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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EAST February 2016 Literature Review Traumacast - Podcast #54
04/07/2016

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 Materials
2016 ASPEN/SCCM ICU Nutrition Guidelines

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Sham Peer Review for Surgeons: EAST Town Hall Discussion - Podcast #53
04/06/2016

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: 

  1. Editorial: Tactics Characteristic of Sham Peer Review by Larry Huntoon, MD, PhD
  2.  Recognizing the Tactics of Sham Peer Review: a 3-part video series presented by Dr. Larry Huntoon
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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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The bigger they are... : Tips and Tricks for Managing Complications in Bariatric Surgery Patients - Podcast #42 - EP
06/12/2015

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 Materials
Bariatric surgery problems and complications syllabus
ASMBS Poster: Pearls for Emergency Care of the Bariatric Surgery Patient

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An Insider’s Guide to the Journal of Trauma, Academic Productivity, and How to Participate - Podcast #41 - EP
04/29/2015

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 materials
View 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 Traumacast and Careercast pages.

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Setting the Agenda and Building Coalitions: The National Trauma Institute and the Coalition for National Trauma Research - Podcast #40 - EP
04/06/2015

An interview with Dr. Donald Jenkins, one of the leading figures behind the National Trauma Institute (NTI) and the newly created Coalition for National Trauma Research (CNTR). Dr. Jenkins discusses the history, formation, mission, and future of these two organizations and how they are positively impacting the ability to perform high-quality clinical trauma research and fostering a national trauma research agenda.

Supplementary Materials
The National Trauma Institute information brochure
Coalition for National Trauma Research Website
"The Trauma Research Imperative" from the NTI

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The Pediatric Trauma Transformation Collaborative (PTTC) - Podcast #39 - EP
03/30/2015

An interview with Dr. Richard Falcone and Dr. Denis Bensard about an exciting new program they have developed to enhance pediatric trauma care in the U.S. They discuss how their Level 1 Pediatric Trauma Center has partnered with multiple adult Level 2 centers to enhance their ability to provide high quality pediatric trauma care, and to successfully obtain ACS verification as pediatric trauma centers.

Supplementary materials: download a presentation with additional information and resources related to the PTTC.

Link to Dr. Falcone’s CME talk on Trauma Simulation Training

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Surgical Management of Clostridium Difficile Colitis - Podcast #38
10/23/2014

Listen to us discuss the surgical management of clostridium difficile colitis with Dr. Paula Ferrada. We tackle surgical and medical therapy based on the best available evidence. See EAST's Online Education session on this topic too.

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Translation of War Trauma Care into the Civilian Sector - Podcast #37
06/23/2014

Listen to Dr. Matthew Martin discuss the great advances in civilian trauma care as a result of 10 years of conflict.  He tackles great topics such as tourniquets, hemostatic dressings, tension pneumothorax and what's ahead. See EAST's Online Education session on this topic too.

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Airway Pressure Release Ventilation for Severely Injured Trauma Patients - Podcast #36
06/12/2014

A discussion with Dr. Adrian Maung on the Airway Pressure Release Ventilation (APRV) mode for respiratory failure in multi-trauma patients.

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Adjunctive Treatment of Abdominal Catastrophes and Sepsis with Direct Peritoneal Resuscitation (DPR): Indication For Use in Acute Care Surgery - Podcast - #35
12/27/2013

A discussion with Dr. Jason Smith on the utilization of direct peritoneal resuscitation in the treatment of abdominal catastrophes.

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Outpatient Laparoscopic Appendectomy - Podcast - #34
12/22/2013

A discussion with Dr. Richard Frazee, in regards to a successful protocol for outpatient laparoscopic appendectomy in acute appenditics.

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Effects of Obesity in the Care of the Traumatically Injured - Podcast #33
11/02/2013

A discussion with Dr. Rob Winfield regarding the effects of obesity in the care of the traumatically injured. 

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An interview with EAST Past President, Dr. Sagraves regarding the future of EAST.. - Podcast #32
10/30/2013

A discussion about the future of EAST with EAST Past President, Dr. Sagraves. 

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Complex_Abdominal_Wall_Hernia_Repair - Podcast #31
09/01/2013

A discussion with Dr. Khashayar Vaziri regarding repair of complex abdominal wall hernia, use of mesh, and placement techniques

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Vasopressin Following Hemorrhagic Shock - Podcast #30
07/31/2013

A discussion with Dr Carrie Sims regarding her research into vasopressin deficiency following hemorrhage and its potential role in resuscitation

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Starting A Trauma_Center - Podcast #29
07/15/2013

A brief discussion of political and financial issues faced when The Trauma Center at Penn opened in 1988. Many of the same issues are still faced by trauma directors in new trauma centers. 

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Damage Control Resuscitation - Podcast #28
07/01/2013

A discussion of damage control resuscitation - what it is and how to implement it and why. An interview with Michael Rotondo,  MD.

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Blunt Splenic Injury - Podcast #27
04/18/2013

A discussion regarding the management of blunt splenic injury with reference to the EAST Practice Management Guideline on this topic.

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Deep Hypothermia - Podcast #26
02/20/2013

Emergency Preservation and Resuscitation Trial evaluating deep hypothermia for cardiac arrest following penetrating trauma. Discussion with Dr Sam Tisherman, the PI for the study. 

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Hypertonic Saline Prehospital - Podcast #25
12/29/2012

A discussion with Dr. Eileen Bulger regarding her two trials evaluating the role of hypertonic saline in the pre-hospital setting.

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Coagulopathy Trauma TEG - Podcast #24
12/28/2012

A discussion regarding causes of coagulopathy in trauma and the use of TEG in its diagnosis and management

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Helicopter Transport and Mortality after Trauma - Podcast #23
08/30/2012

A discussion regarding Dr Haider's study which showed the transportation by helicopter following trauma improves survival

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Adult Concussions - Podcast #22
08/29/2012

A discussion with Dr. Robert Barraco regarding the diagnosis and treatment of concussion in adults.

This podcast is 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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Pediatric Concussions - Podcast #21
08/28/2012

A discussion with Dr. Michael Nance on diagnosis and treatment of concussion in children, including a proposal for determining when kids can return to contact sports. 

This Traumacast is 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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Screening for DVT following Trauma - Podcast #20
08/27/2012

A discussion with Dr. Elliott Haut regarding the pros and cons of screening for DVT in asymptomatic patients following trauma

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Topical Hemostatics - Podcast #19
08/26/2012

A discussion with Dr. Martin Schreiber on the various types of topical hemostatic agents that can be used either pre- or intra-operatively - their mechanisms of action, uses, and limitations.

This Traumacast is 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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Training in Trauma Surgery - Podcast #18
08/25/2012

A discussion comparing the ATLS, ASSET, and ATOM courses and the future role of simulation in trauma surgery training

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Mortality in Minority Hospitals - Podcast #17
08/24/2012

A discussion with Dr Adil Haider regarding reasons for increased mortality noted in hospitals that treat mostly minority patients following injury.

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Getting a Trauma Fellowship and Job - Podcast #16
07/21/2012

Discussion with Dr. Joe Sakran on getting into a trauma fellowship and securing a job

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Beta Blocker Therapy For Traumatic Brain Injury - Podcast #15
01/14/2012

A discussion of the role of beta-blocker therapy following TBI. We discuss Dr. Cotton and others' studies suggesting a mortality benefit, possible mechanisms underlying this finding, and how/when to go about instituting beta-blockade in this population. 

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Trauma Scoring Systems Dr Champion - Podcast #14
01/13/2012

Dr. Champion helped establish EAST and describe the ISS/AIS and TRISS scoring systems. We discussion of various commonly used trauma scoring systems and their shortcomings. We also discuss how to go about assessing and creating a scoring system.

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Rib Fractures and Mortality Dr Luchette - Podcast #13
01/12/2012

A discussion with Fred Luchette regarding factors associated with mortality following rib fractures. We discuss who requires evaluation at a trauma center, how requires ICU admission, pain control, and the role of rib plate fixation and tracheostomy in these patients. 

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Screening For Blunt Cerebrovascular Injury - Podcast #12
01/11/2012

A discussion with Dr. Martin Croce regarding the use of CTA versus angiography to screen for blunt cerebrovascular injury.

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ICU Management of the TBI Patient - Podcast #11
10/26/2011

A discussion of techniques to minimize secondary brain injury, including measurement of cerebral pressures and oxygen tension and interventions such as the role of steroids, transfusion, hypothermia for brain injury. 

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Measuring Outcomes in Trauma - Podcast #10
10/25/2011

A discussion of measuring and comparing outcomes between trauma centers. Discussion involves use of this information by trauma directors and verifying bodies. 

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Damage Control Surgery - Podcast #9
10/24/2011

A discussion with Dr. Bill Schwab regarding the evolution of damage control surgery in trauma care

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Hypothermia in Trauma - Podcast #8
09/16/2011

The current role of hypothermia in trauma care and future directions for use of this modality in the care of the injured patient

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Acute Care Surgery and Training Tomorrow's Trauma Surgeon - Podcast #7
09/15/2011

A discussion of the current status of the acute care surgery training program, why it is needed, and how to attract future surgeons to this field. Dr. Britt also discusses some the skill sets that the ACS surgeon will need/have, board certification for this field, and integration of this new subspecialty into the surgical community. 

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Thromboelastography (TEG) in Trauma Care - Podcast #6
09/15/2011

An in-depth discussion regarding use of TEG to diagnose both hypo- and hyper-coagulable states following injury

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Trauma Exsanguination Protocols in Trauma - Podcast #5
09/15/2011

A discussion regarding the evidentiary basis for trauma exsanguination protocols in trauma systems and how to go about writing and implementing them

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The CONTROL trial: Factor VIIa in Trauma - Podcast #4
09/14/2011

A discussion of the CONTROL trial, it's design, findings, and ramifications regarding the role of Factor VIIa in trauma patients. 

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Brain Tissue Oxygen Monitoring Following TBI - Podcast #3
09/04/2011

An interview with Dr. Peter LeRoux regarding brain tissue oxygen monitoring and the BOOST II trial, a randomized prospective multicenter trial evaluating the feasibility of this technology for TBI.

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Hepatic Necrosis Following Angioembolization - Podcast #2
08/24/2011

Interview with Dr. Tom Scalea regarding the treatment of hepatic necrosis following angioembolization for severe injury

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Clinical Practice Guidelines in Trauma Care - Podcast #1
08/19/2011

An interview with Michael Rhodes regarding implementing and enforcing clinical practice guidelines in a trauma center

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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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