Vascular Consultant may also be present.
The Trauma & Circulating Nurses assist in the trauma by running bloods, taking the patients vital observations (Blood Pressure, Pulse, Oxygen Saturations) and informing the medics of the current observations (a.k.a: Obs). They also carry out ECG’s if necessary and assist the many medical teams.
The Radiographer is primarily responsible for the initial Trauma Series imaging and Radiation Protection of the Trauma Team AND the patient. In a female patient who is of child bearing age a pregnancy status should be carried out prior to the direct irradiation of the abdomen or pelvis, as long as the injuries within this area are not thought to be life threatening. All members of the Trauma Team MUST wear protective lead rubber aprons before any imaging takes place.
- Primary Survey
The Doctors and Surgeons will carry out a quick but thorough initial examination of the patient, carrying out a number of test including blood test, obsevations, GCS testing, pain and sensation reflexes and nowadays FAST (Focused Assessment with Sonography in Trauma) scanning of the abdomen to check for internal bleeding.
Using the ABCDE approach they are able to assess the patient quickly:
A = Airway (Maintenance and Cervical Spine Protection)
B = Breathing (and Ventilations requirements)
C = Circulation (and controlling heamorrhages)
D = Disability (Neurological Evaluation)
E = Exposure (Controlling temperature)
This is somewhat different to the trauma hospitals I’ve worked at, (it’s much more structured and organised) but all of it is DEFINTELY worthwhile in understanding the roles all those people who hand around the trauma bay play.
Nice work Jamie!