Surgical Critical Care
The Surgical Critical Care service is a busy consultation service that provides 24 hour/day care to all critically ill surgical and trauma patients. The service had nearly 1200 admissions last year with an average APACHE II score greater than 17.
The Surgical Intensivists from the Division of Acute Care Surgery and the Department of Anesthesia staff three separate service lines within critical care: Surgery/Trauma ICU, Cardiothoracic Surgery ICU and Neuro Critical Care. The intensivists are just part of a large multi-disciplinary team within the Surgical ICU (SICU) that consists of dedicated nurse practitioners and physician assistants, the critical care trained nursing staff, pharmacists, nutritionists, chaplains, physical and occupational therapists, speech therapsits, case managers and social workers and the learners. Ongoing educational efforts on the Surgical Critical Care Service are directed towards the RWJ medical students, residents from the Departments of Surgery, Anesthesia and Emergency Medicine, and fellows in Surgical Critical Care and Pulmonary Critical Care who rotate in the SICU.
Over the last several years, we as the SICU team, have developed the Foundations of Care Program which consists of multiple evidence-based protocols that were designed to improve patient care, improve communication within the team by providing a common language for all health care providers and to provide consistency in practice patterns amongst all of the intensivists. We currently have protocols for Ventilator Management and Weaning, Communication, Nutrition, GI Prophylaxis, Venousthromboembolism Prophylaxis, Sepsis and Subarachnoid Hemorrhage. And, protocols for Sedation and ICU Activity are forthcoming.
The Trauma Program is one of the three pillars in the Division of Acute Care Surgery. Robert Wood Johnson University Hospital houses one of the three Level 1 Trauma Centers in the State of NJ. Faculty in the Division are all board certified and fellowship trained and provide 24/7/365 coverage of the Level 1 Trauma Center. Over the past several years, the trauma program has undergone dramatic growth, caring for over 2600 injured patients annually. Dedicated outreach and education to local and regional Emergency Medical Services and referring hospitals is responsible for the increase in utilization of the Trauma Center.
In addition to the initial resuscitation of acutely injured patients from throughout the region, the Division faculty are constantly seeking new ways to better treat our patients. For example, a new surgical procedure is being offered for patients with traumatic chest wall injuries. Using cutting edge surgical technique ACS faculty repair flail chest and multiple rib fracture injuries to lessen respiratory compromise, ease pain and enhance return to function. A combination of nurse practitioners, fellows, residents and students, lead by the ACS faculty, care for trauma patients from the time of initial entry into the health care system to the OR, the ICU, the floor and through discharge.
Hernia Abdominal Wall Reconstruction
Advances in medicine in the last two decades have had a huge impact on the prognosis of patients with even the most challenging medical and surgical concerns. At RWJUH, acute care surgeons use the most up-to-date techniques to restore the strength and integrity of the abdominal wall for patients with a wide variety of conditions. Sometimes, a patient can have a loss of their abdominal wall due to surgical complications, traumatic injuries, or herniation. Not only can this be aesthetically dissatisfying for the patient, but they can experience a great deal of abdominal pain from the bulge of their abdominal organs through this defect with potentially serious complications.
Despite the challenges of advanced age and other commonly associated risk factors such as obesity, diabetes, and smoking, our surgeons specialize in all types of hernia repair from the traditional, open technique to laparoscopic surgery ( minimally invasive). We carefully select the appropriate methods to obtain the best outcome for our patients. Our multidisciplinary treatment approach benefits our patients, and is something many other facilities do not provide. This attention to the whole patient is essential to the successful management of these challenging cases.