Traumacast

At the 2017 annual meeting of the Western Trauma Association, the US military Joint Trauma System (JTS) held the third session of a new educational program called "Case Records of the Joint Trauma System". This is a planned series of presentations where an expert panel is presented with interesting and challenging battlefield trauma cases drawn from the Department of Defense Trauma Registry. This registry has captured data on all wounded patients treated at forward military medical treatment facilities during combat and post-combat operations in Iraq and Afghanistan. This program has been spearheaded by Lieutenant Colonel Jennifer Gurney, an Army trauma surgeon and the current Chief of Trauma Systems Development with the JTS. This challenging and entertaining session featured an expert panel representing both civilian and military trauma surgeons, and was co-moderated by Dr. Gurney and Dr. Matt Martin.Panelists: Carlos Brown, MDMitch Cohen, MDJim Davis, MDMatt Eckert, MDJoe Galante, MDOscar Guillamondegui, MDStephanie Savage, MDDeb Stein, MDSupplemental Materials:Joint Trauma System WebsiteFor any questions about this program, suggestions for future venues or cases, and to submit any cases or case material, please email Dr. Jen Gurney.

Global surgery is gaining traction and trauma is a leading cause of mortality in Uganda.  Dr. Kevin Pei had the privilege of teaching an operative trauma and resuscitation course at Makerere University and Mulago Hospital in Kampala Uganda. In this traumacast, Dr. Pei discusses the role of global health surgery with Dr. Jackie, a senior trauma surgeon at the Mulago Hospital. Dr. Jackie discusses challenges and triumphs and how we can facilitate bilateral clinical exchange.

Unfortunately, delivering bad news comes with our job as surgeons, particularly acute care surgeons. Clearly, our ability to effectively communicate with patients and their loved ones is of paramount importance, but are we all well equipped to handle the task?  In this episode, Drs. Nicole Stassen and Charity Evans share their experience and expertise on delivering bad news and end of life discussions.  Drs. Matthew Martin, David Morris, and Kevin Pei serve as moderators.Other referencesCommunicating Evidence for Participatory Decision Making - JAMA, May 19, 2004—Vol 291, No. 19Disclosing Harmful Medical Errors to Patients - n engl j med 356;26 www.nejm.org june 28, 2007

Dr. Jay Menaker, the Medical Director of the Lung Rescue Unit, discusses the evolution of ECMO in acute care surgery. He highlights its role in rescuing patients with severe respiratory failure and the impact of the H1N1 epidemic on its development. The conversation covers the importance of patient selection using the Murray score, the protocols for trauma patients, and potential complications like bleeding. Menaker also emphasizes the necessity of hands-on experience and ongoing education for healthcare professionals to master ECMO techniques.

In this episode of EAST Traumacast, we discuss the paper "Cadaveric comparison of the optimal site for needle decompression of tension pneumothorax by prehospital care providers" with author Dr. Dan Grabo and EAST reviewer Dr. Travis Polk.  The discussion highlights the changing dogma about needle decompression location -- you just might be convinced to change the way you use this technique!

This is the second episode in the series of “Case Records of the Joint Trauma System (JTS). Modern battlefield trauma care is characterized by highly complex and multi-system injury patterns, severe injuries, and care delivered in an austere and resource-constrained environment. This results in fertile ground for challenging management decisions, adverse events, suboptimal outcomes, and even preventable deaths. This episode was recorded during a session at the 2017 EAST Annual Scientific Assembly that consisted of a moderated discussion of 3 cases from the conflicts in Iraq and Afghanistan that resulted in a potentially preventable death, or major adverse outcome. The cases were presented in a standard M&M conference format, with open audience discussion throughout regarding key management decisions and options, and suggestions for preventing or minimizing the adverse events. There were 4 cases presented, emphasizing every phase of battlefield care, from pre-hospital thru to medical evacuation back to the United States.Supplemental Materials:Link to full video of the session on the EAST YouTube Channel.

The mass shooting of schoolchildren and educators at Sandy Hook Elementary school in Newtown, Connecticut shook the nation and forever altered the lives of a tight-knit community. A documentary film that focuses on the aftermath of this event is now being released, and we had the great fortune to hold a screening of this film and a post-screening discussion and Q/A session with the Director, Kim Snyder, and Dr. William Begg, who was the ER physician on duty the day of this tragic event. This special event was arranged through the efforts of Dr. Joe Sakran and immediate EAST Past President Dr. Nicole Stassen. This Traumacast episode is a recording of the post event discussion and question/answer session that was held on January 10, 2017 in conjunction with the 30th EAST Annual Scientific Assembly. Supplemental Materials:From the film’s website www.newtownfilm.com: “Filmed over the course of nearly three years, the filmmakers use unique access and never before heard testimonies to tell a story of the aftermath of the deadliest mass shooting of schoolchildren in American history on December 14, 2012. Newtown documents a traumatized community fractured by grief and driven toward a sense of purpose. Joining the ranks of a growing club to which no one wants to belong, a cast of characters interconnect to weave an intimate story of community resilience.”

Listen to the audio from our latest live EAST Town Hall Debate on a current “hot topic” in emergency general surgery, the use of laparoscopic lavage as a minimally invasive and non-resectional intervention for patients who require emergency surgery for perforated diverticulitis. Listen to our experts, Christian Jones and Tejal Brahmbhatt on the “Pro” side and Kevin Schuster and Andrew Bernard on the “Con” side, discuss a recently published meta-analysis and then all of the clinical and technique-related issues surrounding this contentious topic. Moderated by Dave Morris and Matt Martin.Supplemental Materials:EAST November Literature Review - including discussion of the meta-analysis:Angenete E et al. Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis—a meta­analysis. Int J Colorectal Dis. 2016;(ePub ahead of print)

Drs. Marie Crandall and Christian Jones join moderators Dave Morris and Matt Martin to discuss what may become a landmark paper in emergency general surgery.  Imagine if general surgery diseases could be graded by severity like traumatic injuries are with AIS/ISS.  Dr. Crandall and her co-authors have published just such a severity scoring system, which holds the promise of standardizing our nomenclature across the ACS community.  Listen as Drs. Crandall and Jones discuss the utility of this system and ways to promote its adoption.Article AbstractEAST November 2016 Literature Review

Drs. James Byrne and Amy Makley join moderator Dr. Dave Morris to discuss a very compelling recent paper that looked at the safety of early DVT chemoprophylaxis (within 72 hours of injury) to late (> 72 hrs after injury).  Dr.s Byrne and Makley also discuss the protocols they use in their institutions for this difficult clinical problem and the relative lack of guidelines available to help guide trauma clinicians. Article AbstractEAST PMG: Evaluation and Management of Mild Traumatic Brain Injury