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Trauma ICU Rounds
Dr. Dennis Kim
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
3 days ago
Episode 42 - Management of the Difficult Gallbladder
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.
May 1, 2021
Episode 41 - Acute Colonic Pseudo-Obstruction (aka Ogilvie's Syndrome)
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.
Apr 12, 2021
Episode 40 - Acute Mesenteric Ischemia
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.
Mar 31, 2021
Episode 39 - Necrotizing Soft Tissue Infections (NSTIs)
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.
Feb 12, 2021
Episode 38 - Cricothyrotomy Considerations with Scott Weingart
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: https://emcrit.org/emcrit/surgical-airway/ and review the FANTASTIC content that has been put together by Scott and his team at EMCrit.
Feb 6, 2021
Episode 37 - Basic Mechanical Ventilation III: The Role of PEEP & LVRs
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.
Feb 2, 2021
Episode 36 - ARDS Fundamentals I: Classification, Pathophysiology & Initial Vent Management
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
Jan 15, 2021
Episode 35 - Sleep, Wellness, and the Acute Care Surgeon
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".
Jan 8, 2021
Episode 34 - Bowel Obstruction & the Role of the Gastrografin Challenge
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.
Dec 26, 2020
Episode 33 - Harbor-UCLA Anesthesia Grand Rounds "Resuscitative Thoracotomy (and some stuff on crics)"
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.
Dec 17, 2020
Episode 32 - Blunt Cerebrovascular Injury (BCVI)
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.com Also, you can find the updated 2020 EAST BCVI PMG here: https://www.east.org/education/practice-management-guidelines/blunt-cerebrovascular-injury-evaluation-and-management-of
Nov 16, 2020
Episode 31 - Who Should Manage Vascular Trauma?
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.
Oct 30, 2020
Episode 30 - Acute Kidney Injury in the SICU with kidney_boy Dr. Joel Topf
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!
1 hr 5 min
Oct 10, 2020
Episode 29 - Sepsis 2020: What Surgeons Need to Know
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".
1 hr 14 min
Oct 7, 2020
Episode 28 - Extremity Compartment Syndrome
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.
Sep 25, 2020
Episode 27 - Season 2: Acute Care Surgery
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.
Sep 11, 2020
Episode 26 - Season 1 Recap
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.
Aug 21, 2020
Episode 25 - The Past, Present, and Future of REBOA
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.
Aug 20, 2020
Episode 24 - Hemodynamically Unstable Pelvic Fractures
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.
Aug 18, 2020
Episode 23 - Surgical Cricothyroidotomy: How I Do It
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.
Jul 31, 2020
Episode 22 - UCLA Grand Rounds "Endpoints of Resuscitation: Where to Begin?"
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.
Jul 24, 2020
Episode 21 - The Coagulation Cascade Simplified
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.
Jul 13, 2020
Episode 20 - Reducing Venous Thromboembolism in Trauma Patients
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.
Jul 7, 2020
Episode 19 - Prehospital Tranexamic Acid (TXA) in Patients with Traumatic Brain Injury
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.
Jul 3, 2020
Episode 18 - Rapid Rounds: The Rapid Shallow Breathing Index (RSBI)
In this Rapid Rounds, we provide a quick and closer look at the Yang & Tobin index as originally described in the 1991 NEJM paper.
Jun 29, 2020
Episode 17 - Discontinuing Mechanical Ventilation
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.
Jun 19, 2020
Episode 16 - Abdominal Compartment Syndrome
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.
Jun 12, 2020
Episode 15 - Emergency Preservation & Resuscitation for Cardiac Arrest from Trauma (EPR-CAT)
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, integration of resuscitative endovascular techniques, and common ethical considerations that arise when performing resuscitation research.
Jun 5, 2020
Episode 14 - Circulation First: Rethinking the ABC Sequence of Initial Trauma Care...& Much, Much More!!
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.
May 29, 2020
Episode 13 - Shock Talk II: Diagnosis & Initial Management
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.
May 22, 2020
Episode 12 - Rapid Rounds: Tracheostomy Considerations during the COVID-19 Pandemic
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).
May 21, 2020
Episode 11 - National Stop the Bleed Day & Tourniquet Use in 2020
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.
May 15, 2020
Episode 10 - Basic Mechanical Ventilation II: Modes
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.
May 8, 2020
Episode 9 - The rEVOLUTION of ECMO
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 ECMO we also explore the regionalization of ECMO care here in Los Angeles County, as well as the day-to-day considerations that you want to bear in mind when assessing and caring for your patients requiring extracorporeal life support. *Learning Objectives *By the end of rounds you should be able to: 1. Understand the indications & contraindications to VV and VA ECMO support 2. Describe the basic components of an ECMO circuit 3. Describe the role of eCPR in the management of adult patients…
1 hr 9 min
Apr 30, 2020
Episode 8 - Tracheostomies Demystified
Is there an ideal time to place a tracheostomy? What factors might influence my decision to proceed with an open versus percutaneous tracheostomy? In this episode, we discuss common perioperative considerations influencing our decision to proceed with tracheostomy in critically ill patients requiring prolonged mechanical ventilation. Over the course of rounds, I'll share with you some "tricks of the trade" and review key management principles for safely dealing with potentially life-threatening tracheostomy complications in the postoperative period including unplanned early decannulation and bleeding.
Apr 24, 2020
Episode 7 - Shock Talk I: Pathophysiology & Classification
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, we'll further examine the clinical presentation and management of patients presenting with hypovolemic, cardiogenic, distributive, or obstructive shock.
Apr 16, 2020
Episode 6 - Acute Respiratory Failure II: Recognition, Management & Oxygen Therapies
This episode follows-up on Episode 1 and focuses on the assessment and initial treatment of patients with acute respiratory failure. Through a focused clinical exam, we can identify signs of increased work of breathing which should alert us to the need for support in the form of oxygen and ventilatory therapies. The 3 major types of oxygen delivery systems are also discussed including low- and high-flow, as well as reservoir systems.
Apr 12, 2020
Episode 5 - The Deadly Dozen of Thoracic Trauma
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.
Apr 6, 2020
Episode 4 - Endpoints of Resuscitation
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.
Apr 3, 2020
Episode 3 - Basic Mechanical Ventilation I: Fundamentals
In this episode we review and discuss the core physiologic concepts required to understand basic mechanical ventilation. By examining the respiratory equation of motion or force balance equation, we'll gain insight into the pressures that need to be generated to deliver a positive pressure breath and those pressures that can be monitored during the care of vented patients. This will form the groundwork for Basic Mechanical Ventilation II: Modes of Ventilation.
Apr 3, 2020
Episode 2 - Airway Management during the COVID-19 Pandemic: Rapid Sequence vs. "Protected" Intubation
In this episode we explain what rapid sequence intubation or RSI is and the indications for its use in securing a definitive airway. More importantly, we share lessons learned regarding COVID-specific considerations for intubating patients with acute hypoxemic respiratory failure.
Apr 3, 2020
Episode 1 - Acute Respiratory Failure I: Mechanisms & Pathophysiology
In this, our inaugural episode, we explore common mechanisms underlying acute hypoxemic and hypercapneic respiratory failure. Concepts discussed include the oxygen delivery equation, differentiating hypoxia from hypoxemia, and a discussion of V/Q mismatch and shunts. In the follow-up episode - Acute Respiratory Failure II: Clinical Management & Oxygen Therapies - we'll apply these concepts to the management of acute respiratory failure and discuss the benefits and harms of oxygen therapy.
Mar 26, 2020
Episode 0 - The W5H of Trauma ICU Rounds
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 learning materials in the form of blogs, vlogs, vidcasts, and surgical procedural videos.