Traumacast

A series of audio interviews addressing upcoming research and its application to the injured patient, education efforts related to trauma, and novel methods in the management of injury.

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Select Traumacasts now eligible for AMA PRA Category 1 Credit TM self-assessment credits toward Part 2 of the ABS MOC Program. Visit the EAST Education Center for details.

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*EP after the Traumacast number identifies enhanced podcasts that have bonus visual material in addition to the audio component. The enhanced podcasts are best viewed using the iTunes podcast browser on your laptop or phone, or using a video browser such as QuickTime or Windows Media Viewer.

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Small Bowel Obstruction: Utilizing the Gastrografin® Challenge - Podcast #52
01/21/2016

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

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EAST Town Hall Debate: Hartford Consensus Conference vs. TECC: What is the Right Approach for the Active Shooter Epidemic? - Podcast #51 - EP
01/04/2016

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 Conference
Alexander Eastman, MD
Eric Campion, MD

Pro Tactical Emergency Casualty Care
Babak Sarani, MD
E. Reed Smith, MD
Gene Reilly, MD

Supplemental Materials

ACS Bulletin with the Hartford Consensus III Report

TECC 2015 updated guidelines

TECC website

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EAST Town Hall Debate: Antibiotics-Only vs. Surgery for Acute Appendicitis: The APPAC Trial and Beyond - Podcast #50 - EP
12/30/2015

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 with the study authors by Dr. Livingston.

 

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Highlights from the 2015 Western Trauma Association Meeting - Podcast #49 - EP
12/29/2015

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 model
7:15             Drs. Chapman and Moore on the TEG “Death Diamond” and plasma-first resuscitation
14:17           Dr. Nelson on “Sugar or Salt”: relative role of mineralocorticoids in shock
17:50           Dr. Olson on a randomized trial of heparin vs lovenox for VTE prophylaxis
21:58           Dr. Miller on repairing flank hernias using bone-anchor fixation
27:38           Tourniquet Debate: Carlos Brown vs Kenji Inaba
32:15            Dr. Berndtson on Outcomes with K-Centra 4-factor PCC
36:15            Dr. Russo on pigtail catheter versus chest tube for hemothorax drainage
40:25            Dr. Bensard on the utility of routine serum HgB checks in pediatric trauma
46:28            Dr. Aydelotte on the impact of marijuana legalization on traffic fatalities
51:45            Dr. Parker on the impact of TXA on fibrinolysis parameters by TEG
56:25            Dr. Moren on recursive partitioning to better define massive transfusion
1:01:55         Dr. Pharoan on massive abdominal wall injury due to fireworks
1:06:40         Expert Case Panel: Drs. Shackford, Karmy-Jones, Rhee, & Schreiber
1:09:30         Dr. Cohen on the WTA Multicenter study of the “found down” patient
1:14:30         Dr. Christine Cocanour on the WTA and her term as WTA President

Supplemental Materials: 
WTA 2015 Program Book
Dec 2015 issue of the Journal of Trauma and ACS

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Pediatric Non-Accidental Trauma: Recognizing the Red Flags - Podcast #48
12/20/2015

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 are included below in the supplementary materials section. 

Supplemental Materials: 
NAT Evaluation Note

NAT Algorithm
Non-Accidental Trauma slideset

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Complex Abdominal Wall Reconstruction: A Modern Approach - Podcast #47 - EP
11/18/2015

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 will also serve as a lead-in to our inaugural “EAST Master Classes” live webinar on December 7th. This webinar will also feature Dr. Martindale and Dr. Orenstein, and they will demonstrate several of these repair techniques and strategies. If you miss the live webinar, the session will also be recorded and placed on the EAST Online Education Center as an enduring talk.

Supplemental Materials:
Join us December 7th at 5:00 pm (EST)
for the inaugural “EAST Master Classes” live webinar, featuring Dr. Martindale and Dr. Orenstein discussing complex abdominal wall reconstruction and demonstrating several of their key techniques

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Medical Malpractice, Litigation, and Legal Implications of Practice Management Guidelines - Podcast #46 - EP
11/18/2015

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. Reyes

Minimizing your malpractice risk article by Dr. Reyes
Value of CPGs as “Safe Harbors” for Legal Defense

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Critical Care Management of Traumatic Brain Injury - Podcast #45
11/17/2015

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 Materials
ACS TQIP - Best Practices in the Management of Traumatic Brain Injury

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Rib Fracture Plating: Why and How? - Podcast #44 - EP
07/14/2015

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 Materials
EAST Online Education Center - Surgical Treatment of Rib Plating by Dr. David Ciesla

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Active Shooter Events, Training, and the Hartford Consensus Conference - Podcast #43 - EP
06/22/2015

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. Eastman
DHS Active Shooter Pocket Card
Hartford Consensus Conference 1
Hartford Consensus Conference 2

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*EP after the Traumacast number identifies enhanced podcasts that have bonus visual material in addition to the audio component. The enhanced podcasts are best viewed using the iTunes podcast browser on your laptop or phone, or using a video browser such as QuickTime or Windows Media Viewer.

Your Traumacast Moderators


Matthew Martin, MD, Madigan Army Medical Center


David Morris, MD, Mayo Clinic, Rochester, MN


Kevin Pei, MD, Yale School of Medicine, New Haven, CT

Eastern Association for the Surgery of Trauma

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