Trauma ICU Rounds

This is a Visual Rounds episode — a more foundational crossover from the YouTube side of Trauma ICU Rounds.

Shock is not simply hypotension.

In this episode, we work through a physiology-first approach to shock: oxygen delivery, cardiac output, arterial oxygen content, MAP versus perfusion, compensated shock, mixed shock, and the four major shock states — hypovolemic, cardiogenic, obstructive, and distributive.

The goal is to move beyond simply naming a shock category and instead understand what part of the circulation is failing, what physiology is dominant, and how that should shape the first moves in resuscitation.

Topics include:

• Recognizing shock before profound hypotension develops
• Oxygen delivery: DO₂ = cardiac output × arterial oxygen content
• Cardiac output, preload, contractility, and afterload
• The importance of hemoglobin and oxygen-carrying capacity
• MAP versus tissue perfusion
• Compensated and mixed shock
• Hypovolemic, cardiogenic, obstructive, and distributive shock
• Initial resuscitation and mechanism-specific treatment

This episode is intentionally foundational and provides the framework for deeper Trauma ICU Rounds episodes on individual shock states and resuscitation.

If you find this kind of physiology-first critical care teaching useful, subscribe to Trauma ICU Rounds on YouTube for the full Visual Rounds series.

More resources: traumaicurounds.ca

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

Whole blood has made a remarkable comeback in trauma resuscitation. Physiologically, the rationale is compelling, and observational studies have suggested improved survival. But the recent randomized TOWAR and SWiFT trials have challenged the assumption that whole blood is clearly superior to component therapy.

In this episode of Trauma ICU Rounds, we review the rationale for low-titer group O whole blood (LTOWB), the major observational data supporting its use, what TOWAR and SWiFT actually showed, and how these findings should influence contemporary damage-control resuscitation.

Topics include:

•  Low-titer group O whole blood (LTOWB) 
•  Observational versus randomized evidence 
•  TOWAR and SWiFT 
•  Whole blood versus balanced component therapy 
•  Integrating whole blood into massive hemorrhage protocols 
•  Calcium, warming, TXA and hemorrhage control 
•  RhD considerations in females of childbearing potential 

The central question: whole blood clearly works as a resuscitation product—but is it actually better than excellent component therapy?

Full notes, graphics and references: traumaicurounds.ca

Follow @traumaicurounds on Instagram and TikTok, and subscribe on YouTube for new trauma and critical care teaching.

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

After four years away, Trauma ICU Rounds is back.

In this short relaunch episode, I reflect on the journey from California back to Canada, how my clinical and leadership roles have evolved, and why now is the right time to return to the podcast.

We also share what comes next: clear, practical, evidence-informed conversations in trauma, critical care and resuscitation—designed to make complex topics easier to understand and apply at the bedside.

Welcome back to Rounds.

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

Join us after hours at Dr. Bryan A. Cotton's pop-up bourbon bar at the AAST 2022 Meeting in Chicago. In this FANTASTIC & FUN episode, we talk amongst friends about cutting edge research at this year's meeting. To no one's surprise, coagulopathy, damage control resuscitation, whole blood, and factor replacement therapy just happen to be but a few of the topics discussed on Rounds.

Time Stamps:
00:12 AAST 2022 - Intro
00:42 Sex diamoprhisms in coagulation
01:52 Hemostatic profiles of female donors
02:48 Pediatric whole blood (WB) is safe
03:10 WB for TBI
03:31 Leukoreduction is unnecessary
05:30 TXA, TEG  and trauma
06:44 STAAMP trial
07:21 TXA: go early, big or go home
07:52 Calcium...early!
09:33 Canadian perspective on TXA and TEG – Neil Perry from London, ON
11:25 Nori Bradley from Edmonton, AB
13:53 Jordan Weinberg, not Canadian – Phoenix, AZ
16:12 Issues with WB – COMBAT vs PAMPer
17:31 Cold stored platelets
18:22 Rapid transfusers and whole blood: Only the strong survive!!
19:42 How are we doing with our resuscitation? 1:1:1 is just the beginning, not the end!
21:44 Timing is everything!
23:38 Plasma first resuscitation: “…God damn good!” -BAC
24:37 Dr. Joshua B. Brown - Pittsburgh, PA
25:31 More Canadian perspectives with Perry and Bradley
29:48 Less is best!
31:27 Prothrombin complex concentrate: Yay or nay?
32:18 More on the endotheliopathy of trauma
33:38 Just messing around and having a blast
34:22 What was the best bourbon tonight?

References:
CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010 Jul 3;376(9734):23-32. doi: 10.1016/S0140-6736(10)60835-5. Epub 2010 Jun 14. PMID: 20554319.

Gruen DS, Guyette FX, Brown JB, Okonkwo DO, Puccio AM, Campwala IK, Tessmer MT, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Neal MD, Zuckerbraun BS, Yazer MH, Billiar TR, Sperry JL. Association of Prehospital Plasma With Survival in Patients With Traumatic Brain Injury: A Secondary Analysis of the PAMPer Cluster Randomized Clinical Trial. JAMA Netw Open. 2020 Oct 1;3(10):e2016869. doi: 10.1001/jamanetworkopen.2020.16869. PMID: 33057642; PMCID: PMC7563075.

Guyette FX, Brown JB, Zenati MS, Early-Young BJ, Adams PW, Eastridge BJ, Nirula R, Vercruysse GA, O'Keeffe T, Joseph B, Alarcon LH, Callaway CW, Zuckerbraun BS, Neal MD, Forsythe RM, Rosengart MR, Billiar TR, Yealy DM, Peitzman AB, Sperry JL; STAAMP Study Group. Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial. JAMA Surg. 2020 Oct 5;156(1):11–20. doi: 10.1001/jamasurg.2020.4350. Epub ahead of print. Erratum in: JAMA Surg. 2021 Jan 1;156(1):105. PMID: 33016996; PMCID: PMC7536625.

Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R, Chin T, Burlew CC, Pieracci F, West FB, Fleming CD, Ghasabyan A, Chandler J, Silliman CC, Banerjee A, Sauaia A. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018 Jul 28;392(10144):283-291. doi: 10.1016/S0140-6736(18)31553-8. Epub 2018 Jul 20. PMID: 30032977; PMCID: PMC6284829.

Pusateri AE, Moore EE, Moore HB, Le TD, Guyette FX, Chapman MP, Sauaia A, Ghasabyan A, Chandler J, McVaney K, Brown JB, Daley BJ, M

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.

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

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

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

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

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

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.

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

"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. 

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

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

Explore Trauma ICU Rounds:
https://www.traumaicurounds.ca

Follow:
Instagram: https://www.instagram.com/traumaicurounds
TikTok: https://www.tiktok.com/@traumaicurounds
YouTube: https://www.youtube.com/@traumaicurounds

Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.