Trauma ICU Rounds
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
State of the Rounds
After four years away, Trauma ICU Rounds is back.
In this short relaunch episode, I reflect on the journey from California back to Canada, how my clinical and leadership roles have evolved, and why now is the right time to return to the podcast.
We also share what comes next: clear, practical, evidence-informed conversations in trauma, critical care and resuscitation—designed to make complex topics easier to understand and apply at the bedside.
Welcome back to Rounds.
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Whole Blood in Trauma Resuscitation: What Did TOWAR and SWiFT Change?
Whole blood has made a remarkable comeback in trauma resuscitation. Physiologically, the rationale is compelling, and observational studies have suggested improved survival. But the recent randomized TOWAR and SWiFT trials have challenged the assumption that whole blood is clearly superior to component therapy.
In this episode of Trauma ICU Rounds, we review the rationale for low-titer group O whole blood (LTOWB), the major observational data supporting its use, what TOWAR and SWiFT actually showed, and how these findings should influence contemporary damage-control resuscitation.
Topics include:
Low-titer group O whole blood (LTOWB) Observational ver...Episode 55: AAST 2022 Hot Topics - From Sex Dimorphisms in Coagulation to TXA, TEG, Calcium and Beyond with Drs. Bryan A. Cotton, Neil Parry, Nori Bradley, Jordan Weinberg, Joshua Brown & Alyssa MacLean
Join us after hours at Dr. Bryan A. Cotton's pop-up bourbon bar at the AAST 2022 Meeting in Chicago. In this FANTASTIC & FUN episode, we talk amongst friends about cutting edge research at this year's meeting. To no one's surprise, coagulopathy, damage control resuscitation, whole blood, and factor replacement therapy just happen to be but a few of the topics discussed on Rounds.
Time Stamps:
00:12 AAST 2022 - Intro
00:42 Sex diamoprhisms in coagulation
01:52 Hemostatic profiles of female donors
02:48 Pediatric whole blood (WB) is safe
03:10 WB for TBI
03:31 Leukoreduction is unnecessary
05:30...
Episode 54: Frailty, Geriatric Trauma & TBI with Dr. Bellal Jospeh
In this episode we sit down with the Chief of Trauma, Surgical Critical Care, Burns, & Acute Care Surgery at the University of Arizona, Dr. Bellal Joseph, who share with us his thoughts and research findings on hot topics including frailty, geriatric trauma, leadership, and more.
Timestamps:
00:12 Introductions
01:30 What is frailty? Your physiologic NOT chronologic body.
06:58 Injured elderly trauma patients can have good outcomes
07:30 Trauma specific frailty index
10:48 Failure to rescue
13:57 Geriatricians and the trauma surgeons
15:08 4Ms-What Matters, Mobility, Mentation, Medication
16:48 Geriatric cohorting/wards
22:24 ACS geriatric centers of excelle...
Episode 53: Insights into Modern Critical Care with Dr. Jean-Louis Vincent: Part II
In this episode, we talk all things critical care the one and only, Dr. Jean-Louis Vincent aka. JLV. This episode is a MUST listen. We touch upon the evolution of early goal directed therapy, measures of fluid responsiveness, optimizing oxygen delivery, and the importance of integrating data points versus examining them in isolation when caring for our critically ill and injured patients. This and MUCH MUCH more in arguably one of my favorite episodes to date!!
Timestamps
00:00 Introduction
01:21 What happened to SG catheters and should we use them?
04:05 What decreases mortality in...
Season 3 Trailer
It's been a while! We are coming to you from our new studio in Victoria on Vancouver Island, BC. This Season is PACKED with incredible content, interviews and educational pearls designed to improve the quality of care that you are deliver daily at the bedside to your patients and their loved ones.
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Episode 52: Insights into Modern Critical Care with Dr. Jean-Louis Vincent: Part I
In this episode, we discuss the overarching importance of AVOIDING iatrogenic harm in the ICU with arguably one of the world's leading experts in critical care medicine, the one and only, Dr. Jean-Louis Vincent aka. JLV.
Tune in as Dr. Vincent shares with us the importance of having a systematic, problem-based approach to patient care delivery which, of course, involves giving our patients a FAST HUG every day!
Time Stamps:
2:10 LA Critical Care and Differences between Europe versus USA
4:04 COVID, Modern tech and bedside care
5:32 ICU Rounds – How I...
Episode 51 - Persistent Inflammation, Immunosuppression & Catabolism Syndrome (PICS) with Dr. Scott Brakenridge
"Getting patients resuscitated through sepsis, septic shock, and hemorrhagic shock is not the end...it's the beginning."
In this episode, Dr. Brakenridge from Harborview Medical Center joins us to discuss PICS and the impact of this syndrome on our critically ill and injured patients and their families. Also referred to as the Post-Intensive Care Syndrome, Dr. Brakenridge shares with us the evolution and results of translational research into this now well-recognized morbid condition which often occurs in the setting of chronic critical illness. From the importance of breaking the cycle of "sepsis recidivism" to the. application of t...
Episode 50 - Whole Blood & Modern Hemostatic Resuscitation Strategies with Dr. Bryan A. Cotton
In this, our 50th episode, we are in Austin, TX, for the Annual EAST Scientific Meeting where we are joined by Dr. Bryan A. Cotton who shares his expertise and knowledge regarding the use of whole blood (WB) in trauma patients. From the use of whole blood in prior military conflicts to the design and successful implementation of one of the only prospective randomized controlled trials of modified whole blood use in trauma patients, Dr. Cotton provides an incredible overview of the potential benefits of whole blood or as he refers to it - "the dying blood product". Also...
Episode 49 - TRAUMA with Dr. Ken Mattox: Part II
In the second episode of a two-part series, Dr. Mattox shares his insights and thoughts on hot research topics in trauma in need of investigation. Additionally, he helps us to envision what acute trauma management may look like in the future, while also sharing with us how his book (and one of my ALL-TIME fave surgery books!), Top Knife, came into being. From lessons learned to lessons in need of learning, Dr. Mattox has all of the bases (and basics) covered.
Time Stamps
0:00 Introduction
00:12 "The resuscitation is the incision."
00:44 Welcome & A...
Episode 48 - TRAUMA with Dr. Ken Mattox: Part I
We. Are. Back!!
After a (brief?!) hiatus, we are launching 2022 with a 2-part series with the one and only Dr. Ken Mattox. In this episode, Dr. Mattox shares with us his thoughts on what the modern general surgeon should look like and how we as surgeons differ from our medicine counterparts. Additionally, we review the history of modern trauma resuscitation, the paradigm shifts that have occurred as it pertains to permissive hypotension, as well as the technological advances that have occurred over the last century that have improved care of the critically injured patient. This is an...
Episode 47 - Every Deep-Drawn Breath with Dr. Wes Ely
Dr. Wes Ely from Vanderbilt University School of Medicine joins us on Rounds to discuss the evolution of our understanding and the current impact of ICU-acquired brain disease on our patients and their loved ones. In addition to discussing the evidence behind current best practices in the ICU, Dr. Ely shares with us stories from his new book which highlight the importance of listening to, engaging with, and remaining vulnerable to those whom we are so fortunate and blessed to serve-our patients.
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Episode 46 - Pelvic Binders for Hemodynamically Unstable Pelvic Ring Fractures
In follow-up to a recent pro-con debate on the use of pre-hospital pelvic binders, we explore the why, when, and how of pelvic binder placement. From the indications to post-placement considerations and importance of a multidisciplinary approach to the management of these life-threatening injuries, this episode of Rounds is a great addition to Season 1 Episode 24 Hemodynamically Unstable Pelvic Fractures with Dr. Clay Burlew.
Time Stamps
00:12 Welcome
02:52 Learning Objectives
03:43 Introduction
05:58 Initial Assessment & Management of Patients with Suspected Hemodynamically Unstable Pelvic Fractures
09:54 Young-Burgess Classification of Pelvic Ring...
Episode 45 - Modern Insights into an Academic Career in Trauma & Acute Care Surgery with Dr. Carlos Brown
In this episode, we sit down with Dr. Carlos VR Brown from the Dell Seton Medical Center at the University of Texas to discuss issues relevant to both junior and mid-career trauma & acute care surgeons.
Topics covered include: military-civilian trauma, finding one's niche in academic surgery, work-life balance, and learning from our mistakes. As I prepare to enter a new phase in my academic surgical career, the timing of this interview could not have been more perfect. This episode is packed with career pearls and words of wisdom that are not to be missed!
T...
Episode 44 - Massive Upper GI Bleeds
Massive upper GI bleeds can be intimidating and lethal. An expeditious, multidisciplinary approach is required to improve survival and optimize patient outcomes.
Time Stamps:
00:12 Welcome & Introduction
01:55 Goals & Objectives
02:29 Common Etiologies & Differential Diagnosis for UGIBs
05:15 Initial Evaluation
10:52 Initial Management
15:38 Indications & Timing of Endoscopic and Non-Endoscopic Interventions
18:19 Forrest Classification of Peptic Ulcers
20:43 Indications & Timing of Surgical Interventions
21:30 Surgical management of Bleeding Peptic Ulcers
23:40 Take Home Points
25:10 CTA
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Episode 43 - Penetrating Cardiac Injuries with Dr. Kenji Inaba
Our first in-person interview since the start of the COVID pandemic! Join us for National Stop the Bleed Day as Dr. Kenji Inaba from LAC+USC joins us to discuss management of penetrating cardiac injuries, the Los Angeles County Hospital Emergency Response Team (HERT), and recent updates to the Stop the Bleed campaign. From the utility of FAST to the diagnostic (and potentially therapeutic?!) role of subxyphoid windows, this episode has it all and is not to be missed!
Also, remember to check out Season 1 , Episode 11 - National Stop the Bleed Day & Tourniquet Use in 2020.
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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 D...
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.
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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.
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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.
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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 b...
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.
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Trauma ICU Rounds is...
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
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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".
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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.
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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.
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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.
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.ea...
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 h...
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 D...
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".
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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.
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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.
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Trauma ICU Rounds is intended for healthcare education. I...
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.
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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.
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Trauma ICU...
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.
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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.
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Trauma ICU Rounds is intended for healthcare education. It does not replace...
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.
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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient...
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.
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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.
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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.
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