Dr. Megan Brenner joins us on Rounds to discuss the evolving role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the management of trauma & acute care surgery patients with non-compressible torso hemorrhage. Advances in technology, evolving indications, and controversies regarding the appropriate and safe deployment of REBOA are but a few of the topics covered in this episode. Support the show
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...
Dr. Dennis Kim demystifies surgical cricothyroidotomy, sharing practical tips and personal experience for this critical emergent airway procedure. He details indications, essential equipment, incision techniques, and the vital role of finger palpation for confirmation. The episode also covers post-cric management, including hemorrhage control and the decision-making process for potential tracheostomy conversion, emphasizing patient safety and preparation.
In this episode we discuss endpoints of resuscitation with a focus on the pros and cons of both passive and dynamic hemodynamic measurements including arterial pressure waveform analysis, ultrasonography, and passive leg raising. Please visit www.traumaicurounds.com and check out the Vidcast for this episode. Support the show
Dr. Eric Simms joins us on Rounds to share with us his foolproof and fun way of remembering the dreaded coagulation cascade. Supplementing this podcast is a vidcast (https://www.traumaicurounds.ca/vidcasts) that provides us with a helpful visual explanation for understanding the key factors, steps, and intricacies of the coagulation cascade. Support the show
Dr. Eric Ley from Cedars-Sinai Medical Center joins us on Rounds to discuss the recently published Western Trauma Association's Critical Decisions Algorithm for reducing VTE in trauma patients. Early risk stratification, timing and initial dose of LMWH, weight-based dosing, and surveillance screening are just a few of the key topics we discuss on this episode. Support the show
Dr. Martin Schreiber, Division Head of Trauma, Critical Care, and Acute Care Surgery at Oregon Health and Science University (OHSU) joins us on Rounds to discuss the results of his recently accepted prospective RCT of prehospital TXA use in adult patients with traumatic brain injury. In addition, we discuss the rise of hemostatic adjuncts, balanced resuscitation, and the potential challenges associated with publishing research in one of the top medical journals - JAMA . Support the show...
In this Rapid Rounds, we provide a quick and closer look at the Yang & Tobin index as originally described in the 1991 NEJM paper. Support the show
Determining whether or not your intubated and ventilated patient requires ongoing ventilatory support should not be overly complicated. In this episode we review the approach to determining if our mechanically ventilated patients can be safely extubated. In addition to discussing readiness for spontaneous breathing trial (SBT) criteria, we also discuss the potential utility of "weaning" criteria, choice of method of SBT, and considerations when removing the endotracheal tube. Support the show...
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...
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,...
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 tissue. Early recognition of shock with immediate institution of lifesaving therapies are critical to successful patient outcomes. Establishment of functional IV access together with augmentation of cardiac output through increased preload and appropriate use of vasoactive agents are key aspects in the initial management of sick patients. Support the show
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
Pressure. Packing. Tourniquet. In this episode, we provide a glimpse into the American College of Surgeons Stop the Bleed Program, from inception to present day. We also discuss the increasing use of tourniquets as an adjunct to hemorrhage control in patients with severe extremity injuries. Support the show
In this follow-up episode to Episode 3, we discuss and review the key factors (3 T s) that define a mode of mechanical ventilation. In addition to the T argeted control variable (volume or pressure), the other key factors determining a mode include the T ype of breath and T iming 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...
Dr. Dennis Kim provides an in-depth discussion on tracheostomies, exploring the benefits over endotracheal intubation and the optimal timing for placement in critically ill patients, particularly those with traumatic brain and spinal cord injuries. The episode details essential perioperative considerations, factors influencing the choice between open versus percutaneous approaches, and crucial management principles for life-threatening postoperative complications such as early decannulation, airway obstruction, and tracheoenominate fistula. Finally, it outlines strategies for safely weaning patients from tracheostomies.
What is shock? A clear grasp of this concept is a MUST for any practitioner taking care of patients. Shock is many things. It is dynamic. It is elusive. It is lethal. A high index of suspicion is required to identify patients in shock. While lifesaving therapies are initiated, we must have an organized approach to to shock in order to identify the best diagnostic and therapeutic pathways for our patients. As such, we will review a simple classification system for shock. In a follow-up episode, w...
Dr. Dennis Kim continues the discussion on acute respiratory failure, focusing on key management principles for immediate treatment. The episode details the importance of a focused clinical exam, including the ABCDE approach and identifying signs of increased work of breathing and diaphragmatic failure. It also provides a comprehensive overview of low-flow, high-flow, and reservoir oxygen delivery systems, concluding with guidance on optimal oxygen targets and conservative therapy.
In this episode we review the "lethal 6" and "hidden 6" chest injuries that comprise the deadly dozen of thoracic trauma . Mechanism of injury together with vital signs and findings from the physical exam should provide us with the data needed to identify life-threatening thoracic injuries on our primary survey. For hidden injuries, the diagnostic adjuncts required to identify these injuries are also discussed. Support the show...
Dr. Matt Martin from Scripps Mercy Hospital in San Diego, CA joins us on Rounds to discuss topics related to the resuscitation of critically injured patients with a focus on endpoints of resuscitation. The basic approach to the assessment of "sick" versus "not sick" patients and utility of early transfusion of whole blood are explored, along with the usefulness of physical exam findings and other adjuncts in guiding our resuscitation efforts. Support the show...
Dr. Dennis Kim demystifies mechanical ventilation by exploring its core physiological concepts. The discussion includes indications and goals for invasive ventilation, delves into the respiratory equation of motion to understand pressure generation, and explains key pressures, resistance, and compliance. The episode also details the four phases of a mechanical breath and introduces how to define modes of ventilation, preparing listeners for deeper dives into ventilator management.
Dr. Dennis Kim discusses rapid sequence intubation (RSI) and contrasts it with 'protected intubation' during the COVID-19 pandemic. The episode breaks down the five key steps of RSI, providing essential modifications for intubating patients with acute hypoxemic respiratory failure, with a strong emphasis on meticulous preparation, appropriate PPE use, and post-procedure debriefing for improved safety and outcomes. It highlights lessons learned from clinical care and simulations to protect both patients and healthcare workers.
Dr. Dennis Kim kicks off Trauma ICU Rounds by comprehensively reviewing the mechanisms and pathophysiology of acute respiratory failure. He defines and classifies hypoxemic and hypercapnic respiratory failure, delving into the oxygen delivery equation, oxygen-hemoglobin dissociation curve, and diagnostic tools like the AAO2 difference and P/F ratio. The discussion covers six causes of hypoxemia, with a detailed focus on V/Q mismatch and shunts, before exploring an anatomic approach to understanding hypercapnic respiratory failure, including "won't breathe" and "can't breathe" etiologies.
Look. Listen. Feel. In this trailer for the Trauma ICU Rounds podcast, I outline the objectives of this medical education series. Key topics that will be addressed span the spectrum of surgical critical care, acute care and emergency general surgery, as well as trauma. We'll also explore issues related to professional development and highlight the results of influential and novel research studies. In addition to auditory learning, visit the website http://www.traumaicurounds.ca. for additional l...
