Trauma ICU Rounds

Dr. Dennis Kim
  • 5.0 (3)
  • MEDICINE
  • UPDATED FORTNIGHTLY
Trauma ICU Rounds

Medical education podcast dedicated to providing high-quality, concise, and clinically relevant multimedia content spanning the spectrum of surgical critical care, emergency general & trauma surgery

  1. 20/09/2022

    Episode 54: Frailty, Geriatric Trauma & TBI with Dr. Bellal Jospeh

    In this episode we sit down with the Chief of Trauma, Surgical Critical Care, Burns,  & Acute Care Surgery at the University of Arizona, Dr. Bellal Joseph, who share with us his thoughts and research findings on hot topics including frailty, geriatric trauma, leadership, and more. Timestamps: 00:12  Introductions 01:30  What is frailty? Your physiologic NOT chronologic body. 06:58  Injured elderly trauma patients can have good outcomes 07:30  Trauma specific frailty index 10:48  Failure to rescue 13:57  Geriatricians and the trauma surgeons 15:08  4Ms-What Matters, Mobility, Mentation, Medication 16:48  Geriatric cohorting/wards 22:24  ACS geriatric centers of excellence 29:35  Brain Injury Guidelines (BIG) 38:17  The importance of teamwork & servant leadership 40:28  Imposter syndrome 43:19  Leadership considerations 45:25  Final thoughts References: Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, Wynne J, Tang A, O'Keeffe T, Rhee P. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014 Apr;76(4):965-9. doi: 10.1097/TA.0000000000000161. PMID: 24662858. Joseph B, Obaid O, Dultz L, Black G, Campbell M, Berndtson AE, Costantini T, Kerwin A, Skarupa D, Burruss S, Delgado L, Gomez M, Mederos DR, Winfield R, Cullinane D; AAST BIG Multi-institutional Study Group. Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28. PMID: 35343931.v Joseph B, Pandit V, Haider AA, Kulvatunyou N, Zangbar B, Tang A, Aziz H, Vercruysse G, O'Keeffe T, Freise RS, Rhee P. Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury: The Role of Acute Care Surgeons. JAMA Surg. 2015 Sep;150(9):866-72. doi: 10.1001/jamasurg.2015.1134. PMID: 26107247. Joseph B, Pandit V, Sadoun M, Zangbar B, Fain MJ, Friese RS, Rhee P. Frailty in surgery. J Trauma Acute Care Surg. 2014 Apr;76(4):1151-6. doi: 10.1097/TA.0000000000000103. PMID: 24662884. Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, Fain M, Mohler MJ, Joseph B. Emergency general surgery specific frailty index: A validation study. J Trauma Acute Care Surg. 2016 Aug;81(2):254-60. doi: 10.1097/TA.0000000000001120. PMID: 27257694. Support the show

    48 min

  2. 12/09/2022

    Episode 53: Insights into Modern Critical Care with Dr. Jean-Louis Vincent: Part II

    In this episode, we talk all things critical care the one and only, Dr. Jean-Louis Vincent aka. JLV.  This episode is a MUST listen. We touch upon the evolution of early goal directed therapy, measures of fluid responsiveness, optimizing oxygen delivery, and the importance of integrating data points versus examining  them in isolation when caring for our critically ill and injured patients. This and MUCH MUCH more in arguably one of my favorite episodes to date!! Timestamps 00:00 Introduction 01:21 What happened to SG catheters and should we use them? 04:05 What decreases mortality in critical care patients? 05:30 When to transfuse critical care patient? Use your brain! 08:55 Measures of tissue perfusion and fluid responsiveness 09:36 JLV breaks down the Rivers trial 10:36 Recent EGDT papers 10:54 How to optimize O2 delivery? Late ScVO2, dob challenge, and fluid challenges 13:21 Dynamic measures of fluid responsiveness 13:46 CVP as a relative value 15:14 Passive leg raising (PLR) as a measure of fluid responsiveness 21:20 JLV's take on therapeutic nihilism 24:45 Don’t isolate; integrate! 26:46 Navigating the future of critical care – JLV’s thoughts on AI in the ICU 29:55 Rapid fire hot topics in the ICU – Yes or No -Metabolic cocktail -Corticosteroids for septic shock -Albumin and Lasix or Lasix alone PCT/CRP and sepsis/Abx Resources: International Symposium on Intensive Care and Emergency Medicine (ISICEM): https://www.isicem.org ISICEM Chats Platform: https://www.isicem.org/e-chat/index.asp           Articles: Passive leg raising:five rules, not a drop of fluid! https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0708-5 The fluid challenge https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03443-y Blood lactate levels in sepsis: 8 questions Vincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care. 2021 Jun 1;27(3):298-302. doi: 10.1097/MCC.0000000000000824. PMID: 33852499. We should avoid the term "fluid overload" https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2141-7 EGDT in the Treatment of Severe Sepsis and Septic Shock https://www.nejm.org/doi/full/10.1056/nejmoa010307 A Randomized Trial of Protocol-Based Care for Early Septic Shock https://www.nejm.org/doi/full/10.1056/nejmoa1401602 Support the show

    34 min

  3. SEASON 3 TRAILER

    Season 3 Trailer

    It's been a while! We are coming to you from our new studio in Victoria on Vancouver Island, BC. This Season is PACKED with incredible content, interviews and educational pearls designed to improve the quality of care that you are deliver daily at the bedside to your patients and their loved ones. Support the show

    2 min

  4. 06/09/2022

    Episode 52: Insights into Modern Critical Care with Dr. Jean-Louis Vincent: Part I

    In this episode, we discuss the overarching importance of AVOIDING iatrogenic harm in the ICU with arguably one of the world's leading experts in critical care medicine, the one and only, Dr. Jean-Louis Vincent aka. JLV. Tune in as Dr. Vincent shares with us the importance of having a systematic, problem-based approach to patient care delivery which, of course, involves giving our patients a FAST HUG every day! Time Stamps: 2:10 LA Critical Care and Differences between Europe versus USA 4:04 COVID, Modern tech and bedside care 5:32 ICU Rounds – How I do it 6:00 Team Based ICU Care  7:56 Modern advances in critical care 9:55 Problem-based approach in the ICU 13:18 FAST HUGS 14:00 Feeding 14:36 Analgesia & Sedation 15:46 Thromboembolic prophylaxis 16:25Head of the bed elevated 17:17Ulcer prophylaxis 19:22Glucose control 20:48 Tube feeds, yes? Ulcer ppx , no. 22:30 Outro Support the show

    23 min

  5. 11/02/2022

    Episode 51 - Persistent Inflammation, Immunosuppression & Catabolism Syndrome (PICS) with Dr. Scott Brakenridge

    "Getting patients resuscitated through sepsis, septic shock, and hemorrhagic shock is not the end...it's the beginning." In this episode, Dr. Brakenridge from Harborview Medical Center joins us to discuss PICS and the impact of this syndrome on our critically ill and injured patients and their families. Also referred to as the Post-Intensive Care Syndrome, Dr. Brakenridge shares with us the evolution and results of translational research into this now well-recognized morbid condition which often occurs in the setting of chronic critical illness. From the importance of breaking  the cycle of "sepsis recidivism" to the. application of the SCCM A to F bundle, this episode is a MUST listen for those of us taking care of patients in the ICU. TIME STAMPS 00:12  Introduction 01:46  What is PICS? The role of chronic critical illness (CCI) 05:13  Phenotypes vs. endotypes 06:47  The role of biomarkers in PICS 08:50  When does acute critical illness turn into CCI? 10:14  Risk factors for PICS 15: 07  Prognostication and determining patient trajectory 18:32  The Glue Grant Experience: Genomics of Injury 22:48  Hemorrhagic shock resuscitation: Then and now 25:33  Sepsis recidivism & avoiding secondary insults  29:08 ICU delirium 31:55  The role of early mobilization 32:41  The impact of catabolism in sepsis 34:50  Is there a role for anabolic steroids to counteract PICS? 37:52  What's ahead in terms of PICS translational research? 39:44  Cytokine and immunomodulator therapies 41:49  Final thoughts RECOMMENDED READINGS Brakenridge SC, Wang Z, Cox M, Raymond S, Hawkins R, Darden D, Ghita G, Brumback B, Cuschieri J, Maier RV, Moore FA, Mohr AM, Efron PA, Moldawer LL. Distinct immunologic endotypes are associated with clinical trajectory after severe blunt trauma and hemorrhagic shock. J Trauma Acute Care Surg. 2021 Feb 1;90(2):257-267. Efron PA, Mohr AM, Bihorac A, Horiguchi H, Hollen MK, Segal MS, Baker HV, Leeuwenburgh C, Moldawer LL, Moore FA, Brakenridge SC. Persistent inflammation, immunosuppression, and catabolism and the development of chronic critical illness after surgery. Surgery. 2018 Aug;164(2):178-184. doi: 10.1016/j.surg.2018.04.011. Epub 2018 May 26. Sauaia A, Moore FA, Moore EE. Postinjury Inflammation and Organ Dysfunction. Crit Care Clin. 2017 Jan;33(1):167-191. Stortz JA, Murphy TJ, Raymond SL, Mira JC, Ungaro R, Dirain ML, Nacionales DC, Loftus TJ, Wang Z, Ozrazgat-Baslanti T, Ghita GL, Brumback BA, Mohr AM, Bihorac A, Efron PA, Moldawer LL, Moore FA, Brakenridge SC. Evidence for Persistent Immune Suppression in Patients Who Develop Chronic Critical Illness After Sepsis. Shock. 2018 Mar;49(3):249-258.  Support the show

    44 min

  6. 29/01/2022

    Episode 50 - Whole Blood & Modern Hemostatic Resuscitation Strategies with Dr. Bryan A. Cotton

    In this, our 50th episode, we are in Austin, TX, for the Annual EAST Scientific Meeting where we are joined by Dr. Bryan A. Cotton who shares his expertise and knowledge regarding the use of whole blood (WB) in trauma patients. From the use of whole blood in prior military conflicts to the design and successful implementation of one of the only prospective randomized controlled trials of modified whole blood use in trauma patients, Dr. Cotton provides an incredible overview of the potential benefits of whole blood or as he refers to it - "the dying blood product". Also covered in expert fashion are the role of other hemostatic products and strategies including tranexamic acid, fibrinogen concentrates, and a plasma first resuscitation strategy. Time Stamps: 01:16  The rationale for whole blood & a 1:1:1 transfusion strategy 04:24  Military experience with WB: What's old is new again! 05:44  Modified WB vs. Component Therapy RCT 06:02  Leukoreduction of WB 07:00  Type-specific WB 09:38  Platelet function in WB vs. aphaeresis platelets 11:58  Warm fresh WB vs. cold stored 12:55  The whole is greater than the sum of its parts 15:02  What do we mean by low-titer WB? 19:14  O+ vs. O- WB & the potential for alloimmunization 24:39  Transfusion reactions & safety of WB in trauma patients 25:40  Prehospital WB for the win 27:32  LITES Network 28:27  Hemorrhage control, 1:1:1, viscoelastic assays, cryoprecipitate & fibrinogen                concentrate 32:00  BAC's thoughts on tranexamic acid (TXA) 34:47  BAC's thoughts on hypertonic saline (HTS) for COVID-19 38:51  Final thoughts & future directions Recommended Readings: Cotton BA, Podbielski J, Camp E, Welch T, del Junco D, Bai Y, Hobbs R, Scroggins J, Hartwell B, Kozar RA, Wade CE, Holcomb JB; Early Whole Blood Investigators. A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions. Ann Surg. 2013 Oct;258(4):527-32; discussion 532-3. Williams J, Merutka N, Meyer D, Bai Y, Prater S, Cabrera R, Holcomb JB, Wade CE, Love JD, Cotton BA. Safety profile and impact of low-titer group O whole blood for emergency use in trauma. J Trauma Acute Care Surg. 2020 Jan;88(1):87-93. McGinity AC, Zhu CS, Greebon L, Xenakis E, Waltman E, Epley E, Cobb D, Jonas R, Nicholson SE, Eastridge BJ, Stewart RM, Jenkins DH. Prehospital low-titer cold-stored whole blood: Philosophy for ubiquitous utilization of O-positive product for emergency use in hemorrhage due to injury. J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S115-S119. Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, Adams PW, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Witham WR, Putnam AT, Duane TM, Alarcon LH, Callaway CW, Zuckerbraun BS, Neal MD, Rosengart MR, Forsythe RM, Billiar TR, Yealy DM, Peitzman AB, Zenati MS; PAMPer Study Group. Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. N Engl J Med. 2018 Jul 26;379(4):315-326. doi: 10.1056/NEJMoa1802345. PMID: 30044935. Yazer MH, Jackson B, Sperry JL, Alarcon L, Triulzi DJ, Murdock AD. Initial safety and feasibility of cold-stored uncrossmatched whole blood transfusion in civilian trauma patients. J Trauma Acute Care Surg. 2016 Jul;81(1):21-6. doi: 10.1097/TA.0000000000001100. PMID: 27120323. Websites: LITES Network https://www.litesnetwork.org Southwest Texas Regional Advisory Council https://www.strac.org/blood Support the show

    43 min

  7. 11/01/2022

    Episode 49 - TRAUMA with Dr. Ken Mattox: Part II

    In the second episode of a two-part series, Dr. Mattox shares his insights and thoughts on hot research topics in trauma in need of investigation. Additionally, he helps us to envision what acute trauma management may look like in the future, while also sharing with us how his book (and one of my ALL-TIME fave surgery books!), Top Knife, came into being. From lessons learned to lessons in need of learning, Dr. Mattox has all of the bases (and basics) covered. Time Stamps 0:00 Introduction 00:12 "The resuscitation is the incision." 00:44 Welcome &  Announcements/Call to Action 02:24 Whole blood is good but.....what should our endpoint of resuscitation  be? 03:05 Drones in the prehospital setting 08:03 Reimagining the ER 08:57 General Surgery training: Then & now 10:00 Top Knife, Trauma, Rich’s Vascular Trauma 11:33 How Top Knife came into being – Saturday mornings, coffee, Mary Allen & a tape recorder 16:57 To operate or not operate? 22:11 Mattox Vegas TCCACS  26:11 Final thoughts: ”There’s always a better way." Support the show

    29 min

  8. 07/01/2022

    Episode 48 - TRAUMA with Dr. Ken Mattox: Part I

    We. Are. Back!! After a (brief?!) hiatus, we are launching 2022 with a 2-part series with the one and only Dr. Ken Mattox. In this episode, Dr. Mattox shares with us his thoughts on what the modern general surgeon should look like and how we as surgeons differ from our medicine counterparts. Additionally, we review the history of modern trauma resuscitation, the paradigm shifts that have occurred as it pertains to permissive hypotension, as well as the technological advances that have occurred over the last century that have improved care of the critically injured patient. This is an episode not to be missed! Time Stamps 00:12 Welcome & announcements 04:21 What does the modern "surgeon" look like? 07:48 The interplay between technology & surgery 10:15 Serendipity & Dr. Mattox's early career 11:28 Finessing & integrating clinical practice with research opportunities 13:45 The 2 most impactful advances in trauma care during the last century: the microchip & organized trauma systems 17:00 Dr. Mattox's thoughts on REBOA & intravascular control/treatment techniques 22:32 MAST pants: lessons learned 25:18 Elevate the BP with MAST and fluids? Increase the mortality!! 26:30 Permissive hypotension 27:06 Vasopressors in the ER?! Hypotension is teleological!! References Bickell WH, Pepe PE, Wyatt CH, Dedo WR, Applebaum DJ, Black CT, Mattox KL. Effect of antishock trousers on the trauma score: a prospective analysis in the urban setting. Ann Emerg Med. 1985 Mar;14(3):218-22. doi: 10.1016/s0196-0644(85)80443-1. PMID: 3977145. Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994 Oct 27;331(17):1105-9. doi: 10.1056/NEJM199410273311701. PMID: 7935634. Hirshberg A, Hoyt DB, Mattox KL. From "leaky buckets" to vascular injuries: understanding models of uncontrolled hemorrhage. J Am Coll Surg. 2007 Apr;204(4):665-72. doi: 10.1016/j.jamcollsurg.2007.01.005. Epub 2007 Feb 23. PMID: 17382227. 2022 Mattox Vegas TCCACS https://www.trauma-criticalcare.com/tccacs/program/ Support the show

    31 min
See All (56)

Trailers

Ratings & Reviews

5
out of 5
3 Ratings

About

Medical education podcast dedicated to providing high-quality, concise, and clinically relevant multimedia content spanning the spectrum of surgical critical care, emergency general & trauma surgery

Information

  • Creator
    Dr. Dennis Kim
  • Years Active
    2020 - 2022
  • Episodes
    56
  • Rating
    Clean
  • Copyright
    © 2024 Trauma ICU Rounds
  • Show Website
    Trauma ICU Rounds

You Might Also Like

To listen to explicit episodes, sign in.

Stay up to date with this show

Sign-in or sign-up to follow shows, save episodes and get the latest updates.
Select a country or region

Africa, Middle East, and India

Asia Pacific

Europe

Latin America and the Caribbean

The United States and Canada