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Trauma ICU Rounds

Author: Dr. Dennis Kim

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Medical education podcast dedicated to providing high-quality, concise, and clinically relevant multimedia content spanning the spectrum of surgical critical care, emergency general & trauma surgery
43 Episodes
Join us as we discuss surgical management options for the difficult gallbladder. Is it better to open or proceed with a laparoscopic subtotal cholecystectomy? If the latter, fenestrated or reconstituted? What's the difference?! This week on Rounds, we have several guest professors join us to discuss their perspectives and experience on managing patients with a difficult gallbladder. Joining us from Texas (and favoring subtotal cholecystectomy) are Drs. Sharmila Dissanaike and Michael Truitt.  Drs. Angela Neville and Jessica Keeley from California discuss the merits of converting to an open cholecystectomy for patients with a difficult gallbladder. Also, joining us is Dr. Christian de Virgilio, who co-moderates this lively and educational podcast episode alongside me.
Bowel obstructions may be due to mechanical or functional causes. Although acute colonic pseudo-obstruction (ACPO) falls into the latter category, we must ALWAYS rule out mechanical causes for massive distension of the colon. In this episode, we make our way down the GI tract and discuss the pathophysiology, risk factors, diagnostic and therapeutic considerations for what Dr. Ogilvie coined "Large-intestine Colic" in 1948.
Whether due to occlusive or nonocclusive obstruction of the arterial inflow or obstruction of venous outflow, acute mesenteric ischemia (AMI) continues to be associated with high mortality rate. Early recognition based on a high index of suspicion is critical to early diagnosis and intervention, particularly among patients presenting with pain out of proportion to physical exam findings. In this episode, we discuss the pathophysiology of AMI, together with common causes, the initial clinical presentation, and management strategies for patients with this life-threatening and elusive surgical disease process.
Rare. Morbid. Lethal. NSTIs area group of infections which result in aggressive tissue destruction, systemic toxicity, and can involve any layer of the soft tissue. The key to successful management (like so many disease processes) is having a high index of suspicion together with administration of early, broad-spectrum antibiotics and surgery.
Dr. Scott Weingart joins us on Rounds to discuss a topic that's of great interest to the both of us - surgical cricothyroidotomy. Tune in to hear how Scott's approach to performing a cric has evolved over time and why "trauma surgeons are the worst people to learn crics from?!" From  3 strikes and your out to the use of bougies, this episode covers all things cric.Also check out Episode 23 of Rounds "Surgical Cricothyroidotomy: How I Do It". Even better go to: and review the FANTASTIC content that has been put together by Scott and his team at EMCrit.
What are the determinants of mean airway pressure? Is too much PEEP ever a bad thing? In this episode, we review determinants of oxygenation in mechanically ventilated patients and discuss the benefits and risks of high versus low PEEP strategies, as well as the utility of lung volume recruitment maneuvers.Check out our previous related episodes 1, 3, 6, 10, and 36.
Back to the basics! In this episode we review the evolving criteria,  etiologies, and pathophysiology of ARDS. A brief review of ventilator induced lung lung injury and initial vent setup provide the groundwork for future episodes exploring how to troubleshoot the vent and therapies for ARDS that have been shown to improve oxygenation and mortality. Please check out Episodes 
Dr. Jamie Coleman from Denver Health joins us on Rounds to share her insights and knowledge surrounding wellness, sleep, and stress among surgeons and frontline workers. From healthy pre-call preparation and tips on healthy sleep hygiene to harnessing resilience and measuring the burden of unacknowledged mental health disorders on health care professionals, this episode is a MUST listen for all of us who need to be reminded that sometimes, "It's okay not to be okay".
Dr. Martin Zielinski from the Mayo Clinic, Rochester, MN, joins us on Rounds to discuss best practices in the management of bowel obstruction. In this episode, we review common etiologies for bowel obstruction, discuss the role of imaging, as well as the significance of clinical and radiographic findings on the likelihood of operative intervention. Dr. Zielinski also shares with us the Gastrografin swallow protocol that has been successfully developed and implemented at the Mayo Clinic in the management of patients with small bowel obstruction.
In this follow-up episode to our discussion with Dr. Scott Weingart of EMCrit, we review the indications for performing a resuscitative thoracotomy, together with the potential application of a circulation first resuscitation strategy, and some intricacies regarding performing a surgical cricothyroidotomy. 
Dr.  Walt Biffl from Scripps Memorial Hospital La Jolla joins us on Rounds to discuss the evolution of BCVI management from the early 1990s to present day. Topics discussed include screening criteria, the diagnostic approach and imaging modalities for accurately identifying these injuries in our blunt polytrauma pateints. Grading criteria, antithrombotic therapies, and the use of endovascular stents round out this informative discussion with one of the world's leading experts on the topic. Check out the Show Notes at www.traumaicurounds.comAlso, you can find the updated 2020 EAST BCVI PMG here:
Who should be primarily responsible for managing vascular injuries? Trauma surgery? Vascular surgery? BOTH?! In this episode, we join the teams from the highly successful Behind the Knife and Audible Bleeding Podcasts to discuss the importance of a collaborative approach to the management of vascular trauma in an era marked by a decrease in general surgery resident experience with operative vascular trauma cases, together with an increase in the number of programs offering an integrated vascular surgery residency.  Drs. Tanya Zakrison and Matt Martin (Team Trauma) debate Drs. Benjamin Starnes and Wesley Ohman (Team Vascular) on a topic that has brought about some "heated" exchanges on social media platforms such as Twitter.
Dr. Joel Topf joins us on Rounds to discuss and review key concepts in the recognition and management of acute kidney injury (AKI) in the SICU. AKI is a common and morbid complication among hospitalized patients. Further, trauma and surgical patients, in particular, are at an increased risk for AKI due to the myriad of pre-, intra-, and postrenal insults that commonly occur at the time of injury, during resuscitation, surgery,, as well as from iatrogenic insults including IV contrast, NSAIDs, antibiotics (aminoglycosides and the infamous Pip/Tazo/Vanco ice cream sandwich).  From the use of a DDAVP clamp in patients with severe hyponatremia to the use of balanced solutions in critically ill patients, kidney_boy breaks it down for us as only a true salt whisperer can!
In recognition of Sepsis Awareness Month, Dr. Matt Martin joins us once again on Rounds to discuss state-of-the-art sepsis management in 2020. Also joining us on Rounds is Dr. Vanessa Ho from MetroHealth Medical Center in Cleveland, Ohio, who authored a recently published review paper in Surgical Infections earlier this year, "Sepsis 2019: What Surgeons Need to Know". 
What are the 5 or 6 Ps? If you answered Pain, Pain, Pain, Pain, Pain, and Pain, you can go right ahead and skip this episode. Extremity compartment syndrome is an acute surgical emergency and requires a HIGH index of suspicion in order to make the diagnosis. Therapy consists of fasciotomy. If left untreated, numerous complications and sequelae may develop including AKI and even death.
Over the course of 30+ episodes, we'll be discussing fundamental surgical disease processes & conditions that may prove challenging to even the most seasoned acute care surgeon. Along the way, we'll be joined on Rounds by an incredible group of guest professors who will share their experiences, expertise, and results of recent research investigations with us. 
So apparently not all of the listeners of the show are on Twitter?! In this brief recap of Season 1 (yes, Season 1 is done!) we pay thanks to all of our guest professors, provide you with an update of where we are in terms of the Season 2 launch, and, as usual, invite you to engage with me, the show, and our social media account. 
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.
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.
Knife. Finger. Tube. Sounds simple enough. And you read correctly....a bougie is both unnecessary and superfluous! In this episode I share you some tricks of the trade for performing a cric successfully, together with post-surgical airway considerations including hemorrhage control and the decision to convert to a formal tracheostomy.
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