Podcasts about Eastern Association

Do you find yourself saying: “Hey, what's the big idea with that newfangled whole blood in the refrigerator next to the trauma bay?”  Like using whole blood but not sure why?  Don't like using whole blood but not sure why? Join us for a 30 minute power session in whole blood where we try to get you the information you need to know! Hosts: - Michael Cobler-Lichter, MD, PGY4/R2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (X/twitter) - Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow University of Pennsylvania Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency @urrechisme (X/twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending: Loma Linda University  Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship - Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 6 years in practice University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @jpmeizoso (twitter) Learning Objectives: - Describe the proposed benefits of whole blood resuscitation in trauma -  Identify current problems with synthesizing the existing literature on whole blood resuscitation in trauma - Propose needed areas for future research regarding whole blood resuscitation in trauma Quick Hits: 1. There is significant heterogeneity in study design across whole blood resuscitation studies, complicating comparison 2.  There is likely a mortality benefit to whole blood resuscitation in trauma, however this is likely dependent on the specific population 3. Future research directions should focus on prospective randomized work to try and better quantify the exact benefit of whole blood, and determine in which populations this benefit is actually realized References 1.     Hazelton JP, Ssentongo AE, Oh JS, Ssentongo P, Seamon MJ, Byrne JP, Armento IG, Jenkins DH, Braverman MA, Mentzer C, Leonard GC, Perea LL, Docherty CK, Dunn JA, Smoot B, Martin MJ, Badiee J, Luis AJ, Murray JL, Noorbakhsh MR, Babowice JE, Mains C, Madayag RM, Kaafarani HMA, Mokhtari AK, Moore SA, Madden K, Tanner A 2nd, Redmond D, Millia DJ, Brandolino A, Nguyen U, Chinchilli V, Armen SB, Porter JM. Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding: A Multicenter Study. Ann Surg. 2022 Oct 1;276(4):579-588. doi: 10.1097/SLA.0000000000005603. Epub 2022 Jul 18. PMID: 35848743. https://pubmed.ncbi.nlm.nih.gov/35848743/ 2.     Sperry JL, Cotton BA, Luther JF, Cannon JW, Schreiber MA, Moore EE, Namias N, Minei JP, Wisniewski SR, Guyette FX; Shock, Whole Blood, and Assessment of Traumatic Brain Injury (SWAT) Study Group. Whole Blood Resuscitation and Association with Survival in Injured Patients with an Elevated Probability of Mortality. J Am Coll Surg. 2023 Aug 1;237(2):206-219. doi: 10.1097/XCS.0000000000000708. Epub 2023 Apr 11. PMID: 37039365; PMCID: PMC10344433. https://pubmed.ncbi.nlm.nih.gov/37039365/ 3.     Meizoso JP, Cotton BA, Lawless RA, et al. Whole blood resuscitation for injured patients requiring transfusion: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2024;97(3):460-470. doi:10.1097/TA.0000000000004327 https://pubmed.ncbi.nlm.nih.gov/38531812/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

LISTENER DISCRETION IS ADVISED. REFERENCES: Ferrada P, García A, Duchesne J, Brenner M, Liu C, Ordóñez C, Menegozzo C, Salamea JC, Feliciano D. Comparing outcomes in patients with exsanguinating injuries: an Eastern Association for the Surgery of Trauma (EAST), multicenter, international trial evaluating prioritization of circulation over intubation (CAB over ABC). World J Emerg Surg. 2024 Apr 25;19(1):15. doi: 10.1186/s13017-024-00545-8. PMID: 38664763; PMCID: PMC11044388. Salim Rezaie, "Critical Care Updates: Resuscitation Sequence Intubation – Hypotension Kills (Part 1 of 3)", REBEL EM blog, September 26, 2016. Available at: https://rebelem.com/critical-care-updates-resuscitation-sequence-intubation-hypotension-kills-part-1-of-3/. Salim Rezaie, "Critical Care Updates: Resuscitation Sequence Intubation – Hypoxemia Kills (Part 2 of 3)", REBEL EM blog, September 29, 2016. Available at: https://rebelem.com/critical-care-updates-resuscitation-sequence-intubation-hypoxemia-kills-part-2-of-3/. Salim Rezaie, "Critical Care Updates: Resuscitation Sequence Intubation – pH Kills (Part 3 of 3)", REBEL EM blog, October 3, 2016. Available at: https://rebelem.com/critical-care-updates-resuscitation-sequence-intubation-ph-kills-part-3-of-3/. Scott Weingart, MD FCCM. EMCrit 30 – Hemorrhagic Shock Resuscitation. EMCrit Blog. Published on August 15, 2010. Accessed on December 27th 2024. Available at [https://emcrit.org/emcrit/trauma-resuscitation-dutton/ ].

Contributor: Aaron Lessen MD Educational Pearls: Aortic injury occurs in 1.5-2% of patients who sustain blunt thoracic trauma Majority are caused by automobile collisions or motorcycle accidents Due to sudden deceleration mechanism accidents Clinical manifestations Signs of hypovolemic shock including tachycardia and hypotension, though not always present Patients may have altered mental status Imaging Widened mediastinum on chest x-ray, though not highly sensitive CT is more sensitive and specific, and signs of thoracic injury include an intimal flap, aortic wall outpouching, and aortic contour abnormalities In hemodynamically unstable or otherwise unfit for CT patients, transesophageal echocardiogram may be used Four types of aortic injury (in order of ascending severity) I: Intimal tear or flap II: Intramural hematoma III: Pseudoaneurysm IV: Rupture Management Hemodynamically unstable: immediate OR for exploratory laparotomy and repair Hemodynamically stable: heart rate and blood pressure control with beta-blockers Minor injuries are treated with observation and hemodynamic control Severe injuries may receive surgical management Some patients benefit from delayed repair An endovascular aortic graft is a surgical option Mortality 80-85% of patients die before hospital arrival 50% of patients that make it to the hospital do not survive References Fox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma [published correction appears in J Trauma Acute Care Surg. 2015 Feb;78(2):447]. J Trauma Acute Care Surg. 2015;78(1):136-146. doi:10.1097/TA.0000000000000470 Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg. 2011;53(1):187-192. doi:10.1016/j.jvs.2010.08.027 Osgood MJ, Heck JM, Rellinger EJ, et al. Natural history of grade I-II blunt traumatic aortic injury. J Vasc Surg. 2014;59(2):334-341. doi:10.1016/j.jvs.2013.09.007 Osman A, Fong CP, Wahab SFA, Panebianco N, Teran F. Transesophageal Echocardiography at the Golden Hour: Identification of Blunt Traumatic Aortic Injuries in the Emergency Department. J Emerg Med. 2020;59(3):418-423. doi:10.1016/j.jemermed.2020.05.003 Steenburg SD, Ravenel JG, Ikonomidis JS, Schönholz C, Reeves S. Acute traumatic aortic injury: imaging evaluation and management. Radiology. 2008;248(3):748-762. doi:10.1148/radiol.2483071416 Summarized by Jorge Chalit, OMS3 | Edited by Meg Joyce & Jorge Chalit Donate: https://emergencymedicalminute.org/donate/  

Contributor: Travis Barlock MD Educational Pearls: Assessment of head and neck vascular injury due to blunt trauma Symptomatic patients require screening head and neck CT angiography EAST guidelines include the following criteria for a screening CT angiography in blunt head trauma: Unexplained neurological deficits Arterial nosebleed GCS < 6 Petrous bone fracture Cervical spine fracture Any size fracture through the transverse foramen LeFort fractures type II or type III EAST guidelines include a grading scale for vascular injury: Grade I: Luminal irregularity or dissection with 25% luminal narrowing, intraluminal thrombus, or raised intimal flap Grade III: Pseudoaneurysm Grade IV: Occlusion Grade V: Transection with free extravasation References Bensch FV, Varjonen EA, Pyhältö TT, Koskinen SK. Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke. Emerg Radiol. 2019;26(4):365-372. doi:10.1007/s10140-019-01677-0 Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178(6):517-522. doi:10.1016/s0002-9610(99)00245-7 Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. doi:10.1097/TA.0000000000002668 Summarized & Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

The JournalFeed podcast for the week of Aug 12-16, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Wednesday Spoon Feed:This was a large RCT of critically ill adults with suspected infection who were randomized to receive either continuous infusions or intermittent dosages of intravenous antibiotics. 90-day mortality between groups was not statistically significant, while clinical cure rate was higher in the continuous infusion group.Friday Spoon Feed:Based on key history and physical examination findings, the Eastern Association for the Surgery of Trauma (EAST) developed an algorithm for the evaluation of blunt trauma patients ≥65 years.

In this episode, our team discusses the recent paper from JAMA Surgery Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. Join us as we explore some of the history of blood transfusions, how we got to where we are today, and the role whole blood transfusion may play going forward Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and editor-in-chief of Trauma Surgery and Acute Care Open. Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master's in Medical Education.  LITERATURE Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of whole blood with survival among patients presenting with severe hemorrhage in US and Canadian adult civilian trauma centers. JAMA Surg. Published online January 18, 2023.  https://pubmed.ncbi.nlm.nih.gov/36652255/ Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315-326. https://pubmed.ncbi.nlm.nih.gov/30044935/   Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283-291. https://pubmed.ncbi.nlm.nih.gov/30032977/   Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):605-617. https://pubmed.ncbi.nlm.nih.gov/28225743/   Howley IW, Haut ER, Jacobs L, Morrison JJ, Scalea TM. Is thromboelastography (Teg)-based resuscitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open. 2018;3(1):e000140. https://pubmed.ncbi.nlm.nih.gov/29766129/   Guyette FX, Brown JB, Zenati MS, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. 2020;156(1):11-20. https://pubmed.ncbi.nlm.nih.gov/33016996/   Smart BJ, Haring RS, Zogg CK, et al. A faculty-student mentoring program to enhance collaboration in public health research in surgery. JAMA Surg. 2017;152(3):306-308. https://pubmed.ncbi.nlm.nih.gov/27973649/   National Academies of Sciences E. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury.; 2016. https://nap.nationalacademies.org/catalog/23511/a-national-trauma-care-system-integrating-military-and-civilian-trauma   Braverman MA, Smith A, Pokorny D, et al. Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion. 2021;61 Suppl 1:S15-S21.  https://pubmed.ncbi.nlm.nih.gov/34269467/ **Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/

Did you miss this year's Eastern Association for the Surgery of Trauma meeting?  Don't sweat it!  Behind the Knife has got you covered.  In this episode we discuss “Scientific Papers that Should Change Your Practice” with EAST manuscript and literature committee members Drs. Laura Brown (@laurarbrownMD), Brittany Bankhead (@bbankheadMD), and Julia Coleman (@juliacolemanMD).   Universal blunt cerebrovascular screening?  Early renal replacement therapy?  Artificial intelligence in emergency general surgery?  This episode is PACKED with high-yield material.   To learn more about all the good things happening at EAST visit www.east.org.  Papers discussed:  1.     Do not forget the platelets: The independent impact of red blood cell to platelet ratio on mortality in massively transfused trauma patients (https://pubmed.ncbi.nlm.nih.gov/35313325/) 2.     The 35-mm rule to guide pneumothorax management: Increases appropriate observation and decreases unnecessary chest tubes (https://pubmed.ncbi.nlm.nih.gov/35125448/) 3.     Timing of thromboprophylaxis in patients with blunt abdominal solid organ injuries undergoing nonoperative management (https://pubmed.ncbi.nlm.nih.gov/33048907/) 4.     Universal screening for blunt cerebrovascular injury (https://pubmed.ncbi.nlm.nih.gov/33502144/) 5.     A three-step support strategy for relatives of patients during in the intensive care unit: a cluster randomized trial (https://pubmed.ncbi.nlm.nih.gov/35065008/) 6.     Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (https://pubmed.ncbi.nlm.nih.gov/34133859/) 7.     Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury (https://pubmed.ncbi.nlm.nih.gov/32668114/) 8.     Disparities in Spatial Access to Emergency Surgical Services in the US (https://pubmed.ncbi.nlm.nih.gov/36239953/) 9.     Validation of the AI-based Predictive Optimal Trees in Emergency Surgery Risk (POTTER) Calculator in Patients 65 Years and Older (https://pubmed.ncbi.nlm.nih.gov/33378309/) 10.  Accuracy of Risk Estimation for Surgeons Versus Risk Calculators in Emergency General Surgery (https://pubmed.ncbi.nlm.nih.gov/35594615/) **Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/

Contributor: Aaron Lessen, MD Educational Pearls: In urban settings, it is becoming more common for police to transport critical patients from scene to hospital A 2022 multicenter observational study compared mortality rates in patients with penetrating injury to torso and/or proximal extremity when transported by EMS versus police Approximately 18% of patients were transported by police  Overall mortality was approximately 15% in both groups  In patients with more severe injury, mortality was still similar at approximately 36% and 38% respectively  References Taghavi S, Maher Z, Goldberg AJ, et al. An analysis of police transport in an Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients. J Trauma Acute Care Surg. 2022;93(2):265-272. doi:10.1097/TA.0000000000003563 Jacoby SF, Branas CC, Holena DN, Kaufman EJ. Beyond survival: the broader consequences of prehospital transport by police for penetrating trauma. Trauma Surg Acute Care Open. 2020;5(1):e000541. Published 2020 Nov 26. doi:10.1136/tsaco-2020-000541 Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MS4 & Erik Verzemnieks, MD   In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

In this episode, our team discusses the management of traumatic rib fractures including pearls and pitfalls. Join as we discuss the current standards of treatment as well as controversies in how to manage these patients! Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and incoming editor-in-chief of Trauma Surgery and Acute Care Open. Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master's in Medical Education.  LITERATURE Terry SM, Shoff KA, Sharrah ML. Improving blunt chest wall injury outcomes: introducing the pic score. J Trauma Nurs. 2021;28(6):386-394. https://pubmed.ncbi.nlm.nih.gov/34766933/ Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):e000064. https://tsaco.bmj.com/content/2/1/e000064 Utter GH, McFadden NR. Rib fractures, the evidence supporting their management, and adherence to that evidence base. JAMA Netw Open. 2020;3(3):e201591-e201591. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763488 Dehghan N, Nauth A, Schemitsch E, et al. Operative vs nonoperative treatment of acute unstable chest wall injuries: a randomized clinical trial. JAMA Surgery. Published online September 21, 2022. https://jamanetwork.com/journals/jamasurgery/article-abstract/2796556 Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618-626. https://pubmed.ncbi.nlm.nih.gov/28030502/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/

This week on the podcast we spoke with Dr. Paul Engels, a trauma surgeon from McMaster University in Hamilton, Ontario. We got into some pretty detailed discussions around trauma training specifically, but more broadly about how we define what a resident should be able to perform at the end of training. Links: 1. The current state of resident trauma training: Are we losing a generation? https://pubmed.ncbi.nlm.nih.gov/29806811/ 2. Canadian Collaborative on Urgent Care Surgery (CANUCS): https://canucs.ca/ 3. Cause for concern: Resident experience in operative trauma during general surgery residency at a Canadian centre. https://journalhosting.ucalgary.ca/index.php/cmej/article/view/69323/54233 4. Toward an all-inclusive trauma system in Central South Ontario: development of the Trauma-System Performance Improvement and Knowledge Exchange (T-SPIKE) project. https://pubmed.ncbi.nlm.nih.gov/33720676/ 5. ASSET course: https://www.facs.org/quality-programs/trauma/education/asset/ 6. Treatment of Ongoing Hemorrhage: The Art and Craft of Stopping Severe Bleeding. https://www.amazon.ca/Treatment-Ongoing-Hemorrhage-Stopping-Bleeding/dp/3319634941. 7. Simulated Trauma and Resuscitation Team Training (S.T.A.R.T.T) course: https://caep.ca/cpd-courses/simulated-trauma-and-resuscitation-team-training-s-t-a-r-t-t/ 8. Definitive Surgical Trauma Care (DSTC™) Courses. https://iatsic.org/DSTC/ 9. Advanced Trauma Operative Management (ATOM) course. https://atomcourse.com/#:~:text=The%20Advanced%20Trauma%20Operative%20Management,post%2Dcourse%20exams%20and%20evaluations. 10. BEST - Basic Endovascular Skills for Trauma. https://medschool.ucsd.edu/som/surgery/divisions/trauma-burn/training/courses/Pages/REBOA-Course.aspx. Bio: Paul Engels is a Trauma/General Surgeon and Intensivist at McMaster University in Hamilton, Ontario. He completed his residency in General Surgery and fellowship in Critical Care at the University of Alberta. He completed a fellowship in Trauma & Acute Care Surgery at Sunnybrook Health Sciences Centre in Toronto. He is a Fellow of the Royal College of Surgeons of Canada and the American College of Surgeons, as well as a member of the Eastern Association for the Surgery of Trauma and the American Association for the Surgery of Trauma.

Determining when to order imaging for blunt cerebrovascular injury is a diagnostic quandary that has long engendered controversy. Today we discuss a paper that introduced universal CT angiogram of the neck to screen for BCVI in all blunt trauma patients and then compared the result to what would have happened if some of the current screening guidelines were utilized. Join us as we discuss their fascinating results and what it means for blunt trauma patients going forward. Hosts:  Elliott R. Haut, MD, Ph.D., a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).  Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Master's in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master's in Medical Education.  LITERATURE Black JA, Abraham PJ, Abraham MN, et al. Universal screening for blunt cerebrovascular injury. J Trauma Acute Care Surg. 2021;90(2):224-231. https://pubmed.ncbi.nlm.nih.gov/33502144/ Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. https://pubmed.ncbi.nlm.nih.gov/32176167/ Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. (1999) American journal of surgery. 178 (6): 517-22. https://pubmed.ncbi.nlm.nih.gov/10670864/ Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, Campion EM, Moore EE. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. (2016) American journal of surgery. 212 (6): 1167-1174. https://pubmed.ncbi.nlm.nih.gov/27751528/ Ciapetti M, Circelli A, Zagli G et-al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18 (1): 61. https://pubmed.ncbi.nlm.nih.gov/21092211/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

The medical directors revisit one of our old favorites "The Serial Killers Series" to discuss 5 trauma killers to keep in your front brain as you are preparing or caring for a sick trauma patient. If you've not considered your differential diagnosis until patient contact and initial evaluation then you're too late. Following this episode, you'll be ready to evaluate, act and prevent acute hemorrhage, obstructive shock, hypoxia, traumatic brain injury and DIC in your sickest trauma patients. REFERENCES 1. Childress K, et al. Prehospital End-tidal Carbon Dioxide Predicts Mortality in Trauma Patients. Prehosp Emerg Care. 2018 Mar-Apr;22(2):170-174. 2. Androski CP Jr, et al. Case Series on 2g Tranexamic Acid Flush From the 75th Ranger Regiment Casualty Database. Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals. 2020 ;20(4):85-91. 3. Taghavi S, et al. An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients. J Trauma Acute Care Surg. 2021 Jul 1;91(1):130-140. 4. Sims CA, et al. Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial. JAMA Surg. 2019 Nov 1;154(11):994-1003. 5. Kupas DF, et al. Glasgow Coma Scale Motor Component ("Patient Does Not Follow Commands") Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients. Ann Emerg Med. 2016 Dec;68(6):744-750. 6. Rankin CJ, et al. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. 2020 Mar;88(3):434-439. 7. Laan DV, et al. Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016 Apr;47(4):797-804.

Today we're talking about the Middle Eastern Association here on campus, and we have Fahad Hakim and Sage Taber to help us to do that! In this episode, Fahad describes what it's like to be Middle Eastern on this campus, and Sage describes how she plans to maintain her connection to her Middle Eastern identity. As you listen, you'll find that both Fahad and Sage are committed to seeking out connection with their culture on a daily basis, and the things they've discovered and communities they've created because of that are truly beautiful. Special thanks to MEA board members, Hannah Kefalas, Eddie Simhairy, and Nuriya Mona for helping with our intro! Resources: MEA's Instagram: @plnumea Beyond Unmuted song recommendation - BoroBoro by Arash The Daily (podcast) The Middle East Institute (email list) Al Jazeera (news) Babel: Translating The Middle East (podcast)

In this episode, our team discusses the management of penetrating liver trauma both before, during, and after surgery. Listen in for helpful tips such as how to perform an intraoperative air cholangiogram, creating an occlusion catheter from a red rubber and a Penrose, and much more! Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).  Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master's in Medical Education.  LITERATURE 1.     Murphy PB, de Moya M, Karam B, et al. Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review. Eur J Trauma Emerg Surg. Published online September 18, 2021. https://pubmed.ncbi.nlm.nih.gov/34537859/ 2.     Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85(6):1119-1122. https://pubmed.ncbi.nlm.nih.gov/30462622/ 3.     Kodadek LM, Efron DT, Haut ER. Intrahepatic balloon tamponade for penetrating liver injury: rarely needed but highly effective. World J Surg. 2019;43(2):486-489. https://pubmed.ncbi.nlm.nih.gov/30280221/ 4.     EAST Practice Management Guidelines: Selective Nonoperative Management of Hepatic Injury, Blunt https://www.east.org/education-career-development/practice-management-guidelines/details/hepatic-injury-blunt-selective-nonoperative-management-of 5.     WEST Nonoperative Management of Adult Blunt Hepatic Trauma Algorithm https://www.westerntrauma.org/wp-content/uploads/2020/08/Non-Operative-Management-of-Adult-Blunt-Hepatic-Trauma-Algorithm_FINAL.svg 6.   THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY 3-MINUTE EXPERT CONSULT VIDEO: “BALLOON TAMPONADE FOR PENETRATING LIVER TRAUMA. https://journals.lww.com/jtrauma/Pages/videogallery.aspx?videoId=13 7.     Coccolini F, Coimbra R, Ordonez C, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15:24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106618/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Large diameter 26-32Fr chest tubes are the treatment of choice at many institutions for the treatment of traumatic hemothorax, but does the currently available data support that? Are there better options available? Join our team as we discuss the The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial by Dr. N Kulvatunyou et al to address this question.  Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).  Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master's in Medical Education.  Journal Articles The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/33843831/  Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. https://pubmed.ncbi.nlm.nih.gov/33415448/ Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. https://pubmed.ncbi.nlm.nih.gov/24375295/  14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small? https://pubmed.ncbi.nlm.nih.gov/23188235/  A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter https://pubmed.ncbi.nlm.nih.gov/28795207/  A History of Thoracic Drainage: From Ancient Greeks to Wound Sucking Drummers to Digital Monitoring https://www.ctsnet.org/article/history-thoracic-drainage-ancient-greeks-wound-sucking-drummer s-digital-monitoring Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Clinical Challenges in Trauma Surgery: Penetrating Cardiac TraumaA patient presents with a stab wound to the THE BOX.  What do you do?  X-ray?  FAST?  Heal with steel?  In this episode, the BTK trauma team discusses your options and gives you a few pro tips along the way.Join Drs. Haut, Feinman, and Sigmon for a high-yield clinical challenge.Hosts: Elliott Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST). Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE.  She received her Masters in Education in the Health Professions from Johns Hopkins. David Sigmon, MD, MMEd, a PGY-5 resident at the University of Illinois at Chicago who plans on going into trauma surgery.  He did two years of research in surgical education at the University of Pennsylvania where he also received his Master's in Medical Education. Papers: Inaba K, Chouliaras K, Zakaluzny S, et al. FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Ann Surg. 2015;262(3):512-518; discussion 516-518. https://pubmed.ncbi.nlm.nih.gov/26258320/ Teeter W, Haase D. Updates in traumatic cardiac arrest. Emerg Med Clin North Am. 2020;38(4):891-901.https://pubmed.ncbi.nlm.nih.gov/32981624/  Israr S, Cook AD, Chapple KM, et al. Pulseless electrical activity following traumatic cardiac arrest: Sign of life or death? Injury. 2019;50(9):15071510. https://pubmed.ncbi.nlm.nih.gov/31147/183/  

On today's episode, we have the privilege of speaking with Dr. Gerard Baltazar, who, I will be working with in the future at my residency. Dr. Baltazar is a trauma and intensive care surgeon at NYU Langone Health. Dr. Baltazar obtained his undergraduate degree in biology and fine arts from Georgetown University and his D.O. degree from Touro University in 2007.He completed his general surgical residency at Wyckoff Heights Medical Center in Brooklyn, NY and finished a fellowship in trauma and surgical critical care at Rutgers University Hospital in Newark, NJ. He has received several regional, state and national awards for scientific research, writing and community service. His research interests include traumatic brain injury, international medicine and osteopathic manipulative treatment for surgical patients. He has volunteered for surgical missions on three continents and was the recipient of the 2015 Oriens Award from the Eastern Association for the Surgery of Trauma. Before joining NYU Long Island School of Medicine, Dr. Baltazar was the Director of Surgical Critical Care at a safety-net hospital in the Bronx.

In this episode we were honoured to once again have another icon of trauma surgery join us. Dr. Ernest E. Gene Moore is a trauma surgeon at the Denver General Hospital. In this episode we explore Dr. Moore’s early insights into the developments of acute care surgery as a specialty, how he defined not one but two major surgery journals, and how he continues to think about the evolution of surgery moving forward. Ernest E. “Gene” Moore, MD, was the Chief of Trauma at the Denver General Hospital for 36 years, Chief of Surgery for 28 years, and the first Bruce M. Rockwell Distinguished Chair in Trauma Surgery. He continues to serve as Vice Chairman for Research and is a Distinguished Professor of Surgery at the University of Colorado Denver (UCD), and has been the Editor of the Journal of Trauma since 2011. Under Dr. Moore’s leadership, the Rocky Mountain Regional Trauma Center at Denver General became internationally recognized for innovative care of the injured patient, and its trauma research laboratory has been funded by the NIH for 35 consecutive years. In July 2018, the center was renamed the Ernest E Moore Shock Trauma Center at Denver Health. Dr. Moore has served as president of nine academic societies, including the Society of University Surgeons, American Association for the Surgery of Trauma, International Association for the Trauma and Surgical Intensive Care, and the World Society of Emergency Surgery; and as Vice President for the American Surgical Association. His awards include the Robert Danis Prize from the Society of International Surgeons, Orazio Campione Prize from the World Society of Emergency Surgery, Philip Hench Award from the University of Pittsburgh, Florence Sabin Award from the University of Colorado, Lifetime Achievement Award from the Society of University Surgeons, Lifetime Achievement Award for Resuscitation Science from the American Heart Association, Distinguished Investigator Award from the American College of Critical Medicine, Distinguished Investigator Award from the Shock Society, Lifetime Service Award from the International Association for Trauma and Surgical Intensive Care, and the Medallion for Scientific Achievement from the American Surgical Association. He has honorary fellowships in the Royal College of Surgeons of Edinburgh, the Royal College of Surgeons in Ireland, the Royal College of Surgeons of Thailand, and the American College of Emergency Physicians; and is an honorary member of the Brazilian Trauma Society, Colombian Trauma Society, Eastern Association for the Surgery of Trauma, European Society for Trauma and Emergency Surgery, North Pacific Surgical Association, and Trauma Association of Canada. Dr. Moore is coeditor of the textbook Trauma, in its 9th edition, Surgical Secrets in its 7th edition, and Trauma Induced Coagulopathy, in its 2nd edition; he has >1700 publications and has lectured extensively throughout the world. He is married to Sarah Van Duzer Moore, M.D., an internist at the University of Colorado Denver, and they have two sons; Hunter, a transplant fellow at UCD and Peter, a pulmonary/critical care fellow, both at UCD. Dr. Moore’s additional interests include endurance sports, mountaineering, skiing, and wapiti pursuit. He lives by the principle to work hard you must play hard, with the understanding that family is the ultimate priority. Links 1. AAST Interview w/ Dr. Moore: http://www.aast.org/assets/f658eae6-95c2-4258-9df0-58344a846882/635338644875870000/23-ernest-e-gene-moore-md-1993-1994-pdf 2. Dedication of Ernest E Moore Shock Trauma Center: https://www.denverhealth.org/news/2018/07/dedication-of-the-ernest-e-moore-shock-trauma-center-at-denver-health 3. WSES tribute to Dr. Moore: https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0206-1

IN this episode Ryan Millsap hosts Olympic Athlete and Gold Medalist - Norman Bellingham. Norman competed in three different sports - whitewater kayak slalom, flatwater kayaking, and rowing, earning distinction in each. He was a national team member in slalom at age 17 before switching to flatwater two years later and at the 1984 Olympic trials, his first-ever flatwater race, he qualified for the US Olympic team and then stroked the US four man kayak at the LA Olympics in the 1000 meter event. Four years later came the highlight of his athletic career when he and partner Greg Barton were Olympic Champions in the flatwater kayak doubles 1,000 meter event. Norman subsequently enrolled at Harvard University, earning a varsity letter in heavyweight rowing by winning the Eastern Association of Rowing Colleges Championship and then placed second at Henley in the Thames Cup competition. After that, he took another shot at the kayaking Olympics, placing 4th in both the singles 500 meters and the doubles 1,000 meters. His training partner, whom Norman unselfishly coached, won the 500, thus costing Norman a medal. Norman ultimately graduated from Harvard with an honors BA in economics and later returned to earn an MBA. He has contributed greatly to the USOC on several occasions. From 1993 to 1996, while working there, he improved programs that support athletes and National Governing Bodies. He created and directed the $4.5 million Hometeam ‘96 Program that maximized the US Team's medal performance at the Atlanta Games. He also helped design and implement a system that more closely tied financial support to athletic performance, a system the USOC still uses today. From 1993-2001, Norman was co-chairman of the Athletes' Advisory Council, vice chair from 2000 to 2001, and from 1997-2001, he was a member of the USOC board of directors and executive committee.

Hosts: Patrick Georgoff, MD and Jayne McCauley, MD In this episode (the last of the series) we cover the management of blunt injury to the solid organs…the liver, spleen, and kidney.  DOMINATE THE DAY.   References:  Nonoperative management of blunt hepatic injury: An Eastern Association for the Surgery of Trauma practice management guideline (https://www.east.org/education/practice-management-guidelines/hepatic-injury-blunt-selective-nonoperative-management-of) Western Trauma Association/Critical Decisions in Trauma: Operative Management of Adult Blunt Hepatic Trauma (https://www.westerntrauma.org/algorithms/PublishedAlgorithms/WTACriticalDecisionsOperativeManagementOfAdultBluntHepaticTrauma.pdf) Selective nonoperative management of blunt splenic injury: An Eastern Association for the Surgery of Trauma practice management guideline (https://www.east.org/education/practice-management-guidelines/splenic-injury-blunt-selective-nonoperative-management-of) Western Trauma Association Critical Decisions in Trauma: Management of adult blunt splenic trauma—2016 updates (https://westerntrauma.org/documents/PublishedAlgorithms/WTACriticalDecisionsAdultBluntSplenicTrauma-2016Update.pdf) Western Trauma Association Critical Decisions in Trauma: Management of renal trauma (https://westerntrauma.org/documents/PublishedAlgorithms/WTACriticalDecisionsManagementOfRenalTrauma.pdf)

Hosts: Patrick Georgoff, MD and Jayne McCauley, MD This…episode….covers…rib…fractures…sorry, I am splinting.  Was that a fever?  Am I developing pneumonia?!  Could this have been avoided with regional anesthesia? Or surgical fixation?  Tune in to find out everything you need to know about the management of rib fractures.   References: Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017; 82:618. Carver TW, Milia DJ, Somberg C, et al. Vital capacity helps predict pulmonary complications after rib fractures. J Trauma Acute Care Surg. 2015 Sep;79(3):413-6. Galvagno SM Jr, Smith CE, Varon AJ, et al. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016 Nov;81(5):936-951. Cheema FA, Chao E, Buchsbaum J, et al. State of Rib Fracture Care: A NTDB Review of Analgesic Management and Surgical Stabilization. Am Surg. 2019 May 1;85(5):474-478. Pieracci FM, Leasia K, Bauman Z, et al. A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). J Trauma Acute Care Surg. 2020;88(2):249.  Pieracci FM, Coleman J, Ali-Osman F, et al. A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2018;84(1):1. 

Despite the many advancements made in the field of medicine, there still seems to be a problem that has persisted over the years with minimal progress. It’s an issue that a lot of physicians aren’t aware of, but has greatly impacted the careers of their female colleagues – gender inequality. The healthcare industry seems to be stacked against women, where discrepancies exist and opportunities are not as available. Implicit and unconscious biases that contribute to this problem. 03:26 This week’s guest, SoMeDocs (https://doctorsonsocialmedia.com/) . Dr. Jain shares her personal stories on the challenges she has faced from medical school, to residency and as a practicing doctor that she mistakenly thought were unique to herself. 05:50 She also discusses the direct correlation between improvement of women’s healthcare as more female doctors advance as leaders in the field. 11:52 This is why it’s important that support is given to those who choose to go into medicine and are faced with particular concerns like maternity leave policies. 10:43 She also dives into social media and how it can be leveraged by women doctors. 24:00 In addition to educating and correcting a lot of misinformation that is rampant online, it can also be used in networking, collaborating and mentoring. It’s also a great way to advance your career as you can brand yourself and share research and studies that you have been a part of. 30:09 Dr. Jain (https://twitter.com/shikhajainmd) believes that by using social media to also spread awareness with regards the experiences of women in business will we be able to find interventions and solutions that can improve the healthcare industry overall. White Coat WisdomThis episode’s White Coat Wisdom is all about focusing on your own personal economy (https://www.sdtplanning.com/blog/focus-on-your-economy-during-crisis) rather than on the economy of the state or country you’re currently in. The past few weeks have put the world in a state of fear and confusion because of the COVID-19 pandemic, shaking our economic certainty and prosperity. While it’s okay to feel fear and panic, you can use this time to really look into your personal finances, so you can put your mind at ease. Take a look at the cash you have on-hand. Make a list of your typical spending and saving activities that you can temporarily put on hold so you can improve your cashflow. Identify any savings, investments or lines of credit that can help you as well, just in case you’ll need them. Even with the sense of uncertainty, it’s important to remember that we have already overcome great crises in the past, and we can certainly do that this time around. White Coat AchievementDespite experiencing trauma at a young age, this week’s White Coat Achievement awardee, has used this to become the passionate surgeon that he is today. Dr. Mike Malla, Chief Trauma Resident at Atrium Health, is able to empathize with those who are going through trauma, and understand the effects it may have on the loved ones surrounding the patient. He wrote an essay (https://atriumhealth.org/dailydose/2020/02/05/out-of-blood?utm_source=twitter&utm_campaign=organic_social) that was read at the 2020 Annual Scientific Assembly of the Eastern Association for the Surgery of Traumas, impressing attendees and moving them to tears. The White Coat Wellness podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice. Spaugh Dameron Tenny is a comprehensive financial planning firm serving doctors and dentist in Charlotte, NC. To find out more about Spaugh Dameron Tenny, visit our website at (https://twitter.com/Shane_Tenny) .

Dr. Melissa Red Hoffman began her career as a naturopathic physician and a yoga teacher. She is now an acute care surgeon, board certified in general surgery, surgical critical care and hospice and palliative medicine. Her clinical interests are in surgical palliative care, care of surgical patients with substance use disorder, and medical education. She is an active member of the American College of Surgeons (ACS) and currently serves as the Chair of the Communications Committee for the Resident and Associate Society (RAS) as well as the RAS liaison to the Physician Competency and Health Workgroup of the ACS Board of Governors. She is also an active and proud member of the Eastern Association of Trauma’s Online Education Committee. Dr. Hoffman works at Mission Hospital in Asheville, North Carolina, picks up occasional hospice shifts at the John F. Keever Solace Center, and serves as the co-director of the surgical clerkship for the University of North Carolina School of Medicine Asheville campus. She is blessed with a naughty orange cat and an absolutely amazing boyfriend. She is happy to chat with or mentor anyone who is interested in palliative care. You can follow her on Twitter: @redmdnd.PS - I (Kimberly) feel lucky to call this Red headed Doctor a GOOD FRIEND. See acast.com/privacy for privacy and opt-out information.

Carlos VR Brown, MD is a trauma surgeon in Austin, TX. After a career in the Navy, he moved back home to Austin where he played a key role in building a level I trauma center, a general surgery residency, as -as if that wasn't a lot already - The Dell Medical School at UT Austin. All in a little over 5 years. Dr. Brown shares his thoughts on how he builds teams and makes what "should happen" a reality for his home town.  Dr. Brown can be contacted at carlos.brown@austin.utexas.edu   I mentioned last week that I would be talking to Dr. Satish Nadig. That episode will come later. In the meantime, watch his TEDx talk on the future of nanotechnology in transplant surgery.    In this episode, I also mention the #EAST4All initiative on equity from the Eastern Association for the Surgery of Trauma. Check out past-president Dr. Andrew Bernard introducing that task force in his presidential address from January. 

Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Nachi: With no gold standard diagnostic test and with complications ranging from simple ectopic beats to fulminant cardiac failure and death, this isn’t an episode you’ll want to miss. Jeff: Before we begin, let me give a quick shout out to our incredible group of authors from New York -- Dr. Eric Morley, Dr. Bryan English, and Dr. David Cohen of Stony Brook Medicine and Dr. William Paolo, residency program director at SUNY Upstate. I should also mention their peer reviewers Drs. Jennifer Maccagnano and Ashley Norse of the NY institute of technology college of osteopathic medicine and UF Health Jacksonville, respectively. Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. Jeff: Clearly a large undertaking for a difficult topic to come up with solid evidence based recommendations. Nachi: For sure. Let’s begin with some epidemiology, which is admittedly quite difficult without universally accepted diagnostic criteria. Jeff: As you likely know, despite advances in motor vehicle safety, trauma remains a leading cause of death for young adults. In the US alone, each year, there are about 900,000 cases of cardiac injury secondary to trauma. Most of these occur in the setting of vehicular trauma. Nachi: And keep in mind, that those injuries don’t occur in isolation as 70-80% of patients with blunt cardiac injury sustain other injuries. This idea of concomitant trauma will be a major theme in today’s episode. Jeff: It certainly will. But before we get there, we have some more definitions to review - cardiac concussion and contusion, both of which were defined in a 1989 study. In this study, cardiac concussion was defined as an elevated CKMB with a normal echo, while a cardiac contusion was defined as an elevated CKMB and abnormal echo. Nachi: Much to my surprise, though, abnormal echo and elevated ck-mb have not been shown to be predictive of adverse outcomes, but conduction abnormalities on ekgs have been predictive of development of serious dysrhythmia Jeff: More on complications in a bit, but first, returning to the idea of concomitant injuries, in one autopsy study of nearly 1600 patients with blunt trauma - cardiac injuries were reported in 11.9% of cases and contributed to the death of 45.2% of those patients. Nachi: Looking more broadly at the data, according to one retrospective review, blunt cardiac injury may carry a mortality of up to 44%. Jeff: That’s scary high, though I guess not terribly surprising, given that we are discussing heart injuries due to major trauma... Nachi: The force may be direct or indirect, involve rapid deceleration, be bidirectional, compressive, concussive, or even involve a combination of these. In general, the right ventricle is the most frequently injured area due to the proximity to the chest wall. Jeff: Perfect, so that's enough background, let’s talk differential. As you likely expected, the differential is broad and includes cardiovascular injuries, pulmonary injuries, and other mediastinal injuries like pneumomediastinum and esophageal injuries. Nachi: Among the most devastating injuries on the differential is cardiac wall rupture, which not surprisingly has an extremely high mortality rate. In terms of location of rupture, both ventricles are far more likely to rupture than the atria with the right atria being more likely to rupture than the left atria. Atrial ruptures are more survivable, whereas complete free wall rupture is nearly universally fatal. Jeff: Septal injuries are also on the ddx. Septal injuries occur immediately, either from direct impact or when the heart becomes compressed between the sternum and the spine. Delayed rupture can occur secondary to an inflammatory reaction. This is more likely in patients with a prior healed or repaired septal defects. Nachi: Valvular injuries, like septal injuries, are rare. Left sided valvular damage is more common and carries a higher mortality risk. In order, the aortic valve is more commonly injured followed by the mitral valve then tricuspid valve, and finally the pulmonic valve. Remember that valvular damage can be due to papillary muscle rupture or damage to the chordae tendineae. Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Jeff: Next on the ddx are coronary artery injuries, which include lacerations, dissections, aneurysms, thrombosis, and even MI secondary to increased sympathetic activity and platelet activity after trauma. In one review, dissection was the most commonly uncovered pathology, occurring 71% of the time, followed by thrombosis, which occured only 7% of the time. The LAD is the most commonly injured artery followed by the RCA. Nachi: Pericardial injury, including pericarditis, effusion, tamponade, and rarely rupture, is also certainly on the differential. Jeff: In terms of dysrhythmias, sinus tachycardia is the most common dysrhythmia, with other rhythms, including PVC / PAC / and afib being found only 1-6% of the time. Nachi: And while conduction blocks are rare, a RBBB is the most commonly noted, followed by a 1st degree AVB. Jeff: Though also rare, commotio cordis deserves it’s own section as its the second most common cause of death in athletes < 18 who are victims of blunt trauma. Though only studied in swine models, it’s hypothesized that the impact to the chest wall during T-wave upstroke can precipitate v-fib. Nachi: Aortic root injuries usually occur at the insertion of the ligamentum arteriosum and isthmus. Such injuries typically result in aortic insufficiency. Jeff: And the last pathology on the differential requiring special attention is a myocardial contusion. Again, no standard definition exists, with some diagnostic criteria including simply chest pain and increasing cardiac enzymes, and others including cardiac dysfunction, ecg abnormalities, wall motion abnormalities, and an elevation of cardiac enzymes. Nachi: Certainly a pretty broad differential… before moving on to the work up, Jeff why don’t you get us started with prehospital care? Jeff: Prehospital management should focus on rapid identification and stabilization of life threatening injuries with expeditious transport as longer prehospital times have been associated with increased mortality in trauma. Immediate transport to a Level I trauma center should be the highest priority for those with suspected blunt cardiac injury. Nachi: In terms of who specifically should be transporting the patient, a Cochrane review evaluated the utility of ALS vs BLS transport in trauma. There is reasonably good data to support BLS over ALS, even when controlling for trauma severity. Moreover, when airway management is needed, advanced airway techniques by ALS crews were associated with decreased odds of survival. Regardless of who is there, the message is the same: focus not on interventions, but instead on rapid transport. Jeff: And if it does happen to be an ALS transport crew, without delaying transport, pain management with fentanyl is both safe and reasonable and preferred over morphine. Post opiate hypotension in prehospital trauma patients is a rare but documented complication. Nachi: And if the prehospital team is lucky enough, or maybe unlucky enough, i don’t know, to have a credentialed provider who can perform ultrasound for those suspected of having a blunt cardiac injury, the general prehospital data on ultrasound is sparse. As of now, it’s difficult to conclude if prehospital US improves care for trauma patients. Jeff: Interestingly, the system I work in has prehospital physicians, who do carry US, but I can’t think of a major trauma where ultrasound changed any of the decisions we made. Nachi: Right, and I think that just reinforces the main point here: there may be a role, we just don’t have the data to support it at this time. Jeff: Great, let’s move onto ED care, beginning with the H&P. Nachi: On history, make sure to elucidate if there is any chest pain, and if it’s onset was before or after the traumatic event. In addition, make sure to ask about dyspnea, fatigue, palpitations, and lightheadedness. Jeff: And don’t forget to get the crash details from the EMS crew before they depart! As a side note, for anyone taking oral boards in a few months, don’t forget to ask the EMS crew for the details!!! Nachi: A definite must for oral boards and for your clinical practice. Jeff: In terms of the physical, tachycardia is the most common abnormality in blunt cardiac injury. In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock. But don’t be reassured by normal vitals, especially in the young, who may be compensating well despite being quite ill. Nachi: Fully undress the patient to appropriately inspect and percuss the chest wall - looking for signs of previous cardiac surgeries or pacemaker placement, as well as to auscultate for new murmurs which may be a sign of valvular injury. Jeff: Similarly, as concomitant injuries are common, inspect the abdomen, looking for ecchymosis patterns, which often accompany blunt cardiac injury. Nachi: Pretty standard stuff. Let’s move on to diagnostic testing. Jeff: Lab testing should include a CBC, BMP, coags, troponin, lactate, and T&S. In one retrospective analysis, an elevated troponin and a lactate over 2.5 were predictors of mortality. Nachi: Additionally, in patients with chest trauma, a troponin > 1.05 was associated with a greater risk for dysrhythmias and LV dysfunction. Jeff: And it likely goes without saying, but an EKG is a must on all trauma patients with suspicion for blunt cardiac injury in accordance with the EAST guidelines. New EKG findings requires admission for monitoring. Unfortunately, on the flip side, an ECG cannot be used to rule out blunt cardiac injury. Nachi: Diving a bit deeper into the data, in a prospective study of 333 patients with blunt thoracic trauma, serial EKG and troponins at 0, 4, and 8 hours post injury had a sensitivity and specificity of 100% and 71%, respectively. However, of those with abnormal findings, all but one had them on initial testing, leading to a negative predictive value of 98%. Jeff: Well that’s an impressive NPV and has huge implications, especially in the era of heavily monitored lengths of stay... Nachi: Definitely. In terms of radiography, a chest x-ray should be obtained as rib fractures, hemopneumothorax, and mediastinal free air are all things you wouldn't want to miss and are also associated with blunt cardiac injury. Jeff: Keep in mind, however, that the chest x-ray should not be seen as a test for pericardial fluid as up to 200 mL of fluid can be contained in the pericardial space and remain undetectable by chest radiograph. Nachi: Which is why you’ll have to turn to our good friend the ultrasound, for more useful data. The data is strong that in the hands of trained Emergency Clinicians, when parasternal, apical, and subcostal views are obtained, US has an accuracy of 97.5% for pericardial effusion. Jeff: Not only is US accurate, it’s also quick. In one RCT, the FAST exam reduced the time from arrival in the ED to operative care by 64% in the setting of trauma. Nachi: That’s impressive -- for expediting patient care and for managing ED flow. Jeff: Exactly. The authors do note however that hemopericardium is a rare finding, so, while not the focus of this article, the real utility of the FAST exam may be in its expanded form, the eFAST, in which a rapid bedside ultrasonographic lung exam for pneumothorax is included, as this can lead to immediate changes in management. Nachi: And assuming you do your FAST or eFAST and have no management changing findings, CT will often be your next test. Jeff: Yeah, EKG-gated multidetector CT can easily diagnose myocardial rupture, pneumopericardium, pericardial rupture, hemopericardium, coronary artery insult, ventricular septal defects and even valvular dysfunction. Unfortunately, CT does not perform well for the evaluation of myocardial contusions. Nachi: This is all well and good, and certainly accurate, but let’s not forget that hemodynamically unstable trauma patients, like those with myocardial rupture, need to be in the operating room, not the CT scanner. Jeff: An important point that should not be understated. Nachi: And the last major testing modality to discuss is the echocardiogram. Jeff: The echo is a fantastic test for detecting focal cardiac dysfunction often see with cardiac contusions, hemopericardium, and valve disruption. Nachi: And it’s worth noting that transthoracic is enough, as transesophageal, despite the better images, hasn’t been shown to change management. TEE should be saved for those in whom a optimal TTE study isn’t feasible. Jeff: Great point. And one last quick note on echo: in terms of guidelines, the EAST guidelines from 2012 specifically recommend an echo in hemodynamically unstable patients or those with a persistent new dysrhythmia without other sources of ongoing hemorrhage or neurologic etiology of instability. Nachi: Perfect, so that wraps up testing and imaging for our blunt cardiac injury patient. Let’s move on to treatment. Jeff: In terms of initial resuscitation, there is an ever increasing body of literature to support blood transfusion over crystalloid in patients requiring volume expansion in trauma. There are no specific guidelines for transfusion in the setting of blunt cardiac injury, so stick to your standard trauma protocols. Nachi: It is worth noting, though, that there is literature outside of trauma for those with pericardial effusions, suggesting that those with a SBP < 100 have substantial benefit from volume expansion. So keep this in mind if your clinical suspicion is high and your trauma patient has a soft but not truly shocky blood pressure. Jeff: Operative management, specifically ED thoracotomy is a heavily debated topic, and it’s next on our list to discuss. Nachi: The 2015 EAST guidelines conditionally recommend ED thoracotomy for moribund patients with signs of life. The Western Trauma Association broadens the ED thoracotomy window a bit to include anyone with no signs of life but less than 10 minutes of CPR. The latter also recommend ED thoracotomy in those with refractory shock. Jeff: Though few studies exist on the topic, in one study of 187 patients, cardiac motion on US was 100% sensitive for predicting survivors. Nachi: Not great data, but it does support one's decision to stop any further work up should there be no cardiac activity, which is important, because the decision to pursue an ED thoracotomy is not an easy one. Jeff: And lastly, emergent pericardiocentesis may be another option in an unstable patient when definitive operative management is not possible. But do note that pericardiocentesis is only a temporizing measure, and not definitive for cardiac tamponade. Nachi: Treatment for dysrhythmias is standard, treat in accordance with standard ACLS protocols, as formal randomized trials on prophylaxis and treatment in the setting of blunt cardiac injury do not exist. Jeff: Seems reasonable enough. And in the very rare setting of an MI after blunt cardiac injury, you should involve cardiology, cardiothoracic surgery, and trauma to help make important management decisions. Data is, again, lacking, but the patient likely needs percutaneous angiography for appropriate diagnosis and potentially further intervention. Definitely hold off on ASA and likely nitroglycerin, at least until significant bleeding has been ruled out. Nachi: Yup, no style points for giving aspirin to a bleeding trauma patient. Speaking of medications, the last treatment modality to discuss here is pain control. Pain management is essential with chest injuries, as appropriate pain management has been shown to reduce mortality in pulmonary related complications. Jeff: And in line with every acute pain consult note I’ve ever come across, a multimodal approach utilizing opioids and nonopioids is recommended. Nachi: Perfect, so that sums up treatment, next we have one special circumstance to discuss: sternal fractures. Cardiac contusions are found in 1.8-2.4% of patients with sternal fractures, almost all of which were seen on CT and not XR according to the NEXUS chest CT study. Of these patients, only 2 deaths occured, both due to cardiac causes.  Thus, in patients with isolated sternal fractures, negative trops, ekg, and negative cxr - the patient can likely be discharged from the ED, as long as their pain is well-controlled. Jeff: And let’s talk controversies for this issue. We only have one to discuss: MRI. Nachi: The fact that MRI produces awesome images is not controversial, see figure 3. It’s role, however, is. In accordance with EAST guidelines, MRI may be most useful in differentiating acute ischemia from blunt cardiac injury in those with abnormal ECGs, elevated enzymes, or abnormal echos. It’s use in the hyperacute evaluation, however, is limited, in large part owing to the length of time required to complete an MRI Jeff: What a time to be alive that we even have to say that MRIs may not have a hyperacute role in trauma - absolutely crazy... Nachi: Moving on to disposition: any patient with aortic, pericardial, or myocardial injury and hemodynamic instability needs operative evaluation and likely intervention, so do not hesitate to get the consults coming or the helicopter in the air should such a patient arrive at your non-trauma center. Jeff: And in those that are hemodynamically stable, with either a positive ECG or a positive trop, they should be monitored on telemetry. There is no clear answer as to how long, but numerous studies suggest a 24 hour period of observation is sufficient. For those with persistent ekg abnormalities or rising trops - this is precisely when you will want to pursue echocardiography. Nachi: And if there are positive EKG findings AND a rising trop, they should be admitted to a step down unit or ICU as well -- as ⅔ of them will develop myocardial dysfunction. Similarly, those with hemodynamic instability but no active traumatic bleeding source - they too should be admitted to the ICU for a STAT echo and serial enzymes. Jeff: But in the vast majority of patients, those that are hemodynamically stable with negative serial EKGs and serial tropinins, they can effectively be ruled out for significant BCI after an 8 hour ED observation period, as we mentioned earlier with a sensitivity approaching 100%! Nachi: Though there are, of course, exceptions to this rule, like those with low physiologic reserve, mobility or functional issues, or complex social situations, which may need to be assessed on a more case-by-case basis. Jeff: Let’s wrap up this episode with some key points and clinical pearls. Cardiac wall rupture is the most devastating form of Blunt Cardiac Injury. The sealing of a ruptured wall may lead to a pseudoaneurysm and delayed tamponade. Trauma to the coronary arteries may lead to a myocardial infarction. The left anterior descending artery is most commonly affected. The most common arrhythmia associated with blunt cardiac injury is sinus tachycardia. RBBB is the most commonly associated conduction block. Commotio cordis is the second most common cause of death in athletes under the age of 18. Early defibrillation is linked to better outcomes. Antiplatelet agents like aspirin should be avoided in blunt cardiac injury until significant hemorrhage has been ruled out. An EKG should be obtained in all patients with suspected blunt cardiac injury. However, an EKG alone does not rule out blunt cardiac injury. Serial EKG and serial troponin testing at hours 0, 4, and 8 have a sensitivity approaching 100% for blunt cardiac injury. An elevated lactate level or troponin is associated with increased mortality in blunt cardiac injury. Perform a FAST exam to assess for pericardial effusions. FAST exams are associated with a significant reduction in transfer time to an operating room. Obtain a chest X-ray in all patients in whom you have concern for blunt cardiac injury. Note that the pericardium is poorly compliant and pericardial fluid might not be detected on chest X-ray. Transesophageal echocardiogram should be considered when an optimal transthoracic study cannot be achieved. CT is used routinely in evaluating blunt chest trauma but know that it does not evaluate cardiac contusions well. In acute evaluation, MRI is generally a less useful imaging modality given the long imaging time. There is evidence to suggest that a patient with an isolated sternal fracture and negative biomarkers and negative EKG findings can be safely discharged from the ED if pain is well-controlled. Trauma to the aorta, pericardium, or myocardium is associated with severe hemodynamic instability. These patients need surgical evaluation emergently. Hemodynamically stable patients with a positive troponin test or with new EKG abnormalities should be observed for cardiac monitoring. Nachi: So that wraps up Episode 26 on Blunt Cardiac Injury! Jeff: Additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. Nachi: It’s also worth mentioning for current subscribers that the website has recently undergone a major rehaul and update. The new site is easier to use on mobile browsers, has better search functionality, mobile-friendly CME testing, and quick access to the digest and podcast. Jeff: And as those of us in the north east say goodbye to the snow for the year, it’s time to start thinking about the summer and maybe start planning for the Clinical Decision Making conference in sunny Ponta Vedra Beach, Fl. The conference will run from June 27th to June 30th this year with a pre-conference workshop on June 26th. Nachi: And the address for this month’s credit is ebmedicine.net/E0319, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References 7.* Clancy K, Velopulos C, Bilaniuk JW, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S301-S306. (Guideline) 22.* Schultz JM, Trunkey DD. Blunt cardiac injury. Crit Care Clin. 2004;20(1):57-70. (Review article) 23.* El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008;35(2):127-133. (Review article) 27.* Bock JS, Benitez RM. Blunt cardiac injury. Cardiol Clin. 2012;30(4):545-555. (Review article) 34.* Berk WA. ECG findings in nonpenetrating chest trauma: a review. J Emerg Med. 1987;5(3):209-215. (Review article) 64.* Velmahos GC, Karaiskakis M, Salim A, et al. Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. J Trauma. 2003;54(1):45-50. (Prospective; 333 patients) 73.* Melniker LA, Leibner E, McKenney MG, et al. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227-235. (Randomized controlled trial; 262 patients)

The following is a short list of salient points related to the podcast and the corresponding source literature. As always, read the source literature and critically appraise it for yourself. Take none of the following as a substitution for local protocol or procedure. 2018 NAEMSP Spinal Immobilization paper https://naemsp.org/resources/position-statements/spinal-immobilization/ Securing a patient to the stretcher mattress significantly reduces lateral motion: Am J Emerg Med. 2016 Apr;34(4):717-21. doi: 10.1016/j.ajem.2015.12.078. Epub 2015 Dec 30. C-Collar limits visible external motion in the intact spine, but not internal motion in the unstable injured spine: Horodyski M, DiPaola CP, Conrad BP, Rechtine GR 2nd. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med. 2011 Nov;41(5):513-9. doi: 10.1016/j.jemermed.2011.02.001. Epub 2011 Mar 12. PubMed PMID: 21397431. C-Collar increases ICP: Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996 Nov;27(9):647-9. PubMed PMID: 9039362. C-Collar causes distraction of unstable C-spine: Ben-Galim P, Dreiangel N, Mattox KL, Reitman CA, Kalantar SB, Hipp JA. Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. J Trauma. 2010 Aug;69(2):447-50. doi:10.1097/TA.0b013e3181be785a. PubMed PMID: 20093981. Lador R, Ben-Galim P, Hipp JA. Motion within the unstable cervical spine during patient maneuvering: the neck pivot-shift phenomenon. J Trauma. 2011 Jan;70(1):247-50; discussion 250-1. doi: 10.1097/TA.0b013e3181fd0ebf. PubMed PMID: 21217496. Spinal immobilization negatively impacts the physical exam: March J et al. Changes In Physical Examination Caused by Use of Spinal Immobilization. Prehosp Emerg Care 2002; 6(4): 421 – 4. PMID: 12385610 Chan D, Goldberg R, Tascone A, Harmon S, Chan L. The effect of spinal immobilization on healthy volunteers. Ann Emerg Med. 1994 Jan;23(1):48-51. PubMed PMID: 8273958. Chan D, Goldberg RM, Mason J, Chan L. Backboard versus mattress splint immobilization: a comparison of symptoms generated. J Emerg Med. 1996 May-Jun;14(3):293-8. PubMed PMID: 8782022. Even Manual In Line Stabilization alone increased difficulty during intubation and increases forces applied to the neck: Thiboutot F, Nicole PC, Trépanier CA, Turgeon AF, Lessard MR. Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial. Can J Anaesth. 2009 Jun;56(6):412-8. doi: 10.1007/s12630-009-9089-7. Epub 2009 Apr 24. PubMed PMID: 19396507. Santoni BG, Hindman BJ, Puttlitz CM, Weeks JB, Johnson N, Maktabi MA, Todd MM. Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation. Anesthesiology. 2009 Jan;110(1):24-31. doi: 10.1097/ALN.0b013e318190b556. PubMed PMID: 19104166. Spinal immobilization makes it harder to breath and decreases forced expiratory volume: “...produce a significantly restrictive effect on pulmonary function in the healthy, nonsmoking man.” Chan, D., Goldberg, R., Tascone, A., Harmon, S., & Chan, L. (1994). The effect of spinal immobilization on healthy volunteers. Annals of Emergency Medicine, 23(1), 48–51. https://doi.org/10.1016/S0196-0644(94)70007-9 Schafermeyer RW, Ribbeck BM, Gaskins J, Thomason S, Harlan M, Attkisson A. Respiratory effects of spinal immobilization in children. Ann Emerg Med. 1991 Sep;20(9):1017-9. PubMed PMID: 1877767. Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care. 1999 Oct-Dec;3(4):347-52. PubMed PMID: 10534038. Prehospital providers can effectively apply selective immobilization criteria without causing harm: Domeier, R. M., Frederiksen, S. M., & Welch, K. (2005). Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Annals of Emergency Medicine, 46(2), 123–131. https://doi.org/10.1016/j.annemergmed.2005.02.004 Out of 32,000 trauma encounters, a prehospital clearance protocol resulted in ONE patient with an unstable injury that was not immobilized. This patient injured her back one week prior, required fixation, but had no neurological injury: Burton, J.H., Dunn, M.G., Harmon, N.R., Hermanson, T.A., and Bradshaw, J.R. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma. 2006; 61: 161–167 Ambulatory patients self extricating with a cervical collar results in less cervical spine motion than with the use of a backboard: Shafer, J. S., & Naunheim, R. S. (2009). Cervical Spine Motion During Extrication: A Pilot Study. Western Journal of Emergency Medicine, 10(2), 74–78. https://doi.org/10.1016/j.jemermed.2012.02.082 Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS. Cervical spine motion during extrication. J Emerg Med. 2013 Jan;44(1):122-7. doi:10.1016/j.jemermed.2012.02.082. Epub 2012 Oct 15. PubMed PMID: 23079144 Lift and slide technique is superior to log roll: Boissy, P., Shrier, I., Brière, S. et al. Effectiveness of cervical spine stabilization techniques. Clin J Sport Med. 2011; 21: 80–88 Despite there not being any randomized control trials evaluating spinal immobilization, patients transferred to hospitals immobilized have more disability than those transported without immobilization: Hauswald, M., Ong, G., Tandberg, D., and Omar, Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998; 5: 214–219 “Mechanism of injury does not affect the ability of clinical criteria to predict spinal injury” Domeier, R.M., Evans, R.W., Swor, R.A. et al. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury.Prehosp Emerg Care. 1999; 3: 332–337 Spinal immobilization in penetrating trauma is associated with an increased risk of death: Vanderlan, W.B., Tew, B.E., and McSwain, N.E. Jr. Increased risk of death with cervical spine immobilisation in penetrating cervical trauma. Injury. 2009; 40: 880–88 Stuke, L.E., Pons, P.T., Guy, J.S., Chapleau, W.P., Butler, F.K., and McSwain, N.E.Prehospital spine immobilization for penetrating trauma-review and recommendations from the Prehospital Trauma Life Support Executive Committee. J Trauma. 2011; 71: 763–769 “The number needed to treat with spine immobilization to potentially benefit one patient was 1,032. The number needed to harm with spine immobilization to potentially contribute to one death was 66.” Haut, E.R., Kalish, B.T., Efron, D.T. et al. Spine immobilization in penetrating trauma: more harm than good?. J Trauma. 2010; 68: 115–121 Vanderlan WB, Tew BE, Seguin CY, Mata MM, Yang JJ, Horst HM, Obeid FN, McSwain NE. Neurologic sequelae of penetrating cervical trauma. Spine (Phila Pa 1976). 2009 Nov 15;34(24):2646-53. doi: 10.1097/BRS.0b013e3181bd9df1. PubMed PMID: 19881402. Velopulos CG, Shihab HM, Lottenberg L, Feinman M, Raja A, Salomone J, Haut ER. Prehospital spine immobilization/spinal motion restriction in penetrating trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST). J Trauma Acute Care Surg. 2018 May;84(5):736-744. doi:10.1097/TA.0000000000001764. PubMed PMID: 29283970. Use of LSB can cause sufficient pressure to create pressure ulcers in a short period of time: Cordell W:H, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995 Jul;26(1):31-6. PubMed PMID: 7793717. The natural progression of some C-spine injuries is to get worse, sometimes because we force them into immobilization devices, sometimes because of hypotension, vascular injury, or hypoxia, but surprisingly not because of EMS providers… Harrop JS, Sharan AD, Vaccaro AR, Przybylski GJ. The cause of neurologic deterioration after acute cervical spinal cord injury. Spine (Phila Pa 1976). 2001 Feb 15;26(4):340-6. PubMed PMID: 11224879. Reports of asymptomatic but clinically important spine injuries are, at best, dubious: McKee TR, Tinkoff G, Rhodes M. Asymptomatic occult cervical spine fracture: case report and review of the literature. J Trauma. 1990 May;30(5):623-6. Review. PubMed PMID: 2188001. Bresler MJ, Rich GH. Occult cervical spine fracture in an ambulatory patients. Ann Emerg Med. 1982 Aug;11(8):440-2. PubMed PMID: 7103163.

As a teenager in rural Kentucky, Dr. Andrew Bernard tagged along with his mother to the operating room where she worked as a nurse anesthetist. Taking a different route to the same destination, he became a trauma surgeon, a pillar in his community, and is now President of the Eastern Association for the Surgery of Trauma - one of the main societies of trauma providers in the country. During our interview he shares his perspective on healthcare inequities, diversity and inclusion, and leadership. --- Send in a voice message: https://anchor.fm/brianwilliamsmd/message

The Association of Women Surgeons and Eastern Association for the Surgery of Trauma have teamed up in this podcast to discuss the importance of the EAST mentoring progrm and to discuss the importance of women mentoring other women in surgery.  We are joined by Dr. Marie Crandall and Dr. Cassandra White, whose mentoring relationship began in the EAST program in 2017.  You can learn more about the EAST mentoring program at www.east.org/mentorprogram and more about AWS at www.womensurgeons.org. 

The Association for Women Surgeons (AWS) and Eastern Association for the Surgery of Trauma (EAST) have teamed up in this podcast to discuss the importance of the EAST Mentoring Program and to discuss the importance of women mentoring other women in surgery.  We are joined by Dr. Marie Crandall and Dr. Cassandra White, whose mentoring relationship began in the EAST program in 2017.  

Traumatic Cardiac Arrest; for many of us an infrequent presentation and it that lies the problem. In our previous cardiac arrest podcast we talked about the approach to the arresting patient, however in trauma the approach change significantly. We require a different set of skills and priorities and having the whole team on board whilst sharing the same mental model is key. Have a listen to the podcast and let us know your thoughts. The references are below but if you only read one thing take a look at the ERC Guidelines on traumatic cardiac arrest which we refer to. Enjoy! Simon, Rob & James References & Further Reading Resuscitation to Recovery Document Roadside to Resus; Cardiac Arrest ERC Guidelines; Traumatic Arrest Traumatic cardiac arrest: who are the survivors? Lockey D. Ann Emerg Med. 2006 Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest. Wah W. Am J Emerg Med. 2017  Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest. Beck B. Resuscitation 2017. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. Seamon MJ. J Trauma Acute Care Surg. 2015 EAST guidelines 2015; ED Thoracotomy FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Inaba K. Ann Surg. 2015

LT 097 | Dan Garbutt - Technique vs. Style in Rowing Subscribe & Review on : Apple Podcasts | Stitcher This week's podcast guest is my friend and Women's Head Rowing Coach of Old Dominion University, Dan Garbutt. Dan and I are both South Jersey natives so it was a ton of fun for me to sit down and reconnect with him. Dan Garbutt is  a 2001 graduate of Princeton University. He began his collegiate career in 1998, winning the Freshman Award and being named a member of the United States National Team, while the Tigers captured the Intercollegiate Rowing Association (IRA) Championship. He went on to earn three varsity letters in men's heavyweight crew as Princeton won three Eastern Association of Rowing Colleges (EARC) Championships (1998, 1999, 2001). As a senior in 2001 he received All-Ivy League and All-American honors. Dan has been the Head Coach of Old Dominion Rowing for the past six years and has led the program to new heights and success. Some of his accomplishments include: In the 2015-16 season, his sixth year at the helm, Garbutt guided the Lady Monarchs to a sixth-place finish at the Big 12 Championship in Oak Ridge, Tennessee. The sixth-place finish was a two-spot improvement on the 2015 conference finish. The 2015-16 season also saw the 1V8 earn Big 12 Boat of the Week honors in late March after a dominant performance at the UNC Invite, which marked the first time an ODU boat earned that accolade. In his fifth year as head coach and is in his first season in the Big 12 Conference, the team saw a lot of success, as the Monarchs recorded 19 top-20 finishes, including 13 in the top-5. ODU also started a new tradition by dedicating the Varsity 8 and the Second Varsity 8 boats to President John Broderick and First Lady Kate Broderick. In the 2012-2013 season, the Lady Monarchs received their first ever votes in the CRCA/US Rowing Coaches Top 20 Poll. The seniors from this season, which were part of Garbutt’s first recruiting class, ended their careers at Old Dominion without losing a single home meet. During the fall 2012 season, Old Dominion’s Frosh/Novice Eight boat won the Commodore Cup at the Head of Schuylkill, as well as won gold medals at the Head of the Hooch. The Frosh/Novice Eight boat concluded the fall season with a third place finish at the Rivanna Romp. At the Head of the Schuylkill, ODU’s Open Four boat placed third overall out of 38 total boats. At the Head of the Hooch, the Lady Monarchs Lightweight Four boat placed second. Along with the success on the water, Garbutt also helped open the $2.3 million ODU Rowing Center in the spring of 2011, representing a joint partnership project between the city of Norfolk and the University. A two-story, 13,000 square foot, boathouse facility that houses the Lady Monarchs rowing program just minutes away from ODU on the Lafayette River, is a state-of-the art facility that provides first class accommodations for the program that provides training year round as Garbutt continues to build the highly competitive Lady Monarch program . 3 Key Takeaways you will learn in this interview: The difference between technique and style in rowing. Evaluations and assessments you can do with your athletes The importance of customizing your training program to your athletes needs' Interview Topics: Dan's background and roots as an athlete and coach His thoughts on rowing technique and some key differences of technique vs. style How he evaluates his rowers movement, mobility, strength and physiological capacity Lifeguard rowing and racing Why athletes tend to gravitate towards what they are good at Keys to athletic development and much more. Show Notes: Dan Garbutt's Profile (Old Dominion Rowing) Old Dominion University Rowing (Instagram)

Dr. Coleman is a trauma and acute care surgeon, as well as an Assistant Professor of Surgery at Indiana University School of Medicine in Indianapolis. She completed her medical degree at the University of Tennessee in Memphis in 2005; completed a general surgery residency at the Rush University/Cook County Hospital in 2010; and then a trauma and surgical critical care fellowship at Emory University Grady Memorial Hospital in 2012. Dr. Coleman is also a wife, mother, and writer, with over 2 million views of her work on her blog at www.heelskicksscalpel.com. She has also contributed articles to the Huffington Post, Forbes, KevinMD.com and LinkedIn. Lastly, she is the co-host of the Careercast podcast of the Eastern Association for the Surgery of Trauma. Please enjoy with Dr. Jamie Coleman!

Dr. Ernest Moore discusses a roundup of papers first showcased at this year’s Eastern Association for the Surgery of Trauma annual meeting and published in the July 2016 issue of the Journal. The lead paper appropriately, is the presidential address by Dr. Stanley Kurek. Dr. Kurek provides a timely reflection on the challenges trauma surgeons face in maintaining their resilience. This is followed by the Oriens Lecture delivered by Dr. J. Don Jenkins. Dr. Jenkins offers a cogent perspective on leadership, reviewing the spectrum of leadership styles. Dr. Benjamin Miller et al from Vanderbilt University conducted a retrospective analysis of the impact of administering prehospital packed red cells in their helicopter service. In a related paper, Dr. Mark Yazer and colleagues from the Alleghany General Hospital review their initial ten months experience with transfusing cold-stored uncrossmatched whole blood, i.e., low titer group O positive blood that was leukoreduced with a platelet-sparing filter. Dr. David Jeffcoach et al from the University of Tennessee presented a provocative study on the role of CPR in profound hemorrhagic shock. Dr. Christine Leeper and colleagues from the Children’s Hospital at the University of Pittsburgh performed an analysis of trauma-induced coagulopathy in a pediatric group, i.e. less than the age of 18. Transcript

Dr. Gene Moore presents highlights from the September 2015 issue. Selected articles include an AAST 2014 plenary paper by Dr. Ben Zarzaur et al, who conducted a prospective observational trial to determine risk of splenectomy after nonoperative management. In another recommended article, Dr. Sandy Arabian and Eastern Association for the Surgery of Trauma colleagues investigated interhospital variability and accuracy in data coding and scoring by registrars. Dr. Ting Li’s team at the University of Calgary analyzed the incidence of small bowel obstruction and incisional hernia following both laparotomy and nonoperative management. Dr. Hyun Jin Cho et al’s present a retrospective review of traumatic pulmonary pseudocysts treated at their South Korea hospital.

Dr. Gene Moore’s presents summer reading picks, selected from papers first showcased at this year’s Eastern Association for the Surgery of Trauma annual meeting and published in the July 2014 issue of The Journal of Trauma. Meeting highlights include the presidential address by Dr. Scott Sagraves and the Oriens lecture by Dr. Grace Rozycki. Research papers include Dr. Taghavi et al’s swine model of permissive hypoventilation, Dr. Hampton et al’s cryopreserved RBC study, Dr. Yanna Cao’s team work on never-frozen liquid plasma, and Dr. Ashley Walther and colleagues’ analysis of pediatric trauma outcomes. Transcript

We’re preparing for the EACUBO 2014 Annual Workshop in just a few weeks, and to help us out, we’re joined by guest Roger Stackpoole, Vice President of Finance & Administration at Le Moyne College. Roger and Howard Teibel will be presenting “Reaching Across the Aisle — CFO and CAO Strategic Partnership,” in which they offer insights and observations on cultivating a spirit of collaboration and cooperation between academic and business leadership. This week on the show, Howard and Roger set the stage for their presentation with a discussion on building trust through transparency, shifting responsibility in building a healthy and financially sustainable organization, and cultivating a shared commitment to delivering the mission of the institution. We invite you to listen to the show this week, and to begin to craft your questions and comments as Roger and Howard lead what promises to be an exciting, challenging, and participatory presentation in Philadelphia. _About Roger Stackpoole_Roger is Vice President of Finance & Administration and Treasurer at Le Moyne College in Syracuse, NY. He is a driving force behind sustainability initiatives and strategic planning at Le Moyne College, and is past president of the Eastern Association of College and University Business Officers. Learn more about Roger at LeMoyne.edu.

Dr. Ernest “Gene” Moore, editor-in-chief, presents highlights from the August 2012 issue of The Journal of Trauma. The issue contains papers presented at the 25th annual meeting of the Eastern Association for the Surgery of Trauma. Dr. Moore also discusses selected papers from this month’s Advances in Combat Casualty Care supplement.

This podcast is related to Mumbai 26/11 - A Message To My Father For The Sake of the World, Track 03 of  Full Moon Rising's "Journey to a Brave New You", an personal development program launched in part with the upcoming album "Brave New World - The Time is NOW!"In this episode, we speak on our take on the whole topic of Death and Western and Eastern Association on the topic. LISTEN                 DOWNLOAD