Traumacast

In this podcast we discuss small bowel obstruction – a common problem that can be challenging to treat appropriately – with Dr. Martin Zielinski, Associate Professor of Surgery at Mayo Clinic in Rochester, MN.  Dr. Zielinski  discusses several aspects of small bowel obstruction: which patients need an operation?  Which will resolve with time?  How long should nonoperative management be attempted before taking a patient to surgery?  We also discuss how to utilize the Gastrografin® challenge into the clinical decision making process. The discussion is moderated by Dr. David Morris and Dr. Levi Procter.Supplemental Materials:CT image showing small bowel feces sign and article references

This podcast is from the second EAST Town Hall Debate session, where two panels of experts discuss and compare the Hartford Consensus Conference guidelines and the Emergency Tactical Casualty Care recommendations and program for improving outcomes from active shooter and other intentional mass casualty events. The debate is moderated by Dr. Andrew Bernard.Pro Hartford Consensus ConferenceAlexander Eastman, MDEric Campion, MDPro Tactical Emergency Casualty CareBabak Sarani, MDE. Reed Smith, MDGene Reilly, MDSupplemental MaterialsACS Bulletin with the Hartford Consensus III ReportTECC 2015 updated guidelinesTECC website

This podcast is the recording of the first inaugural EAST Town Hall Debate session, on the topic of treating patients with an “Antibiotics-only” approach for acute appendicitis versus the standard treatment of surgical appendectomy. This has become a particularly controversial topic recently following publication of the APPAC Trial in JAMA (link to article below). The program started with two teams in a standard debate format, followed by additional expert commentary from two invited guest speakers: Dr. Edward Livingston, Deputy Editor of JAMA and Dr. Elliott Haut, author of an invited commentary on the APPAC Trial. The debate was then opened up to questions and comments from any listener during the live session.The Foes:  EAST Emergency General Surgery Section (Pro Appendectomy) vs. EAST Online Education Section (Pro Antibiotics-only)Moderated by Dr. Levi ProcterSupplemental Materials:APPAC Trial - JAMA website. This page also contains links to multiple related commentaries, as well as a podcast interview with the study authors by Dr. Livingston.

Highlights from the 2015 Western Trauma Association Meeting - Podcast #49 - EPThis is the first in our series of podcasts from some of the key trauma and ACS annual meetings. The 2015 Western Trauma Association was held in Telluride, Colorado, and we were there to record the highlights and interviews with many of the attendees and presenters. See below for a listing of the interviews and supplemental materials including a copy of the meeting program book. Next, we look forward to a Traumacast from the 2016 EAST Annual Meeting in San Antonio, Texas.2:15             Hasan Alam on VPA + fluid resuscitation in a TBI model7:15             Drs. Chapman and Moore on the TEG “Death Diamond” and plasma-first resuscitation14:17           Dr. Nelson on “Sugar or Salt”: relative role of mineralocorticoids in shock17:50           Dr. Olson on a randomized trial of heparin vs lovenox for VTE prophylaxis21:58           Dr. Miller on repairing flank hernias using bone-anchor fixation27:38           Tourniquet Debate: Carlos Brown vs Kenji Inaba32:15            Dr. Berndtson on Outcomes with K-Centra 4-factor PCC36:15            Dr. Russo on pigtail catheter versus chest tube for hemothorax drainage40:25            Dr. Bensard on the utility of routine serum HgB checks in pediatric trauma46:28            Dr. Aydelotte on the impact of marijuana legalization on traffic fatalities51:45            Dr. Parker on the impact of TXA on fibrinolysis parameters by TEG56:25            Dr. Moren on recursive partitioning to better define massive transfusion1:01:55         Dr. Pharoan on massive abdominal wall injury due to fireworks1:06:40         Expert Case Panel: Drs. Shackford, Karmy-Jones, Rhee, & Schreiber1:09:30         Dr. Cohen on the WTA Multicenter study of the “found down” patient1:14:30         Dr. Christine Cocanour on the WTA and her term as WTA PresidentSupplemental Materials: WTA 2015 Program BookDec 2015 issue of the Journal of Trauma and ACS

Pediatric abusive injuries and non-accidental trauma (NAT) are unfortunately common and widespread, and can frequently go unrecognized with disastrous outcomes. In this podcast we discuss pediatric NAT with Dr. Tony Escobar and Dr. Elizabeth Pohlson from Mary Bridge Children’s Hospital. Dr. Escobar and Dr. Pohlson are recognized local and national experts on this topic, and have implemented a hugely successful evidence-based and multi-disciplinary screening and evaluation process at their center. In this podcast they discuss the problem of pediatric NAT, as well as the common “red flags” from the history, physical examination, and radiologic studies that should alert a physician to the possibility of NAT. In addition, they discuss some actual cases and real-world scenarios involving pediatric NAT, along with practical advice for the front line medical provider on optimal evaluation and management strategies. A copy of their standardized NAT evaluation note as well as their evidence based evaluation algorithm are included below in the supplementary materials section. Supplemental Materials: NAT Evaluation NoteNAT AlgorithmNon-Accidental Trauma slideset

Management of the patient with large or complicated abdominal wall defects requires a broad and deep understanding of anatomy, physiology, and surgical techniques that go well beyond the standard ventral hernia repair. Today we spoke with two experts in the modern management of the complex or multiply recurrent hernia, Dr. Robert Martindale and Dr. Sean Orenstein. We discussed the scope of the problem, the workup of these patients, optimal techniques including the retrorectus repair and the posterior component separation (or “TAR”), and then key postop management issues. This podcast also served as a lead-in to our inaugural “EAST Master Classes” live webinar held on December 7, 2015 . This webinar featured Dr. Martindale and Dr. Orenstein, and they demonstrated several of these repair techniques and strategies. If you missed the live webinar, the session was recorded and placed on the EAST Online Education Center as an enduring talk.

Medical malpractice claims and other litigation have unfortunately become a common occurrence in all fields of surgery. Although each case has unique and specific aspects, there are common patterns, themes, and risk factors that all practicing physicians should be aware of in order to minimize or even completely avoid these situations. In addition, there is a great deal of misunderstanding about how published guidelines such as the EAST Practice Managemenet Guidelines may be used for or against the physician in establishing the standard of care and any violoations of that standard. We discuss these issues with Dr. Carlo Reyes, a board certified Emergency Medicine physician, health care attorney, and nationally recognized expert in medical malpractice, and Dr. Chet Morrison, a Trauma and Surgical Critical Care attending with  a longstanding interest in this area.Supplemental Materials:Legal implications of Pay for Performance article by Dr. ReyesMinimizing your malpractice risk article by Dr. ReyesValue of CPGs as “Safe Harbors” for Legal Defense

Join Dr. Joshua Levine, Chief of Neurocritical Care at the University of Pennsylvania and a leading expert in neurocritical care, as he dives into the latest guidelines for managing traumatic brain injuries. He highlights the critical role of pre-hospital care and new resuscitation strategies, explores the complexities of blood transfusions, and questions traditional intracranial pressure monitoring practices. Levine advocates for individualized care over one-size-fits-all approaches, blending insights on metrics with a holistic view of patient well-being.

Rib fracture plating has gained popularity in recent years as more and more Trauma providers have adopted this procedure into their treatment armamentarium.  In this episode of Traumacast Dave Morris and Matt Martin discuss rib fracture plating with Dr. Bill Long, who has extensive experience in treating injuries of the chest wall and was instrumental in the development of one of the commercially available rib plating systems, and Dr. Babak Sarani who has adopted the procedure within the last 5 years.  The topics of discussion include the rationale for performing the procedure, how to select patients who will benefit, and some technique tips.Supplementary MaterialsEAST Online Education Center - Surgical Treatment of Rib Plating by Dr. David Ciesla

An interview with Dr. Alexander Eastman, the Trauma Medical Director at Parkland Memorial Hospital and a current law enforcement officer with the Dallas Police Department, and Dr. Imad Haque, an active duty Army surgeon and the Director of Simulation Training at Madigan Army Medical Center. These two nationally recognized experts discuss what to expect in active shooter scenarios, how to respond, and most importantly how to prepare yourself and your facility through the use of realistic and well-planned simulation training. The interview concludes with a discussion of the rationale and recommendations from the Hartford Consensus Conferences.Supplementary Materials:Active shooter slide presentation from Dr. EastmanDHS Active Shooter Pocket CardHartford Consensus Conference 1Hartford Consensus Conference 2