Day in the Life

BURDASH: So, let’s come on down here, and now we’ve talked about those wound cares a little bit. So, let’s give a quick demonstration. And then we’ll break into stations here and you all can give it a try. Simple wounds like this are so, so common. They don’t have to be combat-related. This is, you know, somebody cutting themselves trying to open a package, this is, you know, falling out of a truck, you know, you stumble out and you scrape your leg. So this is something that’s very common, and something we’re guaranteed to see at some point in our careers. Needle at 90 degrees. And then you go through the skin, and try to come out on the other side of your wound, about the same distance that you went in on. Yeah, and that’s great, what you did right there. We have a nice partnership actually with a local butcher who gives us a good deal on pig’s feet. We’ve done classes where we do a cricothyrotomy, or cric, and so you have to make a cut into the airway, and place a breathing tube through that. So we’ve bought pig tracheas before, and we’ve also bought racks of ribs to practice doing chest tubes, as if we would between human ribs. And so, I think the butcher gets good business out of us on things that maybe nobody else is buying, so he can’t be wrong with that. But it gives us a really good, tangible experience because a lot of the stuff, you just can’t learn unless you feel it. To put a chest tube in, you have to feel what it feels like to go in between the tissue of ribs. To have the confidence to do a procedure where you have to use a tool on another person, it’s helpful to have done it at some point before, so that, you know, the first time that they’re doing some sort of lifesaving procedure, and they’re realizing they’re going to have to make a cut in somebody’s throat, they aren’t having to do it for the first time just brand new, having never actually held a scalpel and cut something. And so this is what we try to do to prepare them to be safe to be able to do their jobs.

WINEGARNER: All right, guys, thanks for coming out this morning. So we're here today to do some good TC3 training. Nick, you're our medic today, and so you're going to be kind of taking point, and he's going to be the boss. I'm going to be in the background; I'll be helping direct what's going on. All right, Nick, take it from here. NICK: And you'll be point man on the patrol. You'll be on the right side of the wedge, along with you. When we take casualties, I'll assign roles when we get there. WINEGARNER: All right, guys, you've got superior firepower. NICK: Left side, move to the vehicle. Right side, move to us. Get on the front side of the vehicle. MALE: Hey, we need a hand over here. WINEGARNER: At this stage, which we would call care under fire, is managing massive hemorrhages. NICK: You get the bleeding stopped? MALE: Bleeding's stopped. MALE 1: Bleeding's stopped. WINEGARNER: So we're moving from... NICK: You with me? OK. WINEGARNER: What we would have considered care under fire out there, where all they really did was stop the bleeding and get him somewhere more secure, to what we would call tactical field care here. So this is where our medic's going to take charge; he's going to start addressing every problem that he can find. Nick, what's something that you might have to worry about on this guy with a chest wound, now you've occluded his chest wound? NICK: Might have to needle d him. WINEGARNER: OK. NICK: We're going to check for bilateral rise. He was good; his respirations weren't too high either. [booming noise] MALE: We gotta get going. WINEGARNER: All right, guys, it's not safe anymore. Let's get going. [sounds of gunfire] Move out, move out. So this is simulating — we would, you know, probably have to move him to somewhere safe for a helicopter to land, and then from here we're going to take the patient to a higher level of care. You know, now we're more in a field-hospital setting.

TRENTINI: Alright, so part of residency is academics, so every Tuesday morning we have a conference where all the residents get together, military and civilian. The first thing on the agenda — there’s always an oral boards case. In that situation, one resident’s called up in front to sit with one of the board examiners, and they go through an oral board case in front of the entire residency program. So it’s a little nervewracking. After that we’ll have some simulation sessions to go through, so busy day today. The simulation center is about as close as you can get to a real-life patient encounter. All the residents go through multiple sims throughout their career, and you can do — almost everything that you can do on a real patient, you can do in the simulation center. The experiments that we conduct in the lab downstairs are slice culture experiments. And so what we can do then is change the environment to simulate a stroke. This is the brain slice, again, that’s cut like a piece of pepperoni, lying flat on the grate, and what we’re interested in studying is this part of the brain, which is the cerebral cortex, which is the outside of the brain, which in humans is all the sulci and gyri, all the gray matter of the brain, OK? We’re interested in studying these cells and how these cells respond to an acute stroke, and if our nanoparticle treatment can prevent the damage caused by an acute stroke. I was awarded an ROTC scholarship, which paid for college, and then in return I owed four years of active-duty service to the Air Force. So that’s when I decided to go to USUHS where — it’s a military medical school. There I did my medical degree and also did my Ph.D. degree, and it was entirely funded by the Military. And then after medical school you choose a residency, and so emergency medicine for me fit in perfectly. When I’m done, I’ll go back to an active-duty job using all the knowledge and all the experiences that I’ve built along the way to really serve my country better. TRENTINI: Alright, so part of residency is academics, so every Tuesday morning we have a conference where all the residents get together, military and civilian. The first thing on the agenda — there’s always an oral boards case. In that situation, one resident’s called up in front to sit with one of the board examiners, and they go through an oral board case in front of the entire residency program. So it’s a little nervewracking. After that we’ll have some simulation sessions to go through, so busy day today. The simulation center is about as close as you can get to a real-life patient encounter. All the residents go through multiple sims throughout their career, and you can do — almost everything that you can do on a real patient, you can do in the simulation center. The experiments that we conduct in the lab downstairs are slice culture experiments. And so what we can do then is change the environment to simulate a stroke. This is the brain slice, again, that’s cut like a piece of pepperoni, lying flat on the grate, and what we’re interested in studying is this part of the brain, which is the cerebral cortex, which is the outside of the brain, which in humans is all the sulci and gyri, all the gray matter of the brain, OK? We’re interested in studying these cells and how these cells respond to an acute stroke, and if our nanoparticle treatment can prevent the damage caused by an acute stroke. I was awarded an ROTC scholarship, which paid for college, and then in return I owed four years of active-duty service to the Air Force. So that’s when I decided to go to USUHS where — it’s a military medical school. There I did my medical degree and also did my Ph.D. degree, and it was entirely funded by the Military. And then after medical school you choose a residency, and so emergency medicine for me fit in perfectly. When I’m done, I’ll go back to an active-duty job using all the knowledge and all the experiences that I’ve built along the way to really serve my country better.