Trauma Bay Podcast

In this episode I walk through my MCI experience and discuss my feelings and thoughts in the days, weeks, and months following. Plus some ranting.

In this episode we welcome our first guest Rob Mokszyscki PharmD, BCPS to the podcast. We discuss high dose Nitroglycerin for SCAPE, and also have a brief discussion on sedation agents.

Agrawal, N., Kumar, A., Aggarwal, P., & Jamshed, N. (2016). Sympathetic crashing acute pulmonary edema. Indian Journal of Critical Care Medicine, 20(12), 719–723. https://doi.org/10.4103/0972-5229.195710

Ashok, H., Shtembari, J., Achhami, E., Gaire, S., Shrestha, D. B., & Joshi, T. (2022). Valvular heart disease presenting as Sympathetic Crashing Acute Pulmonary Edema (SCAPE) phenomenon: A diagnostic and management paradigm. Cureus, 14(12), e32352. https://doi.org/10.7759/cureus.32352

Kelly, R. P., Gibbs, H. H., O’Rourke, M. F., Daley, J. E., Mang, K., Morgan, J. J., & Avolio, A. P. (1990). Nitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery. European Heart Journal, 11(2), 138–144. https://doi.org/10.1093/oxfordjournals.eurheartj.a059669

Long, B., Brady, W. J., & Gottlieb, M. (2025). Emergency medicine updates: Sympathetic crashing acute pulmonary edema. The American Journal of Emergency Medicine, 90, 35–40. https://doi.org/10.1016/j.ajem.2024.12.061

Wilson, S. S., Kwiatkowski, G. M., Millis, S. R., Purakal, J. D., Mahajan, A. P., & Levy, P. D. (2017). Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. American Journal of Emergency Medicine, 35(1), 126–131. https://doi.org/10.1016/j.ajem.2016.10.038

In this episode we discuss the physiology and management behind the traumatic cardiac arrest.

In this episode we review a tragic case of an upper GI bleed and the resuscitation efforts that ensue.

Antunes, C., Tian, C., & Copelin II, E. L. (2018). Upper gastrointestinal bleeding. StatPearls [Internet]. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/29262121/

Desai, R., Patel, U., Doshi, S., Rupareliya, C., Bhuva, R., & Shah, N. (2017, October). Burden of arrhythmias in gastrointestinal hemorrhage patients: A nationwide inpatient analysis (Abstract 2714). The American Journal of Gastroenterology, 112(Suppl), S1475.

Jennings, L. K., & Watson, S. (2018, May 16). Massive transfusion. StatPearls. StatPearls Publishing. PMID: 29763104. https://www.ncbi.nlm.nih.gov/books/NBK499929/

In this episode we discuss the basics of ECPR and VA-ECMO. Included is a case review and discussion. Later in the episode we outline some landmark ECPR studies, and review inclusion and exclusion criteria.

Bartos, J. A., Grunau, B., Carlson, C., Duval, S., Ripeckyj, A., Kalra, R., Raveendran, G., John, R., Conterato, M., Frascone, R. J., Trembley, A., Aufderheide, T. P., & Yannopoulos, D. (2020). Improved survival with extracorporeal cardiopulmonary resuscitation despite progressive metabolic derangement associated with prolonged resuscitation. Circulation, 141(11), 877–886. https://doi.org/10.1161/CIRCULATIONAHA.119.042173

Richardson, A. C., Tonna, J. E., Nanjayya, V., Abrams, D., Brodie, D., Pellegrino, V. A., Shekar, K., & Thiagarajan, R. R. (2021). Extracorporeal cardiopulmonary resuscitation in adults: Interim guideline consensus statement from the Extracorporeal Life Support Organization. ASAIO Journal, 67(3), 221–228. https://doi.org/10.1097/MAT.0000000000001344

Schmitzberger, F. F., Haas, N. L., Coute, R. A., Bartos, J., Hackmann, A., Haft, J. W., Hsu, C. H., Hutin, A., Lamhaut, L., Marinaro, J., Nagao, K., Nakashima, T., Neumar, R., Pellegrino, V., Shinar, Z., Whitmore, S. P., Yannopoulos, D., & Peterson, W. J. (2022). ECPR²: Expert consensus on percutaneous cannulation for extracorporeal cardiopulmonary resuscitation. Resuscitation, 179, 214–220. https://doi.org/10.1016/j.resuscitation.2022.07.003

Suvrein, C. G., van de Glind, E. M. M., de Bruin, S., van den Brink, F. S., van der Hoeven, J. G., & Hoedemaekers, C. W. E. (2023). Early extracorporeal CPR for refractory out-of-hospital cardiac arrest. The New England Journal of Medicine, 388(4), 299–309. https://doi.org/10.1056/NEJMoa2204511

Yannopoulos, D., Bartos, J. A., Raveendran, G., Walser, E., Connett, J., Murray, T. A., Khatri, J., O’Connor, D., Bedi, A., & Aufderheide, T. P. (2020). Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): A phase 2, single centre, open-label, randomised controlled trial. The Lancet, 396(10265), 1807–1816. https://doi.org/10.1016/S0140-6736(20)32338-2

In this episode we start our dive into ACLS and managing a patient in Cardiac Arrest. We also discuss the debate surrounding giving epinephrine in cardiac arrest.

Williams, C. A., Fairley, H. E., Tran, Q. K., & Pourmand, A. (2024). Use of epinephrine in cardiac arrest: Advances and future challenges. Medicina, 60(11), 1904. https://doi.org/10.3390/medicina60111904

In this episode we take a look into some general intubation practices and principles. Also examine best practices to take during RSI and discuss some tips and tricks to optimize your practice.

Reference:

Baker, J., Khan, N., Singh, M., & Kuza, C. M. (2022). The efficacy of apneic oxygenation to prevent hypoxemia during rapid sequence intubation in trauma patients. Current Opinion in Anaesthesiology, 35(2), 182–188. https://doi.org/10.1097/aco.0000000000001103

Fuller, B. M., Ferguson, I. T., Mohr, N. M., Drewry, A. M., Palmer, C., Wessman, B. T., Ablordeppey, E., Keeperman, J., Stephens, R. J., Briscoe, C. C., Kolomiets, A. A., Hotchkiss, R. S., & Kollef, M. H. (2017). Lung-protective ventilation initiated in the Emergency Department (LOV-ed): A quasi-experimental, before-after trial. Annals of Emergency Medicine, 70(3). https://doi.org/10.1016/j.annemergmed.2017.01.013

Ye, N., Wei, C., Deng, J., Wang, Y., & Xie, H. (2025). PREOXYGENATION strategies before intubation in patients with acute hypoxic respiratory failure: A network meta-analysis. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1532911

In this episode we take a look into a handful of penetrating trauma cases to understand the nuances and share some tips along the way.

Cothren CC, Moore EE. Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World J Emerg Surg. 2006 Mar 24;1:4. (License: CC BY-2.0)

In this episode we review a trauma case that took an unexpected turn. Viewer discretion is advised.

Reference:

Dalal, R. (2024, November 23). Epinephrine. StatPearls . https://www.ncbi.nlm.nih.gov/books/NBK482160/#:~:text=Through%20its%20action%20on%20α1,renin%20release%20via%20β1%20receptors. 

Farkas, J. (2025, January 4). Bradycardia. EMCrit Project. https://emcrit.org/ibcc/bradycardia/#3rd_degree_block 

Knabben, V. (2023, July 31). Third-degree atrioventricular block. StatPearl. https://www.ncbi.nlm.nih.gov/books/NBK545199/ 

Robichaud L;Ross D;Proulx MH;Légaré S;Vacon C;Xue X;Segal E; (n.d.). Prehospital nitroglycerin safety in inferior st elevation myocardial infarction. Prehospital emergency care. https://pubmed.ncbi.nlm.nih.gov/26024432/ 

Sonne, J. (2023, July 3). Dopamine. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK535451/ 

Warner, M. J. (2023, February 12). Inferior myocardial infarction. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470572/ 

In this episode, we review a handful of trauma activation criteria, and speak on their merits and potential downfalls. Viewer discretion advised.

Citations:

Adult trauma team activation criteria. Trauma Protocols. (2023, July 10). https://wp.uthscsa.edu/surglearning/docs/adult-trauma-team-activation-criteria/#1689019243695-de1fef58-5ce4

School, M. M. (2024, September 17). Trauma team activation policy. Surgery. https://med.uth.edu/surgery/trauma-team-activation-policy/

Trauma activation protocol. (n.d.-a). https://www.waterburyhospital.org/contentassets/97aa09c644df40b0b65000308863a0de/wh-trauma-response-protocol-7.1.19.pdf

Trauma alert/activation criteria. (n.d.-b). https://www.ucdenver.edu/docs/librariesprovider74/trauma-and-acute-care-surgery-pdfs/trauma-protocols/trauma-activation-alert-criteria-checklist.pdf?sfvrsn=910abeb9_2

Trauma and burn activation criteria. (n.d.-c). https://www.vumc.org/trauma-and-scc/sites/default/files/public_files/Protocols/2024 Trauma and Burn Activation Criteria.pdf

Trauma team activation criteria. (n.d.-d). https://health.mo.gov/living/healthcondiseases/chronic/tcdsystem/pdf/MU-ActivationCriteriaFinal.pdf

Trauma team activation guideline. (n.d.-e). https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/689164.pdf