A Young Surgeon's Perspective of G60

1. A Young Surgeon’s Perspective
Gina Renteria Shirah, MD
Trauma, Critical Care and Emergency Surgery
Acute Care Surgical Subspecialists

2. The OLD Gina

3. The OLD Gina
• Excited to get out of residency
– No longer have to deal with medicine

4. The OLD Gina
• After 7 years of taking a history and
physical, my interview skills are TOP
NOTCH!

5. The OLD Gina
• Elderly are frail with many medical
problems
– No need to be so aggressive
– Better for medicine doctors to handle

6. The OLD Gina
• Rounding on these patients will take
up alllllllll of my time

7. The OLD Gina
• Trauma surgeons want to intervene
– Nothing to do in these patients

8. • What have I discovered along the
way…

9. The G60 patient IS MOST DEFINITELY a
trauma patient

10. And More Importantly…
The G60 patient IS MOST DEFINITELY
OUR trauma patient

11. So…
• How is the G60 patient ANYTHING
like a trauma patient?
• What about a trauma surgeon
makes us the best people to take
care of them?

12. Similarities
• Injuries are abrupt

13. Similarities
• They were going on about
their everyday activities

14. Similarities
• They were at their baseline function
prior to injury

15. Characteristics of Trauma Surgeon

16. Characteristics of Trauma TEAM

17. Characteristics of Trauma TEAM
• Get patients to the OR quickly

18. Characteristics of Trauma TEAM
• Get patients to the OR quickly
– Effect of early surgery after hip fracture
on mortality and complications:
systematic review and meta-analysis
• Earlier surgery
– lower risk of death, pneumonia and pressure
sores
CMAJ. 2010: 182 (15): 1609

19. Characteristics of Trauma TEAM
• Postop mobilize immediately

20. Characteristics of Trauma TEAM
• Discharge to rehab

21. About those misconceptions…

22. About those misconceptions…

23. About those misconceptions…

24. Too many medical problems???
• Take Advantage of Opportunity
– Re-evaluate medications
• Anticoagulants
• Anti-hypertensives
• Insulin and oral hypoglycemics
• Thyroid medications

25. Interview skills???

26. Patient Interview KEY POINTS
• Events preceding
• Dementia
• Next of Kin
• Home situation
• The elephant in the room
• Early rehab discussion

27. Patient Interview KEY POINTS
• Events preceding
– Fall
• Safety at home
• Cardiac or CNS event
– Length of time down
• Rhabdomyolysis, DVT
– Driving, Riding, Hiking

28. Patient Interview KEY POINTS
• Dementia

29. Patient Interview KEY POINTS
• Next of Kin

30. Patient Interview KEY POINTS
• Home situation
– Provider fatigue
– Safety

31. Patient Interview KEY POINTS
• The elephant in the room
– Code status
– Respect dignity and wishes
• Be a patient advocate

32. Early rehab discussion
• Change peoples expectation and
mentality regarding rehab
– Preconceived opinions
– Reiterate return to baseline is goal

33. Patient Interview KEY POINTS
• Events preceding
• Dementia
• Next of Kin
• Home situation
• The elephant in the room
• Early rehab discussion

34. Too frail???

35. Too frail???
• Elderly are RESILIENT
– Aggressive measures will get them back
to baseline fastest

36. Pain management alternatives
• On Q nerve blocks
• IV Tylenol
• Lidoderm patches
• Low dose narcotics

37. Taking all my time???

38. Taking all my time???

39. Nothing to do on these patients???
• Trauma surgeons want to intervene
– This aggressive interventional nature is
why it is OUR JOB to take care of these
patients
• In 8 months
– 28 hip blocks
– 263 total cases
• 91 on G60 patients (34%)

40. The NEW Gina
• Excited to be out of residency
• Medicine is medicine, embrace it
• Be a part of culture change

41. Thank you