Non-Trauma Emergency (NTE)

Posted by BJ Opong at Tuesday, September 28, 2010

When I first learned that I had the non-trauma emergency rotation I was excited because I knew I was going to see all sorts of interesting things. The more I thought about it I became more and more uncertain of what I was going to experience because I had no clue as to what exactly was a non-trauma emergency. To put it as concise and simple as I can its really any kind of Gastrointestinal surgery that needs to be performed immediately. The best example I can give is someone has appendicitis and needs an appendectomy immediately; they would be placed on the NTE service.

When this rotation first started the adjustment that I was most concerned with was not learning all the various surgical procedures and treatments. I was concerned with how my body would adjust to having to be at the hospital and ready to go at 5:30am some days earlier. I have never had to be up so early for an entire month, but after the 1^st week I can say I hardly even noticed the time.

The thing I enjoyed the most about this rotation was that 90% of what we were doing was completely new which required a lot of on the spot learning. It also gave me the opportunity to better acquaint myself with the anatomy of the GI system. I’m sure your wondering what exactly the pharmacist does on an NTE rotation so let me begin.

We would arrive at 5:30 or 5:45 to round with the NTE surgical team which consisted of 3 residents, 2 Physician Assistants, a few medical students, and the pharmacy staff consisting of Dr. Kraft, Jason, and myself. While rounding we would discuss the clinical plan for patients with problems ranging from Appendicitis, Pancreatitis, Choledolithiasis, Fistulas and Ostomys. The team would discuss the the best surgical plan, medication plan and even the best nutrition plan for the patients. I was pleasantly surprised at how often the team would look to the pharmacist for information about various medications and nutrition in the patient. Total Parenteral Nutrition (TPN) is a very important aspect of a patients care plan if they want to recover. I realized that a lot of times when patients have GI issues they are incapable of consuming there nutrition by mouth so it must be administered IV. It is up to the pharmacist to make sure that the patient receives the right amount of fluids, protein, carbohydrates, lipids, and electrolytes to restore their health, because a large majority is malnourished. Nutrition happens to be a good indicator at the likely hood of having a successful surgical procedure. Patients with very poor nutrition status were sometimes withheld from surgery to improve there nutrition to increase they chances of recovery post surgery. All in all this was a very beneficial and informative rotation. I learned a great deal about GI surgical, and infection issues.