Trauma ICU Rounds

Dr. Megan Brenner, a clinical professor of surgery specializing in trauma and vascular surgery, sheds light on the fascinating potential of REBOA in trauma management. She discusses the technology’s evolution and the delicate balance between its effectiveness and associated risks. Controversies surrounding REBOA, including its application in critical care and emerging techniques like partial REBOA, are intricately explored. The conversation also delves into the innovative use of bicarbonate during procedures and the future prospects for REBOA in diverse medical scenarios.

Dr. Clay Burlew from Denver Health joins us Rounds to discuss the management of trauma patients with hemodynamically unstable pelvic ring fractures. Topics covered during this episode include utility and technique of preperitoneal packing (PPP), evolution of the institutional multidisciplinary pathway for the management of unstable pelvic fractures at Denver Health, and use of REBOA as an adjunct to hemorrhage control in patients with these potentially devastating injuries.Support the show

Explore the essentials of performing a surgical cricothyroidotomy, where simplicity is key—knife, finger, tube. Discover practical tips to ensure success, while avoiding unnecessary tools like bougies. Gain insights into post-procedure airway management and vital considerations, such as controlling hemorrhage and when to transition to a formal tracheostomy. This informative discussion equips healthcare professionals with crucial knowledge for navigating emergency situations.

Dive into the critical world of resuscitation as experts dissect the importance of endpoints in trauma care. Explore the balance between passive and dynamic hemodynamic measurements, and discover advanced tools like arterial pressure waveform analysis and ultrasonography. Learn how shifting from traditional fluid boluses to tactical strategies can revolutionize patient outcomes. The conversation also highlights the integration of real-time data and the potential of AI in personalized medicine, paving the way for future advancements in trauma monitoring.

Dr. Eric Simms, Chief of Minimally Invasive and General Surgery at Harbor UCLA, brings his teaching expertise to the table. He shares a fun, memorable way to understand the coagulation cascade, emphasizing comprehension over rote memorization. Through humor and creative analogies, he simplifies complex concepts, explains the roles of warfarin and heparin, and highlights key components like protein C and S. With a focus on enhancing practical understanding, Eric’s insights make the intricate world of blood clotting accessible and engaging.

Dr. Eric Ley, a renowned Professor of Surgery and Medical Director of the Surgical ICU at Cedars-Sinai, shares insights on recent advances in managing venous thromboembolism (VTE) in trauma patients. He discusses the importance of early risk stratification and the optimal timing and dosing of anticoagulants. Ley also addresses the complexities of anticoagulation in patients with epidural catheters and highlights innovative pain management strategies. The conversation emphasizes the need for collaboration and updated guidelines in trauma care.

Dr. Martin Schreiber, a trauma and critical care expert at Oregon Health and Science University, shares groundbreaking insights on prehospital use of tranexamic acid (TXA) in traumatic brain injuries. He discusses the evolution of hemorrhage control techniques and the role of adjuncts like TXA in trauma care. Schreiber also dives into the challenges of publishing rigorous research in prestigious journals and explores potential complications of TXA, emphasizing the delicate balance between innovative treatment and patient safety.

Explore the intricacies of the Rapid Shallow Breathing Index and its role in weaning patients off mechanical ventilation. Delve into key insights from the foundational research by Yang and Tobin. Discover the complexities of interpreting clinical indicators and their impact on patient outcomes. This discussion highlights the significance of understanding respiratory metrics for improved care in critical settings.

Explore the critical considerations for safely extubating mechanically ventilated patients. Learn about readiness assessments, weaning criteria, and the impact of spontaneous breathing trials. Discover effective methods for evaluating a patient's stability, and hear insights from landmark studies on weaning techniques. Gain practical tips on the role of healthcare professionals in the process, and engage with expert discussions to deepen your understanding of these crucial practices.

Which of your patients are at risk for developing intraabdominal hypertension (IAH) and the abdominal compartment syndrome (ACS)? In this episode, we review the classification, pathophysiology, and widespread systemic effects of this potentially fatal and, often times preventable, surgical disease process. We also discuss key diagnostic and therapeutic strategies as outlined by the WSACS - The Abdominal Compartment Society.Support the show