I have to recertify my Merit Badge in ATLS next week, and have been reading the text in preparation. This is because the test is over the book, not what’s actually done in ATLS, so you have to know what the book answer is, even though it may be 1-3 years behind current practice due to publication lag, etc.
Here’s the howler I found a few days ago, just by literally flipping open the book and starting to read:
Chapter 1: Assessment/Secondary Survey:
Abdomen:
a. Inspect…
b. Auscultate for the presence or absence of bowel sounds
c. Percuss…
…
The average trauma room is as noisy as standing next to a city bus at idle on a busy street. Often raising ones’ voice is necessary to be heard. It’s not only not useful it’s entirely impractical. The money is in the other exams, and I am amazed this got through.
More sillyness as I find it.
Oh, and I detest Merit Badge Medicine. Both of my Professional Colleges have strong stands against the practice (ACEP and AAEM). Nonetheless we do it ‘because we need it to keep our Level II Certification’. So, it’s the surgeons’ fault I have to put up with this idiocy.
Update: I passed. I missed a question on the written though, so I’m a little bummed.
What I hate is when you have to take ACLS or something on a stupid computer, where it’s like a “reality” video game. Because when you pause to try and think up whatever decision the computer wants you to make, all the stupid staffmembers working on the patient just stop and stare at you—and I always want to shout: “Are the paramedics still here?”
GruntDoc,
You may want to double check the current recommendations for Level II trauma centers. The latest version (2006) has a second edition. If I remember correctly the ATLS requirement is waived if you are currently boarded in Emergency Medicine and have previously taken ATLS. There is a requirement for 16 hours of trauma related CME for the trauma liaison from the ED which could be easily covered by attending just about any Emergency Medicine conference. To get the most up to date version contact the regional chair from the ACS Committee on Trauma. In your neck of the woods that would be Dr. Ronald Stewart in San Antonio.
http://www.facs.org/trauma/regional.html
By the way, if auscultation wasn’t included in that list someone would have complained it was missing. I agree though, it drives me crazy when I’m evaluating a patient in the trauma room and someone, usually the recording nurse, keeps asking me if bowel sounds are present. I had a patient with a self-inflicted stab wound to the abdomen and when I was asked about bowel sounds I pointed to the 18 inches of eviscerated small bowel and said, “You tell me.” I know, nobody likes a smart-ass but I couldn’t resist.
Wow, thanks Terry! I’ll look into it.
Please don’t hate all of us surgeons! I think the ATLS is a massive waste of time as well — but, like all of these “merit badge” things, it is promulgated by folks in academics who haven’t actually cared for a trauma patient since the 1970s.