Trauma ICU Rounds

Dr. Sam Tisherman from the Shock Trauma Center joins us on Rounds to discuss his ongoing, cutting-edge research in EPR-CAT. Colloquially known as "suspended animation", EPR-CAT may provide trauma & acute care practitioners with the desperately needed time that's required to repair lethal exsanguinating injuries through the induction of profound hypothermia after traumatic arrest. During Rounds, we discuss everything from indications for EPR-CAT to the role of selective aortic arch perfusion, integration of resuscitative endovascular techniques, and common ethical considerations that arise when performing resuscitation research.Support the show

Dr. Paula Ferrada joins us on Rounds this week to discuss several topics ranging from a circulation first approach in hemodynamically unstable trauma patients to the importance of inclusion, diversity, and equity in surgery & medicine. Clinical pearls, invaluable insight, and career advice for learners at different stages of their careers round out a fantastic episode that you'll want to share with your friends and colleagues.Support the show

Time is critical when dealing with shock in patients. The podcast delves into diverse presentations of shock and emphasizes the importance of thorough assessments and monitoring vital signs. It underscores immediate therapeutic interventions, showcasing the role of point-of-care ultrasound in fluid resuscitation. With a focus on tailoring treatments to individual needs, the discussion highlights the life-saving impact of timely diagnosis and action in critical care.

To trach or not to trach? That is the question we're addressing in our first Rapid Rounds. One topic. Two to three questions. All in under 10 minutes. This week's rounds is informed by 2 recent articles in the trauma critical care literature published in Trauma Surgery Acute Care Open (TSACO) and the Journal of Trauma and Acute Care Surgery (JTACS).Support the show

Explore the vital role of tourniquets in controlling severe bleeding during emergencies. Discover the achievements of the Stop the Bleed campaign and the importance of public training. Learn about the safety and effectiveness of tourniquets, along with the critical 'ABCs' of bleeding control. Hear essential strategies for managing traumatic bleeding and specific guidelines for pediatric patients. This discussion emphasizes the call to action on National Stop the Bleed Day, aiming to improve survival rates in critical situations.

In this follow-up episode to Episode 3, we discuss and review the key factors (3 Ts) that define a mode of mechanical ventilation. In addition to the Targeted control variable (volume or pressure), the other key factors determining a mode include the Type of breath and Timing of breath delivery. In addition to discussing what defines a mode, we also review when and why one particular mode might be selected over another.Support the show

What are the indications for ECMO beyond ARDS and refractory cardiogenic shock? In which patients should we consider eCPR and is this the new standard of care for patients sustaining out-of-hospital cardiac arrest? Finally, how do I work towards safely and efficiently weaning my patient from VV or VA ECMO? These are just a few of the questions that we address on Rounds with our guest faculty member and Director of the UCLA Adult ECMO Program, Dr. Peyman Benharash. In this comprehensive review of ECMO we also explore the regionalization of ECMO care here in Los Angeles County, as well as the day-to-day considerations that you want to bear in mind when assessing and caring for your patients requiring extracorporeal life support.Learning ObjectivesBy the end of rounds you should be able to:1. Understand the indications & contraindications to VV and VA ECMO support2. Describe the basic components of an ECMO circuit3. Describe the role of eCPR in the management of adult patients with out-of-hospital cardiac arrest4. Discuss key management strategies to safely wean patients from ECMO5. Describe common complications of ECMO and strategies to mitigate themTake Home PointsECMO is time-sensitive, therefore, early and safe cannulation is an important determinant of outcomeECMO is a bridge to therapyUse of scoring systems like the Murray Score may be useful to stratify the severity of ARDS among patients being considered for VV ECMO supportThe indications for ECMO are expanding to include technically challenging operative caseseCPR is a promising therapy for patients presenting to an ECMO center of excellence with refractory VF/VT cardiac arrest ECMO therapy, particularly VA ECMO, may affect virtually organ systemThe potential role of ECMO therapy during the current COVID-19 pandemic remains to be definedTime Stamps00:12 Introduction01:16 Overview of Rounds 02:13 The rise of ECMO 02:46 CESAR & EOLIA trials summarized 05:40 Venovenous (VV) vs. Venoarterial (VA) ECMO08:24 How to decide whether or not to place a patient on VA ECMO?   10:33 Timing & indications for ECMO support11:38 Murray Score explained12:24 Contraindications & patient selection for VV & VA ECMO13:56 Expanding indications for ECMO15:23 ECMO in the Setting of Trauma: Pneumonectomy & Retrohepatic IVC injuries17:45 Regionalization of ECMO in Los Angeles County21:52 Who should be cannulating?23:22 Approach to cannulation24:50 Distal perfusion catheters for VA ECMO26:10 Differences between VV & VA ECMO28:24 The W5H of eCPR34:26 Considerations for access for VV ECMO35:53 Avalon catheter 37:51 VV versus VA ECMO circuits/set-up explained43:30 Getting your patient off of ECMO & other key considerations48:56 Vasopressor & inotropic therapy during VA ECMO50:31 Virchow’s triad,  antithrombotic therapy & bleeding on ECMO54:30 AKI, end-organ dysfunction & the daily assessment of patients on ECMO57:22 ECMO 2.0 & the role of evolving technologies61:20 Role of ECMO during the COVID-19 pandemic 66:45 Take-home points68:38 OutroSupport the show

Explore the critical timing for placing tracheostomies in patients needing extended mechanical ventilation. Discover the differences between open and percutaneous procedures. Learn key management strategies for handling life-threatening complications post-surgery, like unplanned decannulation. Delve into anatomical considerations and the importance of a team approach in overcoming airway emergencies. This insightful discussion equips you with essential knowledge to navigate the complexities of tracheostomy care.

Dive into the intricate world of shock in trauma care. Discover its dynamic nature and the urgency in identifying patients at risk. Learn about the physiological effects of shock on oxygen delivery and cellular health. Explore a straightforward classification system, breaking down hypovolemic, cardiogenic, distributive, and obstructive shock. Understand the vital differences between compensated and uncompensated shock, setting the stage for effective treatment strategies. This insightful discussion is essential for any trauma practitioner.

Dive into the urgent world of acute respiratory failure with a focus on recognizing critical signs during assessments. Discover the ABCDE approach for immediate intervention strategies and the essential role of supplemental oxygen therapy. Learn about diverse oxygen delivery systems, including low-flow, high-flow, and reservoir options, while understanding how to tailor these therapies to patient needs. This discussion emphasizes the importance of timely actions in emergency situations to enhance patient outcomes.