Traumacast

Whole blood transfusion, once the norm, is once again rising to the forefront of hemorrhage resuscitation science.  In this podcast, Drs. Philip Spinella and Alan Murdock share their expert thoughts and opinions regarding the rationale for whole blood transfusion.  After listening, you just may want to start using whole blood in your hospital. Articles Referenced: Cotton BA, Podbielski J, Camp E, Welch T, del Junco D, Bai Y, Hobbs R, Scroggins J, Hartwell B, Kozar RA, Wade CE, Holcomb JB; Early Whole Blood Investigators. A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions. Ann Surg. 2013 Oct;258(4):527-32; discussion 532-3 Spinella PC, Pidcoke HF, Strandenes G, Hervig T, Fisher A, Jenkins D, Yazer M, Stubbs J, Murdock A, Sailliol A, Ness PM, Cap AP. Whole blood for hemostatic resuscitation of major bleeding. Transfusion. 2016 Apr;56 Suppl 2:S190-202. Blumberg BS, Kuvin SF, Robinson JC, Teitelbaum JM, Contacos PG

In this traumacast, Dr. Howard Champion, EAST Founding Member and 1991 EAST President, and surgical simulation expert shares his experience and vision for simulation in surgery training.  Dr. Champion is a seasoned surgical educator, serving as Chief of Trauma at Washington Hospital Center for many years.  In 2001, he founded SimQuest, a leading simulation platform provider.  Dr. Champion not only discusses his views on the utility of simulation in competency based assessment, but also offers encouragement for those interested in a career in simulation-based surgical education.  Drs. Kevin Pei and Matt Martin serve as co-moderators. Supplemental MaterialsMinimizing Surgical Error by Incorporating Objective Assessment into Surgical EducationSimQuest Website

The 29th EAST Annual Scientific Assembly took place January 12-16, 2016 in San Antonio, Texas. The meeting once again had record attendance, and boasted a wide array of educational, scientific, career development, and social programs. And of course - dodgeball! The EAST Traumacast was there to cover it all and bring you highlights, interviews, and summaries from this great meeting. This traumacast starts out with an interview with the 29th EAST President,  Dr. Stan Kurek, then covers the highlights from the entire meeting, and closes with an interview with the 30th EAST President, Dr. Nicole Stassen. Supplemental Materials Summary and downloads from the 29th EAST Annual Scientific Assembly Make your plans now for the 30th EAST Annual Scientific Assembly - January 10-14, 2017 Video highlights and interviews from the 29th EAST Annual Scientific Assembly - See what it is all about!

One of the most well known and attended trauma conferences in the world is the Trauma, Critical Care, and Acute Care Surgery Conference, held annually in Las Vegas. Also known as the “Mattox Meeting”, this conference attracts a large and diverse group of attendees with an interest in trauma and emergency surgical care. For the 49th annual meeting we joined forces with the “Behind the Knife” podcast team to cover the conference and bring you interviews and discussions with the incredible group of expert faculty assembled by Dr. Mattox. We also had the opportunity to sit down and interview the Behind the Knife team about their experience and insights from starting a new surgical podcast that has become one of the top medical podcasts in the country.  Interviewees include: The Behind the Knife team (Scott Steele, Jason Bingham, John McClellan), Kenneth Mattox, Ali Salim, Marty Schreiber, Kenji Inaba, Scott Steele, Mike Sise, and Raul Coimbra. Supplemental MaterialsBehind the Knife: www.behindtheknife.org/Trauma,

In this EAST Traumacast, the state of Early Goal Directed Therapy is discussed with two dynamic speakers, Dr. Donald Yealy who is the lead author on the PROCESS trial , and Dr. Ruby Skinner who is a busy SICU director.  This and two other studies prompted changes in the Surviving Sepsis Campaign Guidelines.  Drs. Yealy and Skinner give insight into how early goal directed therapy has changed since the original studies and how the changes have impacted their patient care.  The discussion is moderated by Dr. Kevin Pei and Dr. Matt Martin.

Social media plays an increasingly important role in all aspects of personal and professional life, and can have profound impacts both positive and negative. Having a solid basic understanding of the mechanics and “rules of the game” is critical to successfully adopting and using social media. EAST as an organization has embraced social media, and for the 2016 Annual Scientific Assembly made a concerted effort to increase the social media presence of the meeting on Twitter. We were able to sit down with the core group of EAST Twitter users, aka the “EAST Twitterati”, and discuss how to get started on social media, practical tips and advice for optimizing the experience, key potential pitfalls to be aware of, and how the use of social media has impacted their personal lives and careers. Interviewees: Elliott Haut, Joe Sakran, Christian Jones, Paula Ferrada, Rob Winfield, Jason Smith, Brad Dennis, Alex Eastman, Jamie Coleman, and Tareq Kheirbek Supplemental Materials:Twitter 101 tip sheet

In this episode, we have a lively discussion about the papers reviewed by Dr. Niels Martin in the February EAST literature review.  We were also very fortunate to have Dr. Bob Martindale, who was one of the lead authors for the 2016 ASPEN/SCCM ICU nutrition guidelines, join us to discuss the key issues of importance to Trauma/ICU providers.  We also discuss the effect of age of stored red blood cells with Dr. Martin Schreiber.  Also joining in this discussion were EAST members Dr. Kevin Schuster and Dr. Andrew Bernard.  The discussion is moderated by Dr. Dave Morris and Dr. Matt Martin. Supplemental Materials2016 ASPEN/SCCM ICU Nutrition Guidelines

In this podcast we discuss the process of professional peer review, and how this process can be used or mis-used for a variety of reasons. Our guest is Dr. Larry Huntoon, who has become a recognized national expert in the area of “sham peer review”, and who was written and lectured extensively about common themes in techniques and tactics that are used in these proceedings. He gives some great advice about recognizing, reacting to, and even preventing this type of adverse professional action for surgeons. This interview was done as a “Town Hall” session, and Dr. Huntoon takes questions from the attendees after the formal moderated interview. The discussion is moderated by Dr. Matthew Martin and Dr. Andrew Bernard.  Supplemental Materials:  Editorial: Tactics Characteristic of Sham Peer Review by Larry Huntoon, MD, PhD  Recognizing the Tactics of Sham Peer Review: a 3-part video series presented by Dr. Larry Huntoon

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 Proctor. 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, MD Pro Tactical Emergency Casualty CareBabak Sarani, MDE. Reed Smith, MDGene Reilly, MD Supplemental Materials ACS Bulletin with the Hartford Consensus III Report TECC 2015 updated guidelines TECC 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 Procter Supplemental Materials:APPAC Trial - JAMA website. This page also contains links to multiple related commentaries, as well as a podcast interview

Highlights from the 2015 Western Trauma Association Meeting - Podcast #49 - EP This 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: Carlo

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

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 CP

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.

In this Traumacast, Drs. Levi Procter and Andrew Bernard interview Dr. Joshua Levine, Chief of Neurocritical Care and the University of Pennsylvania regarding the critical care management of traumatic brain injury.  Dr. Levine is a nationally recognized expert in Neurocritical care. Recently, the ACS COT updated their guidelines on the management of severe traumatic brain injury. We discuss the new-tiered therapies, the pros and cons and how to apply this in your practice.  Supplementary MaterialsACS TQIP - Best Practices in the Management of Traumatic Brain Injury

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

An interview with Dr. Matthew Martin, the Trauma Medical Director at Madigan Army Medical Center and one of their core faculty on the Bariatric Surgery Service. Dr. Martin is an active member of the American Society for Metabolic and Bariatric Surgery, and serves as an Associate Editor with Surgery for Obesity and Related Diseases. This session is moderated by Dr. Levi Procter, and special guest moderator Dr. Andrew Bernard, who discuss the increasingly common issue of urgent and emergent complications among patients who have had a prior bariatric surgical procedure. The interview covers the initial evaluation and diagnostic workup, operative and nonoperative management strategies, and clinical "pearls" for the acute care surgeon who is faced with one of these challenging scenarios. Supplementary MaterialsBariatric surgery problems and complications syllabusASMBS Poster: Pearls for Emergency Care of the Bariatric Surgery Patient

An interview with Dr. Ernest "Gene" Moore, a giant in the field of trauma and the current Editor in Chief of the Journal of Trauma and Acute Care Sugery. Dr. Moore takes us behind the scenes of a major academic journal, and provides advice and insights on starting an academic career and producing high quality and publishable research. He then discusses how to become more active with scientific journals by serving as a peer-reviewer and what it takes to join the Editorial Board. The interview concludes with Dr. Moore's thoughts and experience on the relatively unique career path of becoming the Editor in Chief of a major journal. Supplementary materialsView the online CME activity "So You Want to Publish in the Journal of Trauma and Acute Care Surgery (JOT)? Tips and Tricks for Academic Success in Trauma and Acute Care Surgery" given by Dr. Juan Duchesne. This interview is a combined effort between EAST's Online Education Section and Career Development Section. The interview has been posted on the EAST Traumac