Under Pressure

What happens to the human body in the most extreme environments?

In this episode, we’re joined by Dr. Scott Parazynski – physician, innovator and former NASA astronaut – for a conversation that goes far beyond the operating room. Dr. Parazynski shares insight from his time at NASA, his medical training, and his work at the intersection of tech and human performance. We discuss decision-making in high-stakes environments, how teams operate when there’s no room for error, and what clinicians can learn from spaceflight about resilience, monitoring, and pushing the limits of what’s possible.

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Dr. Samir Mehta joins Under Pressure for a conversation on orthopaedic trauma, surgical judgment, innovation, and the evolving role of data in medicine. From teaching residents and building expertise in high-pressure environments to advancing personalized approaches for predicting fracture healing, Dr. Mehta shares insights from decades of experience in trauma care and education. We also explore how orthopaedic surgery has changed over time, what separates technical skill from true clinical judgment, and why some of the most important lessons in medicine happen outside the operating room.

In this episode, Dr. William Obremskey joins us for a discussion on how compartment syndrome actually presents in practice, the realities of surgical decompression, and the difficult scenarios surgeons rarely talk about, including what happens when a compartment is no longer viable. We also explore knee dislocations, scapula fractures, and infection prevention strategies with MSK implants.

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Comparing the Effects of Age, Sex, and Extremity Fracture Location on Continuous Intra-compartmental Pressure (ICP) Measurements in Trauma Patients

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Acute compartment syndrome is one of the most feared diagnoses in orthopaedic trauma, yet despite decades of teaching, controversy and uncertainty remain. In this episode, Dr. Andrew Schmidt joins us for a thoughtful and refreshingly candid discussion on why compartment syndrome continues to generate anxiety among surgeons, the limitations of traditional diagnostic thinking, and how dogma, research challenges, and medicolegal pressures have shaped the field. We explore what fasciotomy truly represents, why defining a diagnostic “gold standard” remains elusive, and what the future of multimodal treatment strategies might look like.

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When surgeons talk about compartment syndrome, the focus is often on diagnosis and surgical urgency. Far less attention is given to what happens next for the patient. In this episode, Dr. Christopher Doro joins us for a conversation on the downstream realities of acute compartment syndrome, recovery timelines, functional challenges, and the physical and psychological hurdles patients face following fasciotomy or limb loss. We also discuss real cases, the implications of false-positive pressure findings in ACS, and how multidisciplinary care impacts patients’ lives.

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• Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?
• Intracompartmental Pressure Monitoring Using a Handheld Pressure Monitoring System

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Trauma care doesn’t happen in a vacuum, and neither does innovation.

In this episode, Dr. Jonathan Sackier sits down with Dr. Sandip Tarpada, orthopaedic trauma surgeon at Harlem Hospital Center, to explore how cutting-edge science meets real-world constraints. From his work on DNA methylation as a predictor of trauma outcomes to implementing new technologies in underserved communities, Dr. Tarpada shares what it actually takes to move the needle on patient care.

Blood and Bone-Derived DNA Methylation Ages Predict Mortality After Geriatric Hip Fracture: A Pilot Study

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Pediatric trauma brings a unique set of challenges, from subtle clinical signs to children who can’t always articulate what hurts, and injury patterns that behave differently than those of adults. In this episode, Dr. Jonathan Sackier sits down with Dr. Kristin Livingston, pediatric orthopaedic surgeon at Boston Children’s Hospital and faculty at Harvard Medical School, to explore the complexity of acute compartment syndrome in kids, why it’s so different, and what makes timely diagnosis so difficult.

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In this episode of Under Pressure, Dr. O’Toole takes us inside landmark studies like VANCO and PREVENT CLOT, explaining what they mean for infection prevention, VTE prophylaxis, and real-world surgical protocols. He also shares why research consortia like METRC are so critical for answering big clinical questions and discusses emerging topics like continuous compartment pressure monitoring, perfusion data, and evolving tools for trauma decision-making.

VANCO Trial

PREVENT CLOT

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In this episode of Under Pressure, host Dr. Jonathan Sackier speaks with Mr. Dafydd “Taff” Edwards, Consultant Orthopaedic Trauma Surgeon, Clinical Director, and former Army surgeon whose career spans conflict zones, UK major trauma centres, and cutting-edge elective upper limb surgery. Mr. Edwards shares powerful real-world experiences, from managing polytrauma patients in austere environments to leading teams at one of the busiest trauma centers in the UK, and dives into the evolving role of continuous pressure monitoring, training the next generation, and what it takes to make the right call when seconds count.

Award-winning journalist and pilot Miles O’Brien has spent over three decades bringing science, space, and technology stories to the public through CNN, PBS NewsHour, NOVA, and more. In this episode of Under Pressure, Miles shares his remarkable career journey, from covering shuttle launches to flying planes, and the story of how a seemingly minor injury turned into acute compartment syndrome, ultimately costing him his left arm.

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Follow Miles' Podcast on Spotify: Miles To Go