Tiger Country: The Trauma Podcast

In this episode, your intrepid podsurgeons talk to the venerable and famed Martin Zielinski, lately of the Mayo Clinic and currently Chief of Trauma and Acute Care Surgery at Baylor. Dr. Zielinski talks with us about damage control surgery. For something so widely practiced and studied, there are few better examples of the art of surgery than DCS. When does one know that a patient is in a damage control state? It is physiologic derangement or the severity of the injuries? When does one know the patient's ready to go back to the OR? How has the shift away from crystalloid altered thinking and practice? That leads to a discussion about direct peritoneal resuscitation and management of the open abdomen before Dr. Zielinski talks about what it's like to move from the paradise that is the northern Midwest to Houston, where the average temperature is approximately a hundred and thirty degrees. In December.

In this episode, which is the second in a row that was recorded without me, Milos and DuBose interview Dr. Kevin Schuster, a Professor of General Surgery, Trauma, and Surgical Critical Care at Yale. I am reminded, as I listen, to my very first question in my very first room of my general surgery oral boards. A cardiac surgery patient with sepsis, likely intraabdominal. Was it acalculous cholecystitis? It was. Did I completely blank out? I did indeed. Did I say, "I'm going to get a CT scan," and was I met with an abrupt transition to the next patient? Yes and yes. Did my realization of my error lead to my conviction that I had irrevocably failed my oral exam? Yes. Did that conviction relax me for the remainder of the day and make me think more clearly and speak more fluidly? Also yes.

Like me and DuBose, Dr. Chad Ball is an expert in BDSM - Boards in Diverse Surgical Majors. He's as associate professor of surgery and oncology at the University of Calgary, where he practices hepatobiliary, pancreatic, acute care, and trauma surgery. We discuss how the desire to master surgical subspecialties is rooted in masochism, really, and how that training affects practice.

In this episode of Tiger Country, we talk to Dr. Ram Nirula, the Dr. D. Rees and Eleanor T. Jensen Presidential Endowed Chair in Surgery at the University of Utah, and we discuss rib fractures. My understanding of rib fractures has come a long way since my high school football coach taped up my thorax before sending me back out on the field - that, of course, was the city championship game against Andrew Johnson High School, in which I scored four touchdowns. In the intervening years, we've learned a tremendous amount about how frailty and fractures interact and, while our understanding has increased, fixation technology has, as well. It's all very confusing, and Dr. Nirula goes a long way in both simplifying the matter and making me not feel bad for being confused. He also has some very incorrect opinions about hockey, but we can look past that, because he's from Winnipeg, which is the home of The Weakerthans.

Appropriate for Spooky Season, this episode focuses on brains...braaaaains...BRAAAAAAINS. Dubose, Buhavac and I talk with the one and only Deb Stein, the President of the Eastern Association for the Surgery of Trauma (EAST), the Director of Critical Care Services for the University of Maryland Medical System, the Chair of the Certifying Committee for the Trauma, Burns, and Surgical Critical Care Boards, and my fingers are cramping up so I'm going to have to stop typing all of her titles and offices. Suffice it to say that there are very few surgeons on the planet who are as respected and authoritative as Dr. Stein, which is why it is both a compliment and a hardship that she takes it upon herself to make fun of me on a daily basis. Not even kidding. She spent fifteen minutes yesterday roasting me about my sweater. Anyway, she knows everything there is to know about traumatic brain injury. We talk to her for an hour and I double my knowledge base. Also, my cats make a spectacle of themselves.

Dr. DuBose talks with Mss. Eaton, Lidard and Miller about nurse practitioners, their place in trauma care, and how, together with attendings and residents, NPs and advanced practice providers in general can form cohesive and effective teams. The subject is too often neglected, and we as surgeons end up working alongside and depending upon professionals whose journey and expertise we don't really understand. Hopefully, this episode will help rectify that.

For a single organ, the esophagus lends a disproportionate degree of complexity to management of the injured patient. Dr. DuBose finds clarity in a discussion with Dr. Feliciano, speaking from an undisclosed second location. Feliciano finishes by revealing that Harrison Ford is one of his favorite actors, which is unsurprising given how much they resemble each other.

Dr. DuBose interviews current Shock Trauma surgical critical care fellow, Navy veteran and pediatric surgeon Dr. Howard Pryor. The relatively unaccomplished Dr. Pryor discusses the basics of trauma in the child, which is both qualitatively and quantitatively different from trauma care in the adult. They conclude with a discussion about Caps Lock, which both mistakenly believe is unnecessary.

In this episode, Dr. DuBose talks about the occasionally fraught, always essential relationship between the trauma surgeon and the trauma nurse from both perspectives.

Dr. DuBose explores rectal injuries with Dr. Carlos V. R. Brown of UT-Austin's Dell Seton Medical Center. Not once does the phrase "damn near killed 'em" come up, but they do close out with the revelation that Dr. Brown has eaten only sandwiches for lunch. Like, if it's lunch, he's eating a sandwich or nothing at all.

Podcast celebrity and emergency medicine physician Scott Weingart (EMCrit, Chief of Emergency Critical Care, SUNY Stonybrook) and EM critical care fellow William Teeter join Dr. DuBose and discuss the relationship between our specialties, why we should be the best of friends and why we often aren't. Finally, the question of the creepiness of clowns is definitively settled.

Dr. Scalea returns with an oral history of a topic near and dear to the hearts of Dr. DuBose and my own good self: endovascular trauma surgery. Also included are a surprising revelation about The Boss's favorite movie. Truly, you won't have seen his answer coming at all.

Dr. Feliciano discusses fasciotomy, a procedure whose technical simplicity belies the complexity of the associated pathophysiology and indications. Closing out the discussion, Dr. DuBose grills the titan of the field on why the 'Reply All' button should be abolished.