Quick bites of trauma: spend a half hour or less with trauma surgeons from around the world, discussing interesting cases, pearls of wisdom, lessons learned, whether or not a hot dog is a sandwich and whether brushing one’s teeth in the shower is economy of motion or a waste of water.
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Dr. Martin Zielinski, a leading expert, delves into the nuances of damage control surgery (DCS), from its historical evolution and current indications balancing physiological derangement with surgical judgment to practical aspects like temporary abdominal closure techniques and the role of direct peritoneal resuscitation. The discussion also covers critical post-operative resuscitation, optimal timing for reoperation, and strategies for challenging abdominal wall closures. Furthermore, Dr. Zielinski shares his experience transitioning from Mayo Clinic to Baylor and offers advice on sustaining a surgical research career.
Dr. David Feliciano joins the podcast to explore the historical evolution and current surgical management of gastric and duodenal ulcer disease. He details how advances like PPIs and H. pylori eradication transformed treatment from routine elective surgeries to rare emergency procedures for bleeding or perforation, primarily in older, sicker patients. The discussion covers specific surgical techniques for various ulcer types, the role of "damage control," the diminished use of vagotomy, and the importance of distinguishing benign from malignant lesions. Dr. Feliciano also shares personal stories about training with legendary surgeon Michael DeBakey and his wife's influence on his well-being.
Dr. Kevin Schuster, a Professor of General Surgery at Yale, joins the hosts to delve into the complexities of gallbladder surgery. The conversation covers defining challenging gallbladders, optimal surgical timing, when to opt for cholecystostomy tubes, and navigating laparoscopic versus open approaches. Dr. Schuster also provides expertise on managing patients on anticoagulants, strategies for common bile duct exploration and injury, and performing cholecystectomy in pancreatitis cases. The episode concludes with personal reflections on his transition from electrical engineering to surgery and the pursuit of work-life balance in a demanding career.
Dr. Martin Schreiber, head of Trauma at Oregon Health Sciences University, joins the hosts to explore the resurgence of whole blood in trauma care. He details its historical use, the reasons for its decline, and the complexities of modern implementation, including low titer blood, use in women, logistical hurdles, and ongoing randomized trials. The discussion also covers the pros and cons of leukoreduction, pre-hospital programs, risks of over-resuscitation, and concludes with entertaining personal stories about dance moves and a unique dual wedding experience.
Dr. Chad Ball, a hepatobiliary and trauma surgeon, joins dual-trained vascular and trauma surgeons Drs. Teshera, Kundi, and DuBose to discuss the shift from generalist surgeons to hyper-specialization. They explore the pros and cons of this evolution, the value of combining fellowships, and the debate surrounding who should handle complex trauma cases. The conversation highlights the importance of collegiality, continuous learning, and adapting training paradigms to produce well-rounded surgeons capable of complex care.
This episode features Dr. Dante Yeh, Chief of Emergency General Surgery at Denver Health, detailing his comprehensive MUSTANG trial on appendicitis treatment in North America. He challenges the long-held belief of orderly disease progression, highlighting demographic differences in complicated appendicitis and discussing patient-centered approaches to non-operative management versus appendectomy. The conversation also covers antibiotic use, the innovative "Casa Relax" study, and personal anecdotes about fashion and the evolving landscape of medical education through podcasts.
Dr. Greg Beilman, Chief of General Surgery at the University of Minnesota, shares his extensive expertise on pancreatitis. The discussion covers critical aspects from early diagnosis and ICU management, including fluid resuscitation and scoring systems, to complex complications like peripancreatic fluid collections, necrosectomy, pseudoaneurysms, and abdominal compartment syndrome. Dr. Beilman also delves into chronic pancreatitis, advanced surgical options like islet auto-transplantation, and reflects on his roles in military trauma and healthcare administration.
Dr. Ram Nirula discusses contemporary approaches to rib fracture care, covering initial patient workup and identifying high-risk individuals needing ICU care or surgical fixation. He details surgical techniques, including minimally invasive strategies and plating principles. The episode also explores pain management, optimal timing for intervention, and potential complications, offering comprehensive insights into evolving trauma surgery practices.
Dr. David Spain discusses his research linking unprofessional surgical team behavior to higher patient complication rates, emphasizing medicine as a team sport where professionalism is crucial for outcomes. The conversation explores defining professionalism, how to teach it to medical students and junior faculty, and strategies for effectively addressing behavioral lapses. It also highlights the importance of fostering a culture of mutual advocacy and informal resolution over formal complaints to maintain team cohesion and patient safety.
In this episode, Dr. Deb Stein, President of EAST and Director of Critical Care Services at UMMC, offers her unparalleled expertise on neurotrauma and traumatic brain injury. She delves into optimal pre-hospital and emergency department management, including controversial topics like TXA and early intubation. The discussion extends to nuanced ICU care, advanced neuromonitoring, and the challenges and unintended consequences of evolving TBI assessment guidelines like the BIG criteria, providing invaluable perspectives for trauma professionals.
Hosts Miloš Buhavac, Joe DuBose, and Rishi Kundi welcome esteemed guests Dr. David Feliciano and Dr. Greg Magee to discuss axillosubclavian vascular injuries. The conversation delves into the mechanisms of injury, diagnostic imaging, and the nuanced decisions between open and endovascular repair, including the role of hybrid operating rooms. Experts share insights on managing specific injuries like pseudoaneurysms and AV fistulas, practical surgical techniques, and damage control algorithms.
Dr. DuBose speaks with Barbara Eaton, Katie Lidard, and Jen Miller, all experienced nurse practitioners, about their essential contributions to modern trauma and acute care surgery. The conversation delves into the diverse educational routes for NPs and PAs, including the evolving trend towards doctorate-level programs, and highlights key differences in their training and clinical strengths. They candidly discuss the challenges of integration, patient perception, and the crucial teaching and mentorship roles NPs play for residents, ultimately advocating for a more comprehensive understanding and collaboration within healthcare teams.
Dr. Ravi Rajani, a leading vascular surgeon, provides an in-depth look at assessing and diagnosing peripheral vascular trauma. He distinguishes the approach for blunt versus penetrating injuries, critiques the utility of physical exams, Ankle Brachial Index (ABI), CT Angiography (CTA), and duplex ultrasound, highlighting their strengths and limitations. The discussion also covers decision-making for operative exploration, the role of hybrid suites, and crucial strategies for post-repair surveillance and long-term patient care, including the evolving understanding of isolated tibial artery injuries.
Dr. David Feliciano discusses the complexities of esophageal trauma, detailing diagnostic strategies for neck and thoracic injuries, including imaging modalities and the evolution of esophagoscopy. He explains surgical exposure techniques for different anatomical regions, outlines repair methods, and emphasizes buttressing high-risk repairs. The conversation also covers post-operative feeding, management of delayed injuries, and insights into tracheoesophageal fistulas and esophageal stents.
Drs. Latham and Liang join Dr. DuBose to discuss contemporary approaches to facial trauma management, emphasizing the critical collaboration between trauma and plastic surgeons. They delve into specific factors influencing surgical decisions, such as injury mechanisms, fracture types, and associated brain injuries, alongside best practices for imaging, antibiotics, and communication for optimal patient outcomes.
This episode features pediatric surgeon Dr. Howard Pryor, who highlights essential distinctions in trauma care for children compared to adults. He delves into tools like the Breslow tape, specific vital sign limits, airway management, and imaging protocols tailored for pediatric patients. The discussion also touches upon Dr. Pryor's decision to pursue a critical care fellowship, his views on medical advancements, and the unexpected challenges posed by the COVID-19 pandemic on the healthcare system.
Dr. Bennie Jeng, Chair of Ophthalmology at the University of Maryland, educates trauma surgeon Rishi Kundi on the nuances of ocular trauma. They discuss initial assessment, types of eye injuries like globe ruptures and orbital fractures, and the importance of eye preservation. The conversation also delves into surgical management, post-operative complications, rehabilitation, and the various subspecialties within ophthalmology.
This episode delves into the essential yet often challenging relationship between trauma surgeons and nurses, exploring common stereotypes from both perspectives. It outlines ten key rules for improving physician-nurse collaboration, emphasizing communication, empathy, and understanding each other's stressors. The discussion also touches upon various nursing stereotypes, the evolution of communication tools, and the future landscape of trauma nursing.
In this episode, Dr. Kundi and Dr. DuBose delve into the complexities of deep vein thrombosis (DVT), pulmonary embolism (PE), and IVC filter management in trauma patients. They explore the unique physiological challenges, the limitations of current screening protocols, and the nuances of pharmacologic versus interventional treatments. The discussion highlights the need for individualized care, the evolving role of IVC filters, and advanced PE therapies like ECMO, concluding with a look at open questions and key takeaways.
Dr. Carlos Brown joins the podcast to delve into the complexities of rectal injuries in trauma, sharing findings from a large multi-center study that challenges long-standing treatment paradigms, particularly regarding proximal diversion and presacral drains. The discussion covers optimal CT protocols, distinguishing intraperitoneal from extraperitoneal injuries, and managing concomitant bladder or pelvic fracture injuries. The episode also touches on personal anecdotes, music tastes, and valuable career advice for aspiring trauma surgeons.
This episode features Dr. Joe DuBose and Dr. Pedro Texeira delving into blunt thoracic aortic injury. They discuss initial detection challenges, including the limitations of chest X-rays versus the utility of CTA, and the critical role of immediate medical management through blood pressure control. The conversation also explores the significant shift from open surgery to endovascular repair (T-BAR), detailing pre-operative considerations, optimal timing, and common post-operative challenges. Dr. Texeira stresses that despite advanced repair techniques, BTIA remains a major injury requiring careful management.
This episode features emergency medicine physician Scott Weingart and EM critical care fellow William Teeter alongside trauma surgeon Joe DuBose to explore the often-tense relationship between their specialties. They delve into common stereotypes from both perspectives, discussing the underlying stressors and cultural differences that lead to conflict, especially in the trauma bay. The conversation also covers the contrasting dynamics of academic versus community hospital settings, offering insights into fostering better collaboration and empathy for improved patient outcomes.
This episode features Dr. Joe DuBose dissecting the nuances of chest tube management, a topic often underestimated in its complexity. He delves into appropriate indications for placement, the efficacy of different tube sizes, and the significant risks of retained hemothorax, including a 30% empyema rate. The discussion also covers controversial practices like oxygen therapy, antibiotic prophylaxis, and the evidence-based approach to chest tube removal and persistent air leaks, offering a comprehensive guide for modern trauma care.
This episode features Dr. Tom Scalea providing a detailed oral history of endovascular trauma surgery, beginning with its conceptualization as a "fantasy" and tracing its early development in the 1980s, driven by figures like Sal Scolfati during New York's violent "crack wars." Dr. Scalea discusses his pivotal role at Shock Trauma, emphasizing strategic decisions like establishing a dedicated hybrid OR and fostering a "trauma mindset" among specialists. He concludes by envisioning the future of the field, highlighting advanced technologies and the importance of dual-trained "strike teams."
This episode features Dr. Ben Zarzaur exploring the complexities of splenic injury. The discussion delves into both operative and non-operative management, including indications for splenectomy, optimal surgical techniques, and post-operative vaccination protocols. Key topics also include the revised AAST grading system, the role of vascular abnormalities, and the nuances of angiography and embolization, with a focus on balancing risks and patient outcomes.
This episode features Dr. David Feliciano demystifying fasciotomies, a critical procedure in trauma. He details the pathophysiology of compartment syndrome, diagnostic methods, and the nuanced debate between prophylactic and therapeutic approaches. The discussion also covers surgical techniques, common pitfalls, post-operative wound care, and addresses the long-term ramifications for patients. Dr. Feliciano concludes by sharing valuable professional lessons and advice for aspiring researchers.
Dr. Demetrios Demetriades, a trauma surgery giant, joins to dissect the evolution of colon injury management. He challenges historical myths regarding injury location and bullet sterility, advocating for evidence-based primary repair over routine diversion, even in high-risk cases. The discussion also covers optimal surgical techniques, post-operative care, and critical areas for future research, concluding with personal reflections on teaching and Greek culture.
Drs. Sheldon Teperman, a New York trauma icon, and Matt Martin, a retired Army surgeon who volunteered in NYC, recount their experiences during the early COVID-19 surge. They discuss the rapid escalation of the crisis, the challenges of PPE shortages, and the innovative solutions implemented. The conversation also delves into the emotional toll on healthcare workers, comparing it to military deployments, and highlights the importance of leadership, team cohesion, and personal support systems in navigating unprecedented medical challenges.
In this episode, Dr. David Feliciano tackles challenging vascular trauma scenarios, detailing damage control strategies like arterial shunting, techniques for definitive reconstruction in contaminated surgical fields, and appropriate graft material selection. He also covers critical aspects of post-operative monitoring and medication management for vascular repairs. The discussion concludes with personal reflections on life and career advice, including his passion for powerboat racing.
Dr. Thomas Scalea provides a masterclass on hepatic trauma management, from initial damage control packing and the nuances of the Pringle maneuver to definitive surgical resections like the breben hepatectomy. He discusses strategies for challenging retrohepatic bleeds, the utility of the Poghetti balloon for deep parenchymal injuries, and the role of the MARS system for extreme cases. The episode emphasizes the importance of experience, seeking senior guidance, and innovative thinking in surgical practice.
