Back on it this am and amazing workout at the gym- vibe and kettle bells, loving my workouts here but missing the vibe crew!
Off to work for the twilight shift, I am working out how the teams work and there is another good team on the weekend- Saturday night too. Another comment is that the hospital I am working is a very good government run and resourced much more than the others- this is the best in the province even though I have observed resources are low- this is as good as it gets for that but the medicine is excellent regardless. How will I find the differences in private unit?
Well another amazing day! My observations and knowledge grow every day.
The trauma unit also takes minor trauma (although that minor trauma would be major to us!) as some of the walk in traumas should be dealt with in the day hospitals ie simple pneumo's ICD insertion, but the unit gets all hence this makes it busier to manage the real major trauma.
Nonetheless overall the teams of doctors and nurses are very good and a high standard, they are particularly good at trauma resus and critical care of patients- quick, know their roles and treat effectively and the area is immediately cleaned by a cleaner. Strict regular obs from the nurses from then on.
The medicine, surgery and management is really impressive. The doctors are extremely proactive and do everything themselves -DIY! One excellent doctor I have been working with- today just took a tubed ventilated immobilised patient on his own to CT... I was amazed and off course insisted I go to help him!
The doctors work long hours, back to back 12 hrs and 24hrs... so different from our doctors in the UK no working time directive in SA! It is very doctor orientated- the doctors triage all the ambulances and are in charge much more- much different to us in the UK where the nurses run the ED.
Again the average wait is 24hrs to get to a ward this is because all specialties have to review the patient then get the bed, there might be 4-5 specialties to review due to the dense polytrauma ie plastics, neuro, ortho, max-fax .... there is no 4 hr target for admission or discharge... there are no targets that's why patients wait and wait... also everyone is so busy.
Another difference in traumas is the Trauma/ED doctors and nurses deal with the patients then call the specialties- I have not seen an anaesthetist in site - ever! They deal with the airway and continue to while the patient is tubed- end of until the patient goes to ITU or HDU. Like wise for surgeons or cutting reg as they are called- they are contacted once the patient has been sorted unless surgery is needed immediately.
Another compiling factor for health care professionals is a huge percentage of patients are HIV +ve +/- TB adding to the stressors and risks.
I spent my day seeing patients with severe assaults, stabbings and MVA. Severe MVA- brain injuries and poly trauma. Again suturing up faces and scalps from diffuse injuries.
Last resus off the day- Pedestrian hit by car- infact he was completely run over, the tyre marks evident across both arms and legs. Open book pelvis, distended abdo full of blood, racoons eyes, huge scalp swelling, widespread chest surgical emphysema bilateral puemo/haemo- after arriving he went into cardiac arrest aka traumatic cardiac arrest. The definitive management for blunt cardiac arrest is bilateral ICD review then CPR.... he was futile no more interventions performed...
The clinical exposure is text book- conditions you tend to only read but I am experiencing first hand.... if clinicians what experiences come here!
All the nurses and doctors are so friendly and welcoming, I am part of the team and seem to be respected from all- porters, security, doctors and nurses- pleasure to work with all!!
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