Traumacast

Join us for an in depth discussion of NSTI with Dr. Eileen Bulger, MD, Professor of Surgery at the University of Washington and Chief of Trauma Surgery for Harborview Medical Center and Dr. Rondi Gelbard, MD, upcoming NSTI PMG Team Leader and Assistant Professor of Surgery at Emory University.   We discuss the timing of debridement, antibiotic management, role for transfer, HBO and so much more!   Moderated by Drs. Carrie Valdez and Dave Morris

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, M

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

Extracorporeal Membrane Oxygenation (ECMO) is an advanced modality for rescue of patients with hypoxic respiratory failure with or without associated cardiac failure, and failure to respond to conventional therapy and ventilator management. Previously, ECMO was limited to a few select centers and had scant supporting literature in adult patients for most indications. Over the past 5 years there has been an explosion in interest in ECMO and a proliferation of ECMO programs in the U.S., likely as a result of improved techniques and equipment, a large and relatively successful experience with the H1N1 influenza epidemic, and publication of the CESAR randomized trial that supports ECMO use and referral to an ECMO center for refractory respiratory failure. We discussed ECMO with two leaders in the field: Dr. David Zonies and Dr. Jay Menaker, who shared their knowledge and experience in a review format for the Acute Care Surgeon. Supplemental Materials:The Extracorporeal Life Support Organization (ELSO) website Dow

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 Uni

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

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 Abstract EAST PMG: Evaluation and Management of Mild Traumatic Brain Injury 

In this episode, Drs. Carlos Brown and Lewis Kaplan discuss modern management of ARDS and hypoxic respiratory failure.  Both experts share practical and useful insight and raise important questions and controversies.  You won’t be disappointed!  Drs. Kevin Pei, Matt Martin, and Dave Morris served as moderators.                                                                                 Supplemental MaterialsNEJM Article on Proning                 

In this episode of Traumacast, we interviewed Dr. Jason Smith and Dr. Ben Zarzaur about an exciting new EAST program called: Investigator Support Team Core, or INVEST-C. This program aims to leverage the considerable amount of research resources of the EAST membership in order to provide research mentorship, research design assistance, multicenter collaborations, statistical support, and editorial services for young investigators with promising research ideas and projects. The program will formally kick off in 2017 with a two-day research “Hackathon” where a small group of selected junior researchers will receive intensive mentorship and assistance to fully develop their research plan, study design, and IRB/IACUC proposal, and leave with a complete or near-complete project that is ready to execute. Listen for some great insights into not only this new EAST program, but also on key lessons and tips to succeed in the field of surgical research. Supplemental Materials: EAST Careercast Programs: There are three c

In this episode of Traumacast, we hosted an EAST roundtable discussion on firearms policy and firearm-related injury prevention. The discussion centered around the recently released EAST literature review and Practice Management Guideline on the efficacy of restrictive licensing and concealed carry laws for preventing firearm-related injuries, as well as the recent efforts of the Committee on Trauma to promote open discussion and consensus buidling to tackle this challenging problem. The panelists included Marie Crandall and Alex Eastman (co-authors of the EAST PMG), Ronny Stewart (Chair, COT), Nicole Stassen (EAST President), and Kevin Schuster (Chair, EAST Manuscript and Literature Review Committee). This interview was recorded live at the 2016 AAST Annual Meeting in Waikaloa, Hawaii. Supplemental Materials:EAST Practice Management Guideline: Prevention of Firearm-Related Injuries with Restrictive Licensing and Concealed Carry Laws  Firearm Injury Prevention: A Consensus Approach to Reducing Preventable Dea

In this episode we discuss two issues highlighted in the August 2016 EAST Literature review concerning Pediatric Trauma: the meaning and definition of pediatric traumatic coagulopathy and what to do with an injured child with a tender c-spine and negative imaging. Drs. Barbara Gaines, David Mooney, and John Petty joing moderators Dave Morris and Matt Martin for a thought-provoking discussion that will be interesting to anyone who cares for injured children -- even providers who don't normally treat pediatric patients. Supplemental MaterialsAcute traumatic coagulopathy in a critically injured pediatric population: Definition, trend over time, and outcomes. Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma.  

Election season is upon us…Drs. Schuster and Stassen (EAST president) face off with Drs. Patel and Skinner!  The experts debate the merits of cervical spine collar clearance based on CT alone in the obtunded patient.   This debate is based on the EAST 2015 PMG (link below).  Audience members called in and pressed our experts for answers to difficult questions.  Who won the debate…click “PLAY” and find out.  Stay tuned for the next Traumacast! Drs. Kevin Pei and Matthew Martin served as moderators for this debate. Supplemental MaterialsEAST PMG - Cervial Spine Collar Clearance in the Obtunded Adult Blunt Trauma Patient

IMPORTANT NOTE: This podcast is a lead-in to an EAST Master Class online webinar on REBOA that will be held on October 6, 2016 at 5pm (Eastern Standard Time). See the link below to register. After that date, the webinar will be available on the EAST website to view In this episode of Traumacast, we interview Dr. Laura Moore and Dr. Elizabeth Benjamin on one of the current “hot topics” in trauma care and resuscitation, resuscitative endovascular balloon occlusion of the aorta (REBOA). These techniques and devices offer a new therapeutic option for the patient with significant non-compressible truncal hemorrhage, and can serve as a resuscitative bridge to provide additional time to get the patient to the operating room or angiography suite. Dr. Moore and Dr. Benjamin share their experience and insights as two early adopters of REBOA at their Level 1 trauma centers. This interview was recorded live at the 2016 AAST Annual Meeting in Waikaloa, Hawaii. Supplemental Materials:Collection of major REBOA studies and a

At the 2016 annual meeting of the Military Health System Research Symposium, the US military Joint Trauma System (JTS) held the inaugural session of a new educational program called "Case Records of the Joint Trauma System". This is the first in 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 multiple military services and several allied nations, and was co-moderated by Dr. Gurney and Dr. John Holcomb. Panelists:Colonel Ray Fang, US Air ForceColonel (retired) Don Je

Viscoelastic assays for assessing the coagulation system have been around for decades, but have recently seen a surge in interest and research in the trauma community. Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM) provide a real-time assessment of multiple aspects and factors involved in clot initiation, development and maturation, and then breakdown or lysis. Many trauma centers have begun incorporating viscoelastic testing in the initial evaluation of injured patients, particularly among those with known or suspected active bleeding. Although TEG/ROTEM have many theoretical advantes compared to standard or conventional coagulation assays, there have been no prospective controlled trials comparing them head to head until now. We interviewed Dr. Gene Moore, the senior author and principal investigator on a recently published prospective randomized trial comparing the utility and associated outcomes of massive transfusions guided by TEG versus those guided by conventional coagulation assa

In this episode, we discuss an interesting study which was recently published in the Journal of Trauma and Acute Care Surgery (see link below) with the study’s lead author, Dr. Matthew Carrick, and the senior author, Dr. Kenneth Mattox.  Drs. Carrick and Mattox describe the extension of the hypotensive resuscitation paradigm beyond the trauma bay and into the operating room, as well as some details about how they were able to accomplish this prospective, randomized trial with exception from informed consent.  In characteristic form, Dr. Mattox also challenges the audience to take on more areas of untested dogma — what he calls the “sacred cows” of patient care — and to make an impact in clinical science research. Article ReferencedCarrick MM, Morrison CA, Tapia NM, Leonard J, Suliburk JW, Norman MA, Welsh FJ, Scott BG, Liscum KR, Raty SR, Wall MJ Jr, Mattox KL. Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma: Early termination of a randomized prospective c