Editor's Note: In this interview from SAWC Spring 2023, Greg Patterson, MD, FACS, DABS, CWS and Mary Ann Obst, RN BSN, CWON, CCRI describe how to treat a trauma patient from a multidisciplinary point of view.

Transcript

My name is Mary Ann Obst and I am the complex abdomen specialist at Regions Hospital, which is a level one trauma center in St. Paul, Minnesota.

I'm Greg Patterson. I'm a surgeon. I do a vascular and general surgery and work for Vita Surgery which is a group in Southwest Georgia. I'm the medical director of a level III trauma center.

When encountering a trauma wound patient, what first steps should a wound professional take?

Mary Anne Obst, RN, BSN, CWON, CCRI:

I think when you encounter a wounded trauma patient or a trauma patient with a wound from a nursing perspective, and I think Dr. Patterson will probably really have a very different perspective. Many times I'm leaning on the surgeon or the doctor to take care of the big picture problems that I can't see, and so I really address the wound.

And a lot of times, you know, on a brand new trauma patient, because there's so much going on, we'll do a very simple dressing, just keeping the wound moist and covered, and let the trauma surgeons kind of figure out the rest of the injuries, don't you?

Greg Patterson, MD, FACS, DABS, CWS:

Right, and I agree. I think the big thing, you know, and we can go into other trauma protocols that we talk about a little bit in our talk, but the basics should have already been done. So the, what we talk about, the ABCDE, airway breathing, circulation, deficits, and then exposure and environmental concerns, we've already done. And there's some other mnemonics that we talk about, MARCH PAWS being one of those where the W, the last part of it is wounds, and then you deal with those wound at that point. And then, of course, you splint as the next part of that.

When we're consulting a wound professional to deal with things that like Mary Ann does, the big complex, most of those things we're going to take care of. And so, I think the most important thing is for the surgeon, I think, is the burden is on the surgeon, to talk with her or talk with that wound professional and tell them what's going on underneath, because they don't have the luxury of having known the patient. They don't have the luxury of seeing all the advanced imaging modalities that were done, CT and angiography, even exploration of the wound to see what's going on. So hopefully we've already repaired any type of arterial or vascular associated injury, any neuro injury, and then hopefully repaired some continuity of that injury, like fascial closure or things. We may be asking them to look at some reconstructive related issues, which they are the expert in. But we need to relay that information. And it's not really their burden to find out that information. It's really my burden to tell them that information, and if we don't then we're not going to get a good patient outcome Overall and so then they can take over and do what they need to do at that point.

Mary Anne Obst, RN, BSN, CWON, CCRI:

It's definitely a team sport.

Greg Patterson, MD, FACS, DABS, CWS:

It is, very much.