In this EAST Traumacast, the state of Early Goal Directed Therapy is discussed with two dynamic speakers, Dr. Donald Yealy who is the lead author on the PROCESS trial , and Dr. Ruby Skinner who is a busy SICU director.  This and two other studies prompted changes in the Surviving Sepsis Campaign Guidelines.  Drs. Yealy and Skinner give insight into how early goal directed therapy has changed since the original studies and how the changes have impacted their patient care.  The discussion is moderated by Dr. Kevin Pei and Dr. Matt Martin.

Social media plays an increasingly important role in all aspects of personal and professional life, and can have profound impacts both positive and negative. Having a solid basic understanding of the mechanics and “rules of the game” is critical to successfully adopting and using social media. EAST as an organization has embraced social media, and for the 2016 Annual Scientific Assembly made a concerted effort to increase the social media presence of the meeting on Twitter. We were able to sit down with the core group of EAST Twitter users, aka the “EAST Twitterati”, and discuss how to get started on social media, practical tips and advice for optimizing the experience, key potential pitfalls to be aware of, and how the use of social media has impacted their personal lives and careers.Interviewees: Elliott Haut, Joe Sakran, Christian Jones, Paula Ferrada, Rob Winfield, Jason Smith, Brad Dennis, Alex Eastman, Jamie Coleman, and Tareq KheirbekSupplemental Materials:Twitter 101 tip sheet

In this episode, we have a lively discussion about the papers reviewed by Dr. Niels Martin in the February EAST literature review.  We were also very fortunate to have Dr. Bob Martindale, who was one of the lead authors for the 2016 ASPEN/SCCM ICU nutrition guidelines, join us to discuss the key issues of importance to Trauma/ICU providers.  We also discuss the effect of age of stored red blood cells with Dr. Martin Schreiber.  Also joining in this discussion were EAST members Dr. Kevin Schuster and Dr. Andrew Bernard.  The discussion is moderated by Dr. Dave Morris and Dr. Matt Martin.Supplemental Materials2016 ASPEN/SCCM ICU Nutrition Guidelines

In this podcast we discuss the process of professional peer review, and how this process can be used or mis-used for a variety of reasons. Our guest is Dr. Larry Huntoon, who has become a recognized national expert in the area of “sham peer review”, and who was written and lectured extensively about common themes in techniques and tactics that are used in these proceedings. He gives some great advice about recognizing, reacting to, and even preventing this type of adverse professional action for surgeons. This interview was done as a “Town Hall” session, and Dr. Huntoon takes questions from the attendees after the formal moderated interview. The discussion is moderated by Dr. Matthew Martin and Dr. Andrew Bernard. Supplemental Materials: Editorial: Tactics Characteristic of Sham Peer Review by Larry Huntoon, MD, PhD Recognizing the Tactics of Sham Peer Review: a 3-part video series presented by Dr. Larry Huntoon

In this podcast we discuss small bowel obstruction – a common problem that can be challenging to treat appropriately – with Dr. Martin Zielinski, Associate Professor of Surgery at Mayo Clinic in Rochester, MN.  Dr. Zielinski  discusses several aspects of small bowel obstruction: which patients need an operation?  Which will resolve with time?  How long should nonoperative management be attempted before taking a patient to surgery?  We also discuss how to utilize the Gastrografin® challenge into the clinical decision making process. The discussion is moderated by Dr. David Morris and Dr. Levi Procter.Supplemental Materials:CT image showing small bowel feces sign and article references

This podcast is from the second EAST Town Hall Debate session, where two panels of experts discuss and compare the Hartford Consensus Conference guidelines and the Emergency Tactical Casualty Care recommendations and program for improving outcomes from active shooter and other intentional mass casualty events. The debate is moderated by Dr. Andrew Bernard.Pro Hartford Consensus ConferenceAlexander Eastman, MDEric Campion, MDPro Tactical Emergency Casualty CareBabak Sarani, MDE. Reed Smith, MDGene Reilly, MDSupplemental MaterialsACS Bulletin with the Hartford Consensus III ReportTECC 2015 updated guidelinesTECC website

This podcast is the recording of the first inaugural EAST Town Hall Debate session, on the topic of treating patients with an “Antibiotics-only” approach for acute appendicitis versus the standard treatment of surgical appendectomy. This has become a particularly controversial topic recently following publication of the APPAC Trial in JAMA (link to article below). The program started with two teams in a standard debate format, followed by additional expert commentary from two invited guest speakers: Dr. Edward Livingston, Deputy Editor of JAMA and Dr. Elliott Haut, author of an invited commentary on the APPAC Trial. The debate was then opened up to questions and comments from any listener during the live session.The Foes:  EAST Emergency General Surgery Section (Pro Appendectomy) vs. EAST Online Education Section (Pro Antibiotics-only)Moderated by Dr. Levi ProcterSupplemental Materials:APPAC Trial - JAMA website. This page also contains links to multiple related commentaries, as well as a podcast interview with the study authors by Dr. Livingston.

Highlights from the 2015 Western Trauma Association Meeting - Podcast #49 - EPThis is the first in our series of podcasts from some of the key trauma and ACS annual meetings. The 2015 Western Trauma Association was held in Telluride, Colorado, and we were there to record the highlights and interviews with many of the attendees and presenters. See below for a listing of the interviews and supplemental materials including a copy of the meeting program book. Next, we look forward to a Traumacast from the 2016 EAST Annual Meeting in San Antonio, Texas.2:15             Hasan Alam on VPA + fluid resuscitation in a TBI model7:15             Drs. Chapman and Moore on the TEG “Death Diamond” and plasma-first resuscitation14:17           Dr. Nelson on “Sugar or Salt”: relative role of mineralocorticoids in shock17:50           Dr. Olson on a randomized trial of heparin vs lovenox for VTE prophylaxis21:58           Dr. Miller on repairing flank hernias using bone-anchor fixation27:38           Tourniquet Debate: Carlos Brown vs Kenji Inaba32:15            Dr. Berndtson on Outcomes with K-Centra 4-factor PCC36:15            Dr. Russo on pigtail catheter versus chest tube for hemothorax drainage40:25            Dr. Bensard on the utility of routine serum HgB checks in pediatric trauma46:28            Dr. Aydelotte on the impact of marijuana legalization on traffic fatalities51:45            Dr. Parker on the impact of TXA on fibrinolysis parameters by TEG56:25            Dr. Moren on recursive partitioning to better define massive transfusion1:01:55         Dr. Pharoan on massive abdominal wall injury due to fireworks1:06:40         Expert Case Panel: Drs. Shackford, Karmy-Jones, Rhee, & Schreiber1:09:30         Dr. Cohen on the WTA Multicenter study of the “found down” patient1:14:30         Dr. Christine Cocanour on the WTA and her term as WTA PresidentSupplemental Materials: WTA 2015 Program BookDec 2015 issue of the Journal of Trauma and ACS

Pediatric abusive injuries and non-accidental trauma (NAT) are unfortunately common and widespread, and can frequently go unrecognized with disastrous outcomes. In this podcast we discuss pediatric NAT with Dr. Tony Escobar and Dr. Elizabeth Pohlson from Mary Bridge Children’s Hospital. Dr. Escobar and Dr. Pohlson are recognized local and national experts on this topic, and have implemented a hugely successful evidence-based and multi-disciplinary screening and evaluation process at their center. In this podcast they discuss the problem of pediatric NAT, as well as the common “red flags” from the history, physical examination, and radiologic studies that should alert a physician to the possibility of NAT. In addition, they discuss some actual cases and real-world scenarios involving pediatric NAT, along with practical advice for the front line medical provider on optimal evaluation and management strategies. A copy of their standardized NAT evaluation note as well as their evidence based evaluation algorithm are included below in the supplementary materials section. Supplemental Materials: NAT Evaluation NoteNAT AlgorithmNon-Accidental Trauma slideset

Medical malpractice claims and other litigation have unfortunately become a common occurrence in all fields of surgery. Although each case has unique and specific aspects, there are common patterns, themes, and risk factors that all practicing physicians should be aware of in order to minimize or even completely avoid these situations. In addition, there is a great deal of misunderstanding about how published guidelines such as the EAST Practice Managemenet Guidelines may be used for or against the physician in establishing the standard of care and any violoations of that standard. We discuss these issues with Dr. Carlo Reyes, a board certified Emergency Medicine physician, health care attorney, and nationally recognized expert in medical malpractice, and Dr. Chet Morrison, a Trauma and Surgical Critical Care attending with  a longstanding interest in this area.Supplemental Materials:Legal implications of Pay for Performance article by Dr. ReyesMinimizing your malpractice risk article by Dr. ReyesValue of CPGs as “Safe Harbors” for Legal Defense