Trauma ICU Rounds

In this episode, we sit down with Dr. Carlos VR Brown from the Dell Seton Medical Center at the University of Texas to discuss issues relevant to both junior and mid-career trauma & acute care surgeons. Topics covered include: military-civilian trauma, finding one's niche in academic surgery, work-life balance, and learning from our mistakes. As I prepare to enter a new phase in my academic surgical career, the timing of this interview could not have been more perfect. This episode is packed with career pearls and words of wisdom that are not to be missed!Time Stamps00:12 Introduction02:37 Welcome Dr. CVR Brown05:39 When did your interest in trauma surgery begin?08:26 Military versus civilian trauma surgery11:16 Carlos Brown is a Hero (No Matter What He Says)13:18 Military & advances in clinical knowledge14:29 Research & the importance of mentorship15:04 The path to academic surgery: LAC-USC 2002-200717:45 Mentorship and research20:31 Coming home & the opportunity to build23:33 What is really important in a job? People, place, and family26:32 “If you build it, they will come” BUT you need to surround yourself with REALLY GOOD people. Oh, and time management is also essential!28:08 If you don’t have to be at work, leave! And go do the things that bring pleasure to you outside of work.30:25 “We all make mistakes….”31:36 Ask yourself, “What’s the best fit for both your career and family?”32:51 Outro and call to actionLinks:Carlos Brown is a Hero (No Matter What He Says)https://www.texasmonthly.com/articles/carlos-brown-is-a-hero-no-matter-what-he-says/Support the show

Massive upper GI bleeds pose serious risks, requiring rapid response and teamwork in treatment. Listeners learn about common causes and crucial initial evaluations to identify issues. The discussion emphasizes the importance of resuscitation strategies and the timing of both endoscopic and surgical interventions. Detailed insights into the Forrest Classification of peptic ulcers and management approaches for chronic ulcers are shared, ensuring a comprehensive understanding of tackling these medical emergencies.

Dr. Kenji Inaba, Chief of Trauma at LAC+USC Medical Center, shares his expertise in managing penetrating cardiac injuries. He dives into the complexities of cardiac trauma, discussing the critical differences in handling stab versus gunshot wounds. The conversation highlights the role of bedside ultrasound and resuscitative thoracotomy in emergencies. Additionally, Dr. Inaba details innovative advancements in the Stop the Bleed campaign, emphasizing the importance of community education and collaboration in trauma care.

Join expert surgeons Sharmila Dissanaike, a leader in subtotal cholecystectomy, Michael Truitt, renowned for his trauma expertise, and Angela Neville, who shares insights on challenging gallbladder cases. They delve into the debate between open and laparoscopic surgery, dissect complications, and explore diagnostic imaging's role. The conversation highlights the evolving practices, training challenges, and the significance of collaborative approaches in improving surgical outcomes, ensuring patients receive the best care during difficult gallbladder surgeries.

Dive into the intriguing world of bowel obstructions! The discussion highlights the critical distinction between mechanical and functional causes, shedding light on acute colonic pseudo-obstruction. You'll discover its pathophysiology and the essential risk factors to watch for. The podcast also covers vital diagnostic strategies and therapeutic options, emphasizing the importance of patient safety and monitoring. Unraveling the complexities of Ogilvie's syndrome makes for an enlightening listen!

Explore the high-stakes world of acute mesenteric ischemia, a life-threatening condition with a high mortality rate. Experts discuss its elusive nature and the alarmingly subtle signs leading to severe complications, including bowel necrosis. Delve into the critical pathophysiology and the urgency for timely intervention to improve patient outcomes. The conversation also highlights common causes and effective management strategies, emphasizing the importance of swift diagnosis in transforming care in this challenging medical landscape.

Dive into the terrifying world of necrotizing soft tissue infections. Learn about their aggressive nature and the urgent need for early diagnosis. The conversation highlights crucial treatment strategies, including broad-spectrum antibiotics and the importance of timely surgical interventions. Discover the risk factors that contribute to these lethal infections and why maintaining a high index of suspicion is vital for survival.

Dr. Scott Weingart, a renowned physician and the godfather of critical care podcasts, joins the discussion on surgical cricothyrotomy. He shares how his techniques have evolved and humorously claims trauma surgeons are not the best teachers for this procedure. The conversation delves into the psychological demands of emergency decision-making, advocating for a simplified approach using just a scalpel and bougie. Weingart emphasizes emotional resilience and mastering effective techniques, turning cricothyrotomy from a daunting task into a vital lifesaving skill.

Dive into the intriguing world of mechanical ventilation as the discussion uncovers the role of PEEP in managing ARDS. Explore the fine balance between high and low PEEP strategies and their impact on oxygenation. Hear about the potential downsides of excessive PEEP and when it can be counterproductive. The importance of lung volume recruitment maneuvers is highlighted, offering insights on their effectiveness in patient care. This episode is a must-listen for anyone interested in the complexities of respiratory support.

Dive into the complexities of ARDS, exploring its evolving classification and the critical challenges faced during management, especially during the pandemic. Discover the vital pathophysiology behind ARDS and how to identify its leading causes. Learn essential ventilator management strategies that lay the groundwork for improving oxygenation and patient outcomes. This foundational knowledge prepares you for deeper insights into troubleshooting and advanced therapies in future discussions.