4 < Back Trauma Resources Society Guidelines American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) Best Practice Guidelines Imaging Management of Traumatic Brain Injury Management of Orthopaedic Trauma Management of Geriatric Trauma Massive Transfusion in Trauma Recognition of Child Abuse, Elder Abuse, and Intimate Partner Violence Palliative Care Western Trauma Association Algorithms. Evidence-based critical decision algorithms in trauma. Pediatric Trauma Society. Guidelines and educational resources. Brain Trauma Foundation Guidelines. Concussion, prehospital and surgical management of TBI, pediatric TBI, prognosis in TBI, combat-related head trauma. Joint Trauma System: Clinical Practice Guidelines. Evidence-based guidelines developed by subject matter experts from both the military and civilian communities. Tutorials ER-REBOA PLUS Catheter , Prytime Medical. Quick Reference Guide. ER-REBOA PLUS Convenience Kit. ER-REBOA PLUS Catheter, Instrutions for Use. ER-REBOA PLUS Catheter, Product Video. Videos and Lectures Joint Trauma System: Emergency War Surgery Course. Lecture series based on JTS CPGs and the Emergency War Surgery Book. Trauma in a Flash. Brief videos on trauma topics, hosted by the Arizona Trauma Association. American College of Surgeons Resources Resources for Optimal Care of the Injured Patient, 2014. Framework for developing a trauma system. Compares the different resources available at Level 1, 2, and 3 verified trauma centers. "An ideal trauma system includes all the components identified with optimal trauma care, such as prevention, access, prehospital care and transportation, acute hospital care, rehabilitation, and research activities. Guidelines for Field Triage of Injured Patients Recommendations of the National Expert Panel on Field Triage, 2011. Basic algorithm for triage of trauma patients based on mechanism of injury, physiologic criteria, and anatomic region of injury. Stop the Bleed. Trains non-healthcare providers in point of injury treatment for massive hemorrhage. AAST Resources Brief Topic Reviews. COVID-19, Aspiration, Blunt Cardiac Injury, Blunt Splenic Injury, Child Passenger Safety, Clostridium Difficle, ICU Illness, Wound Care Instructions, Field Triage, Epidemiology and Injury Prevention, Mechanical Ventilation, Pelvis Injuries, Rib Fractures, Sports Concussions, Thromboembolic Disease, Trauma Systems, TBI Rehabilitation. CME Opportunities. Meet the Masters, high yield journal articles, in addition to countless other resources. Some are free, and some are $25 for non-members. Virtual Grand Rounds. AAST hosts virtual grand rounds, a web-based educational series Acute Care Surgery Fellow Educational Resources. 67 Educational Modules for ACS Fellows. Created by the ACS Committee. ONLY accessible by ACS Fellows. Previous Next

< Back What happens in the trauma bay? A glimpse into the inner workings of a trauma activation The radio crackles and the paramedic's voice cuts through the din of the emergency department. “Doctor to the radio”. The clock already started and time isn’t on our side. “30s-year-old male, a gunshot wound to the right arm and left back. GCS 7. Highest heart rate 110, lowest blood pressure 80 systolic. 5 minutes out.” The management of trauma starts at the time of injury, with bystanders and dispatched first responders. Immediate interventions can be performed on the scene, which is followed by rapid transport to the hospital. En route, care continues to be delivered as needed (starting IV, giving fluids/ blood, maintain an open airway, etc). The hospital is contacted to prepare them for an incoming patient. Key details dictate the resources that are mobilized in response. There are no universal criteria for what constitutes each level of trauma activation, and different hospitals have unique designations for the highest activation (Trauma Red, Level 1, Code 1, etc). However, triage is designed to rapidly transport the patient to the most appropriate facility. An adult trauma code 1 is paged out to the trauma team. As the team arrives, the minutes before the patient arrives are spent relaying key patient details shared from the pre-hospital team. For a hypotensive patient or report of massive bleeding, massive transfusion is initiated. Chest trauma? Chest tubes, possibly open thoracotomy tray. Extremity wounds? Check that the tourniquets are ready. Team roles are assigned, and a plan is discussed. When the patient arrives, the pre-hospital team presents key data to the entire team. At one of the facilities I trained, there was a standardized presentation. It was organized, succinct, and appropriately relevant; the trauma team and the pre-hospital team both knew what information was to be shared. Pre-hospital team report Age (or approximate age), gender, mechanism, time of injury, significant event details (prolonged extrication, death on the scene, etc). Significant pre-hospital interventions and events (tourniquet time and location, intubation, change in mental status). Presence of IV access (size and location) and administration of pre-hospital fluids or medications. Highest heart rate, lowest blood pressure. Trauma Evaluation/ ATLS After the report, the patient is transferred to the bed and the primary and secondary surveys are performed. Primary survey- assess airway patency, adequacy of breathing (bilateral breath sounds, chest rise and fall), circulation (control active hemorrhage, assess pulses), disability (rapid neurologic assessment with GCS and pupil exam), and exposure (remove clothing to facilitate exam, make sure they get covered with blankets to minimize hypothermia). Concurrent with the primary survey, IV access is obtained, blood is drawn, and interventions are performed based on the findings of the survey. If there are no immediate life-threatening injuries on the primary survey, the secondary survey is performed, which is a comprehensive head to toe exam (see below), including log rolling the patient to examine their back. Common diagnostic testing includes commonly, patients undergo FAST (see vignette "Blast Injury "), chest x-ray, and pelvis x-ray. Based on hemodynamic stability and injuries, patients are then dispositioned to the operating room, radiology for further imaging, admitted to the ICU or floor for ongoing resuscitation, observation, consults, serial exams, etc. Secondary Survey Head/ ears/ nose/ throat- facial abrasions/ ecchymosis/ tenderness, periorbital edema/ ecchymosis, crepitus, open wounds, blood from nares/ ears. Tympanic membrane. Jaw occlusion. Neck- c-collar in place, obvious ecchymosis, abrasions, open wounds, tenderness. Chest- wounds, ecchymosis, tenderness, crepitus. Axilla- wounds. Abdomen- wounds, ecchymosis, tenderness Pelvis- stability, pain. Back- midline spinal tenderness/ step-off, ecchymosis, abrasions, wounds. Rectal- tone, blood on rectal exam. Extremities- sensation/ motor strength. Abrasions, wounds, gross deformities Vascular- carotid, femoral, DP/PT, radial pulses bilaterally. GU- perineal ecchymosis or wounds, blood at meatus. Previous Next

Learning how to live with an ostomy Peer Support < Back Learning how to live with an ostomy Acute Care Surgery can lead to a need for subsequent elective procedures, including ostomy reversals, abdominal wall reconstruction after open abdomen management, and various wounds. I frequently see young, healthy males with ostomies. Thankfully, most patients are great candidates for reversal. But there are a variety of reasons why patients can't undergo reversal, at least not immediately. Injury to the anorectal sphincter complex would put the patient at a very high risk of incontinence. Another possibility is when the ostomy was created in the setting of acute bowel perforation, with an undiagnosed underlying inflammatory process. Reversing an ostomy without further workup could be problematic. I have seen several young, healthy males who have to spend at least a handful of months with their ostomy while undergoing preoperative workup, and more than one who will likely have a prolonged or permanent ostomy. This can be daunting, especially when they were anticipating minimal delay before undergoing a reversal. Common concerns include how to wear normal clothes and how to manage the odor. While I can be supportive, I don't have any first-hand experience of living with an ostomy. One particular patient expressed a desire to return to college, but he was convinced that he couldn’t go to class with an ostomy. Essentially he was resigned to putting his life on hold until his ostomy was reversed. His situation inspired me to seek out a peer who could show him it's possible to live with an ostomy. I reached out to my network of medical personnel that might know how to connect a patient with a peer support group. We have multiple support groups, including trauma survivors, epilepsy, and stroke, to name a few. Unfortunately, I quickly realized there is no group or service to link patients with someone who will answer their questions and hopefully decrease their fears and worries. Many of the trauma patients who have an ostomy are young and healthy, leading active lives. Unlike elective ostomies, such as for inflammatory bowel disease, waking up after trauma with an ostomy is unanticipated and can be very distressing. Also, there is minimal or no chance for preoperative patient education. There is a certain taboo associated with talking about certain bodily functions, and I don't think many young males would ask their trauma surgeon if there is someone they can talk to about having an ostomy. But I think this could be an opportunity to improve the quality of life for a population that is likely overlooked. Previous Next

< Back Ultrasound: Trauma E-FAST Purpose: identify acute traumatic pathology including presence of pericardial fluid, pneumothorax, and intra-abdominal fluid. Probe Can use curvilinear probe, but usually switch to the phased array for the cardiac view, so it might be easiest to just use a phased array for the whole study. The linear probe can also be used when evaluating for pneumothorax through the anterior chest wall. Abdominal Cavity Assess for fluid in 3 different regions of the peritoneal cavity. Can use curvilinear probe, but usually switch to the phased array for the cardiac view, so it might be easiest to just use a phased array for the whole study. Right upper quadrant- 1) between liver and kidney [Morrison's pouch], 2) tip of the liver in the right paracolic gutter, 3) lower right hemithorax Left upper quadrant- 1) between the spleen and kidney, 2) subdiaphragmatic space, 3) tip of the spleen in the left paracolic gutter, 4) lower left hemithorax Pelvic- males- between bladder and rectum, females- behind the uterus, anterior to the rectum (pouch of Douglas). Image in transverse and sagittal planes. Cardiac The phased-array or curvilinear probe can be used. The probe is placed inferior and to the right of xiphoid, pointed to left shoulder, with the probe in a horizontal plane (not directed to the bed). Identify presence of hemopericardium (4th trans-abdominal window of the FAST). Assess gross function (contractility). Assess volume status- full or collapsed left ventricle. Thoracic cavity- The “E” in E-FAST The linear probe is used to identify oresence of a pneumothorax. It is placed in the mid clavicular line, oriented cephalad-caudad, 3rd-4th intercostal space. Pneumothorax is present when there is lack of apposition of the pleural lining to the chest wall which leads to loss of lung sliding. Also no comet tail artifact or lung pulse, presence of a lung point (where the pleural surfaces meet, the junction between sliding and absence of sliding). The curvilinear or phased array probe can be used to identify hemothorax by visualizing fluid above the diaphragm in the upper quadrants abdominal views. References Society for Academic Emergency Medicine: FAST Exam Ultrasound Tutorial: FAST (Focused Assessment with Sonography for Trauma) scan | Radiology Nation Previous Next

Currently reading, Books to Read, Books I've Read Books Currently Reading Fiction Lady Sherlock: A Ruse of Shadows (#8) Everything is Tuberculosis Up Next... Three Pines (Chief Inspector Gamache) : The Black Wolf (#20) Jarrod Jarvis Father-Daughter Mystery Series : My Father Always Finds Corpses Books I Want to Read: Fiction Crime/ Mystery A Particularly Nasty Case The Last Thing He Told Me Big Lies in a Small Town The Appeal All Good People Here Happiness Falls The Cloisters Murder Your Employer: The McMasters Guide to Homicide The God of the Woods All the Colors of the Dark The Secret History The Busybody Book Club The Last Mandarin Crime/ Mystery: Series Killers of a Certain Age : Kills Well with Others (#2) Charles Lenox Mysteries : The Hidden City (#15) Castle Knoll Files : How to Seal Your Own Fate (#2) Joe Talbert : The Stolen Hours (#3) Detective Max Rupert : Forsaken Country (#5) Ernest Cunningham : Everyone This Christmas has a Secret (#3) The Antique Hunter's Guide to Murder : The Antique Hunter's Death on the Red Sea (#2) Nora Breen Investigates : Murder at Gulls Nest (#1) The Checquy Files : Stiletto (#2) and Blitz (#3) Verity Kent Mysteries : #2-7 Gabriela Rose : The Recovery Agent (#1) and The King’s Ransom (#2) The Brighton Mysteries (by Elly Griffiths) : #1-7 Harbinder Kaur (by Elly Griffiths) : #1-4 The Glass Library : #3-6 Death in Paradise : #1-4 Kendra Donovan : #3-7 Sebastian St. Cyr Series : (21 books) Lady Darby Mysteries: (13 books) Tate and Bell Mysteries: (7 books) Miss Marple: (13 books) Vera Stanhope : (11 books) Kate Burkholder : (17 books) Veronica Speedwell: (10 books) Michael Bennett (James Patterson) Inspector Torquil McKinnon Ruth Galloway (by Elly Griffiths) Sebastian St. Cyr No. 1 Ladies' Detective Agency Hercule Poirot (Agatha Christie) Kovac and Liska Assistant to the Villain D.I. Lottie Parker Cormac Reilly Stewart Hoag The Charity Shop Detective Agency Erast Fandorin Mysteries Maisie Dobbs Colin Pendragon Mysteries Blythe Baker (multiple mystery series) Crime/ Mystery: Series: Sherlock and Spin-offs Lady Sherlock: The Vanished Sister (#9) Sherlock Holmes by Arthur Conan Doyle: #4-9 Holmes, Margaret and Poe : (2 books) Mary Russell and Sherlock Holmes: (19 books) The Daughter of Sherlock Holmes : (8 books) Sherlock Holmes Pastiche by Nicholas Meyer : (7 books) Charlotte Holmes : (4 books) Historical Fiction Kate Quinn: The Huntress , The Diamond Eye Kristin Harmel: The Book of Lost Names , The Forest of Vanishing Stars , The Winemaker's Wife Marie Benedict: The Other Einstein , The Only Woman in the Room Kristin Hannah: The Nightingale Clare Marchant: The Mapmaker's Daughter, The Queen's Spy The Frozen River The Lost Girls of Paris The Lobotomist's Wife The Paris Library The Clockmaker's Daughter The Bookbinder Transcription Dangerous Women The Frozen River The Shadow Key Things in Jars The Girl from Greenwich Street West with Giraffes Science Fiction/ Fantasy The Other Valley A Quantum Love Story Last Night in Montreal Hummingbird Salamander Recursion Book of Doors Shark Heart The Lost Bookshop Erin Morgenstern: The Night Circus and The Starless Sea Matt Haig: The Life Impossible , The Possession of Mr. Cave , The Humans Science Fiction/ Fantasy: Series The Invisible Library: #3-8 Borne : Borne (#1), The Strange Bird (#1.5), Dead Astronauts (#2) Winternight Trilogy : #1-3 Romance/ Chick Lit The Wise Women The Unmaking of June Farrow The Wedding People Novels/ Series The Borrowed Life of Frederick Fife Murphy Shepherd: #1-3 Harold Fry : The Love Song of Miss Queenie Hennessy (#2) and Maureen (#3) The Hundred-Year-Old Man : The Accidental Further Adventures of the Hundred-Year-Old Man (#2) Ann Leary: The Good House and The Children Jason Fitger: The Shakespeare Requirement (#2) and The English Experience (#3) Books I've Read: Fiction Crime/ Mystery Paula Hawkins Collection: The Girl on the Train , A Slow Fire Burning Liane Moriarty Collection: Nine Perfect Strangers , Apples Never Fall Lucy Foley Collection: The Guest List , The Paris Apartment (read first half) A Most Agreeable Murder The Witch Elm Sometimes I Lie Before the Fall The Lovely Bones Burglars Can't Be Choosers The 7 1/2 Deaths of Evelyn Hardcastle Wrong Place, Wrong Time The House in the Pines The Golden Spoon Killers of a Certain Age The Bequest The Lifeguards The Truth about the Harry Quebert Affair The Truth and Other Lies The Finishing School Mother-Daughter Murder Night The Woman in the Library The Last Flight The Devil and the Dark Water Last Night The Husband's Secret The Man Who Died One Death at a Time Crime/ Mystery: Series Three Pines (Chief Inspector Gamache) : #1-19 Charles Lenox Mysteries : #1-14 Cormoran Strike : #1-7 Nell Ward Mysteries : #1-6 Dr. Thomas Silkstone : #1-6 Dublin Murder Squad : #1-6 Detective Varg : #1-4, including #0.8 Hawthorne and Horowitz : #1-5 Thursday Murder Club : #1-5 Sam Clair : #1-4 Detective Max Rupert: #1-4 The Marlow Murder Club : #1-3 Thomas De Quincey : #1-3 Susan Ryeland : #1-3 Quantico Files : #1-3 Claire DeWitt Mysteries: #1-3 Letty Davenport : #1 and #2 Jack Reacher : #1 and #2 Molly the Maid : #1 and #2 Cal Hooper : #1 and #2 Joe Talbert : #1 and #2 Ernest Cunningham : #1 and #2 Ghostwriter Mysteries : #1 and #2 Miss Marple: #1 and #2 The Glass Library : #1 and #2 Kendra Donovan : #1 and #2 The Checquy Files : The Rook (#1) Inspector Ian Rutledge : A Test of Wills (#1) Castle Knoll Files : How to Solve Your Own Murder (#1) Charlotte and Thomas Pitt : The Cater Street Hangman (#1) Kaely Quinn Profiler : Mind Games (#1) Rabbit Factor : The Rabbit Factor (#1) Verity Kent Mysteries : This Side of Murder (#1) We Solve Murders : We Solve Murders (#1) Vera Stanhope : The Crow Trap (#1) Corie Geller: Takes One to Know One (#1) Slough House : Slow Horses (#1) Crime/ Mystery: Series: Sherlock and Spin-offs Lady Sherlock: #1-7 Sherlock Holmes by Arthur Conan Doyle: #1-3 Holmes, Margaret and Poe : Holmes, Marple and Poe (#1) Mary Russell and Sherlock Holmes: #1-4, including #2.5 Historical Fiction Nora Beady : The Girl in His Shadow (#1) and The Surgeons Daughter (#2) Kate Quinn: The Alice Network , The Rose Code Kristin Hannah: The Women Ann Leary: The Foundling All the Light We Cannot See The Kitchen Front Code Name Hélène The Dictionary of Lost Words The Lost Apothecary The Miniaturist The Book of Speculation The Summer Before the War The Secret History of Audrey James Science Fiction/ Fantasy Matt Haig: The Midnight Library , How to Stop Time Neil Gaiman: Neverwhere , Stardust , Trigger Warning: Short Fictions and Disturbances Emily St. John Mandel: Station Eleven , Sea of Tranquility , The Glass Hotel A Wrinkle in Time Hitchhikers Guide to the Galaxy The Coincidence Makers The Invisible Life of Addie LaRue Spoonbenders The Impossible Lives of Greta Wells The First 15 Lives of Harry August The Alchemist Other Birds Good Morning, Midnight Day Tripper The Last Murder at the End of the World Every Arc Bends Its Radian Science Fiction/ Fantasy: Series Maze Runner : #1-5 Divergent : #1-4 Red Queen : #1-3 Southern Reach : #1-3 Caraval : #1-3 Mither Mages (Orson Scott Card): #1-3 Shades of Magic (VE Schwab): A Darker Shade of Magic (#1) The Mortality Doctrine : The Eye of Minds (#1) Wayward Children : Every Heart a Doorway (#1) The Invisible Library: The Invisible Library (#1) Romance/ Chick Lit The Bookish Life of Nina Hill : #1 and #2 Katherine Center: Things you save in a Fire , What You Wish For , The Bodyguard The Art of Hearing Heartbeats Lessons in Chemistry The Queen of Hearts Oh Dear Silvia Ghosted The Overdue Life of Amy Byler My (not so) Perfect Life Foreign Affairs Humor Eleanor Oliphant is Completely Fine Nothing to See Here The Answer is No Novels Phaedra Patrick Collection: The Curious Charms of Arthur Pepper , The Messy Lives of Book People , The Library of Lost and Found , The Secrets of Love Story Bridge Jodi Picoult Collection: Wish You Were Here , The Book of Two Ways Tomorrow, and Tomorrow, and Tomorrow A Week in Winter Seven Days of Us I Miss You When I Blink Ella Minnow Pea The Keeper of Lost Things Gravity is the Thing The School for Good Mothers Something to Live For (Previously: How not to die alone) Anxious People The Gifted School Wicked Leaks A Thousand Pardons The Department of Rare Books and Special Collections Remarkably Bright Creatures The Chemist Dear Edward Jason Fitger: Dear Committee Members (#1) Series Millennium : #1-6 Penumbra : Mr. Penumbra's 24-Hour Bookstore and Ajax Penumbra 1969 Don Tillman : #1 and #2 Harold Fry : The Unlikely Pilgrimage of Harold Fry (#1) Olive Kitteridge : Olive Kitteridge (#1) The Hundred-Year-Old Man : The 100-Year-Old Man Who Climbed out the Window and Disappeared (#1) Books I Want to Read: Non-Fiction History Civilizations Rise and Fall (Jared Diamond): Guns, Germs, and Steel: The Fates of Human Societies (#1), Collapse: How Societies Choose to Fail or Succeed (#2) and Upheaval: Turning Points for Nations in Crisis (#3) The Secret History of Home Economics: How Trailblazing Women Harnessed the Power of Home and Changed the Way We Live The Secret History of Food: Strange but True Stories About the Origins of Everything We Eat Death in the Air: The True Story of a Serial Killer, the Great London Smog, and the Strangling of a City Climbing and Adventures Shackleton's Way: Leadership Lessons from the Great Antarctic Explorer Buried in the Sky: The Extraordinary Story of the Sherpa Climbers on K2's Deadliest Day Over the Edge of the World: Magellan's Terrifying Circumnavigation of the Globe Touching the Void: The True Story of One Man's Miraculous Survival The Next Everest: Surviving the Mountain's Deadliest Day and Finding the Resilience to Climb Again The Boys of Everest: Chris Bonington and the Tragedy of Climbing's Greatest Generation Forever on the Mountain: The Truth Behind One of Mountaineering's Most Controversial and Mysterious Disasters The Climb: Tragic Ambitions on Everest Climb: Stories of Survival from Rock, Snow and Ice The Third Pole: Mystery, Obsession, and Death on Mount Everest The Ledge: An Adventure Story of Friendship and Survival on Mount Rainier Medical Nine Pints: A Journey Through the Money, Medicine, and Mysteries of Blood Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted Blood and Guts: A History of Surgery Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors Do No Harm: Stories of Life, Death and Brain Surgery You Can Stop Humming Now: A Doctor's Stories of Life, Death and in Between When We Do Harm: A Doctor Confronts Medical Error Diagnosis: Solving the Most Baffling Medical Mysteries This is Going to Hurt: Secret Diaries of a Young Doctor Swallow: Foreign Bodies, Their Ingestion, Inspiration, and the Curious Doctor Who Extracted Them Expert: Understanding the Path to Mastery Women in White Coats: How the First Women Doctors Changed the World of Medicine You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation Attending: Medicine, Mindfulness, and Humanity Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health Quackery: A Brief History of the Worst Ways to Cure Everything Psychology: Individual Think Again: Think Again: The Power of Knowing What You Don't Know How We Decide Predictably Irrational: The Hidden Forces That Shape Our Decisions Algorithms to Live By: The Computer Science of Human Decisions How Not to Be Wrong: The Power of Mathematical Thinking Amazing Decisions: The Illustrated Guide to Improving Business Deals and Family Meals The Logic of Failure: Recognizing and Avoiding Error in Complex Situations Sway: The Irresistible Pull of Irrational Behavior Anatomy of a Secret Life: The Psychology of Living a Lie The Secret Life of the Mind: How Your Brain Thinks, Feels, and Decides Gut Feelings: The Intelligence of the Unconscious Superminds: The Surprising Power of People and Computers Thinking Together Incognito: The Secret Lives of the Brain The Paradox of Choice: Why More Is Less The Forgetting Machine: Memory, Perception, and the Jennifer Aniston Neuron Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones How Emotions Are Made: The Secret Life of the Brain Subtract: The Untapped Science of Less Psychology: Interacting with Others You're Not Listening: What You're Missing and Why It Matters The Next Conversation: Argue Less, Talk More The Stuff of Thought: Language as a Window into Human Nature Invisible Women: Data Bias in a World Designed for Men Shape: The Hidden Geometry of Information, Biology, Strategy, Democracy, and Everything Else Rock Breaks Scissors: A Practical Guide to Outguessing and Outwitting Almost Everybody The Confidence Game: Why We Fall for It . . . Every Time Reading People: How Seeing the World through the Lens of Personality Changes Everything The Wisest One in the Room: How You Can Benefit from Social Psychology's Most Powerful Insights Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives The Lucifer Effect: Understanding How Good People Turn Evil Flash Boys: A Wall Street Revolt Incerto by Nassim Nicholas Taleb : The Bed of Procrustes: Philosophical and Practical Aphorisms (#3) and Antifragile: Things That Gain from Disorder (#4) Expert Political Judgment: How Good Is It? How Can We Know? / Philip Tetlock Unmaking the West: "What-If?" Scenarios That Rewrite World History / Philip Tetlock Counterfactual Thought Experiments in World Politics: Logical, Methodological, and Psychological Perspectives / Philip Tetlock Revenge of the Tipping Point: Overstories, Superspreaders, and the Rise of Social Engineering Biography Furiously Happy: A Funny Book About Horrible Things Broken (In the Best Possible Way) The Journal of Best Practices: A Memoir of Marriage, Asperger Syndrome, and One Man's Quest to Be a Better Husband Self-Help Tiny Beautiful Things: Advice from Dear Sugar Crime American Sherlock: Murder, Forensics, and the Birth of American CSI All that is Wicked The Casebook of Forensic Detection: How Science Solved 100 of the World's Most Baffling Crimes Books I've Read: Non-Fiction Medical What Patients Say, What Doctors Hear When Breath Becomes Air How Doctors Think Cheating Death: The Doctors and Medical Miracles that Are Saving Lives Against All Odds Stiff: The Curious Lives of Human Cadavers The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases Admissions: Life as a Brain Surgeon Patient H.M.: A Story of Memory, Madness, and Family Secrets Under the Knife: A History of Surgery in 28 Remarkable Operations Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health Medical: By Atul Gawande Being Mortal: Medicine and What Matters in the End Checklist Manifesto: How to Get Things Right Better: A Surgeon's Note on Performance Complications: A Surgeons Notes on an Imperfect Science Under the Knife: A History of Surgery in 28 Remarkable Operations History Unbroken: A World War II Story of Survival, Resilience, and Redemption Crime Never Sucks a Dead Man's Hand: Curious Adventures of a CSI Climbing Adventures Into Thin Air: A Personal Account of the Mt. Everest Disaster Biography Scrappy Little Nobody [Anna Kendrick] Bossypants [Tina Fey] Let’s Pretend This Never Happened: A Mostly True Memoir [Jenny Lawson] Big Dumb Eyes: Stories from a Simpler Mind [Nate Bargatze] Social Psychology Lying Leonard Mlodinow: The Drunkards Walk: How Randomness Rules our Lives and Elastic: Unlocking Your Brain's Ability to Embrace Change Daniel Kahneman: Thinking, Fast and Slow and Noise: A Flaw in Human Judgment Scienceblind: Why Our Intuitive Theories About the World Are So Often Wrong Contagious: Why Things Catch On Made to Stick: Why Some Ideas Survive and Others Die A Field Guide to Lies: Critical Thinking in the Information Age Loonshots: How to Nurture the Crazy Ideas That Win Wars, Cure Diseases, and Transform Industries When: The Scientific Secrets of Perfect Timing You Are Not So Smart Behave: The Biology of Humans at Our Best and Worst Grit: The Power of Passion and Perseverance Range: Why Generalists Triumph in a Specialized World Originals: How Non-Conformists Move the World Everybody Lies: Big Data, New Data, and What the Internet Can Tell Us About Who We Really Are Everything is Obvious: Once You Know the Answer The Disappearing Spoon: And Other True Tales of Madness, Love, and the History of the World from the Periodic Table of the Elements Freakanomics: A Rogue Economist Explores the Hidden Side of Everything Farsighted: How We Make the Decisions That Matter the Most Superforecasting: The Art and Science of Prediction Barking up the Wrong Tree: The Surprising Science behind why everything you know about success is [mostly] wrong Quirky: The Remarkable Story of the Traits, Foibles, and Genius of Breakthrough Innovators Who Changed the World Start with Why: How Great Leaders Inspire Everyone to Take Action Team of Teams: New Rules of Engagement for a Complex World The Knowledge Illusion: Why we never think alone The Signal and the Noise: Why So Many Predictions Fail--but Some Don't The Basic Laws of Human Stupidity Incerto/ Nassim Nicholas Taleb : Skin in the Game: Hidden Asymmetries in Daily Life, Fooled by Randomness: The Hidden Role of Chance in Life and in the Markets and Black Swan: The Impact of the Highly Improbable Maybe You Should Talk to Someone: A Therapist, HER Therapist, and Our Lives Revealed Social Psychology: By Malcolm Gladwell Outliers: The Story of Success The Tipping Point: How Little Things Can Make a Big Difference Blink: The Power of Thinking without Thinking David and Goliath: Underdogs, Misfits, and the Art of Battling Giants Where to get books Check out your local library- many have accounts with online resources, including e-books, audiobooks, etc. Library card required. Overdrive. Access to electronic books and audiobooks from your local library. Audible. $7.95 or 14.95/ month (1-month free trial). Likewise. Find new books, movies, and TV shows based on your favorites. *Follow me to check out my list of recommendations* What Should I Read Next? Enter a book you enjoyed or a favorite author, and find recommendations for other books. Military? You can access magazines, books, videos, newspapers, audiobooks, and random other stuff. First, you need to get an account with an MWR Library. Navigate from the website designated from the MWR resource page, and then save the link for the websites (can't use the generic RBDigital and Overdrive websites). Establish an account and enjoy exploring! MWR Library Resources Online Resources. List of resources- RBDigital, Overdrive, Mango Language service, etc. RBDigital Magazines, e-books, audiobooks, video Overdrive E-books, audiobooks, and videos Mango Language Services. PressReader Newspapers and magazines The Great Courses: Lecture Series. Thousands of lectures on hundreds of topics. Economics and Finance, food and wine, health/ fitness/ nutrition, history, hobby and leisure, literature and language, mathematics, music and fine arts, philosophy, professional and personal development, science, and travel. MWR Library Resources: How-To Access Navigate to: https://mwrlibrary.armybiznet.com . There is a link on this site to the Army MWR Digital Library. “Select your home library below or use the Army MWR Digital Library to search eresources only". You can also go straight to the Army MWR Digital Library page. On the top of the page, click on “find a resource. Click on Ebooks and audiobooks. Under "Overdrive/ Libby"→ click on “access” Verify your eligibility (DODID and DOB)→ you will be sent to the Overdrive website Drop-down “Select your library”→ DOD MWR Libraries Book Reviews Scienceblind Read More Range Read More Everything is Obvious Read More Start with Why Read More Freakanomics Read More Loonshots Read More A Field Guide to Lies Read More Everybody Lies Read More Team of Teams Read More When Read More Black Swan Read More Made to Stick Read More

Medical Literature Evidence-Based Medicine After you have established a firm foundation of the basics of your chosen specialty, you're ready to develop regular habits to stay up to date on the newest research. Evidence-based medicine is the basis of high-quality patient care, but it can seem overwhelming to try to keep up with the ever-growing body of research. There are countless journals, and it would be time-consuming to search them regularly. So how does one go about navigating the vast ocean of available data? Registering for email alerts is a simple way to get notified when there are new publications. With a quick skim through the article titles to see if anything is relevant, followed by a review of the abstract/ article itself, you can be on the cutting edge of the latest information in your field. Several require individual registration, but it's a very simple and quick process. Many journals require a subscription, often available through your medical school or hospital library. If you are military, you have access to AMEDD Virtual Library (abundant medical resource collection). Thankfully, three publishers (LWW Wolters Kluwer , Springer and Elsevier ) have centralized their journals, so you can quickly subscribe to several journals [these journals are designated by L, S or E]. Medicine and Critical Care Journal of the Ameri can Medical Association New England Journal of Medicine Intensive Care Medicine Critical Care Medicine (L) Current Opinions in Critical Care (L) Journal of Intensive Care (S) Critical Care (S) Journal of Critical Care (E) Critical Care Clinics (E) Surgery World Journal of Surgery World Journal of GI Surgery JAMA Surgery J Gastrointestinal Surg Advances in Surgery Annals of Surgery (L) Annals of Surgery Open (L) BMC Surgery (S) Surgery (E) American Journal of Surgery (E) Journal of the American College of Surgeons (E) Surgical Clinics of North America (E) Advances in Surgery (E) Trauma and Emergency Surgery European J Trauma and Emergency Surgery Trauma Surgery and Acute Care Open Journal of Trauma and Acute Care Surgery (L) World Journal of Emergency Surgery (S) World Neurosurgery (E) Other Specialities Journal of Neurotrauma World Journal of Cardiology JAMA Cardiology JAMA Neurology JAMA Network Open Anesthesia and Analgesia (L) Current Opinion in Anesthesiology (L) Current Opinion in Clinical Nutrition (L) Current Opinion in Infectious Diseases (L) Current Opinion in Neurology (L) Diseases of the Colon and Rectum (L) Journal of the American College of Cardiology (E)

Surgery trainee education. Trauma surgeon. Acute Care Surgery. Collaboration Interested in being a guest contributor? Any suggestions and contributions will be promptly reviewed and added to the appropriate page/ subpage. The contributor will be noted on the website- you can choose if you want your name or Twitter handle or whatever other identification you would like (or none at all if you would like to be anonymous). Content currently under development. Note- this list is NOT all-inclusive. Database of clinical vignettes in key topics of trauma, critical care and emergency general surgery. Focused on more complex scenarios (ie not run-of-the-mill appendicitis)! Please check out the vignettes I currently have to get an idea of what I’m trying to create- and reach out with any suggestions or cases. Literature reviews - deep dives, high-yield articles, etc Procedural or skill tutorials (pre-peritoneal packing, using the ultrasound in critical care, reading a chest x-ray). Each tutorial is followed by a list of primary sources, encouraging readers to pull information from multiple references. If there is any particular procedure or skill that you would like to create a tutorial for, or something that is currently on the website that you would like to enhance (for example, more advanced ultrasound techniques or ventilator settings), please feel free to reach out with suggestions! There is a wide array of other content that you can add to as well. Note templates Recommendations on networking opportunities Recommendations on social media accounts to follow Educational resources (textbooks, journal articles, training courses, web based open access medical education) Please send me an email (form at the bottom of the page) or contact me on Twitter @doc_on_the_run if you have any questions or want to submit something.

Surgery trainee education. Trauma surgeon. Acute Care Surgery. FAQs Why did you make this website? Over these years of learning about the practice of surgery, I've also learned a lot about myself. I am not an expert, and I did not follow a typical pathway- but I have some knowledge and resources to share. As I transition into my new Acute Care Surgeon role after 17 years in training, I'm pausing to share my experience, tips for success, and random nuggets of wisdom. This will be a work in progress, and I look forward to seeing how it evolves. My goal is to share my experience and knowledge in the hopes of helping those who desire to follow this path. But why do we need another medical education website? There are so many good resources already... There are endless ways to explain clinical concepts- pictures, text, analogies, clinical cases, podcast discussions of cases or principles, review articles, etc. There are also different learning styles. When I was trying to grasp advanced ventilator management, I read basic critical care textbooks, a book dedicated solely to ventilator management, and various websites and journal articles. This website is another way to interact with the information. Hopefully you will understand some of the concepts in a new way that helps you remember and apply them in clinical scenarios. In addition, I have also tried to create a comprehensive collection of all the useful resources I know, like apps and open access medical education resources (websites, clinical guidelines, etc) in one place for trainees to What does Doc on the Run mean? The summer before my last year of medical school was the start of my running career. My focus was enjoying the outdoors, not pace or distance. During my residency, I met someone who helped me refine my running. I started timing myself, training, and racing. Within a year or two, I pushed through personal barriers to become a "runner." My first half marathon was on Thanksgiving in my third year of surgical residency. I am at the end of my formal training, I am now an Acute Care Surgeon. As a surgeon, there are numerous factors that I can't control. It's fast-paced, demanding, and dynamic. I enjoy the organized chaos and high-stakes cases. Running is key to my work-life balance. Unlike in the operating room or the trauma bay, I have control over most aspects of my runs- pace, distance, route, and thoughts. It's not chaotic- it's basically the polar opposite of my work. During the day, my mind is going a million miles an hour. When I run, everything becomes clearer- I can solve problems, mull over ideas, or process dilemmas. And perhaps the most concrete impact is the runner's high that I enjoy after finishing. I have continued to run 10Ks, 10 milers, and the occasional 5K or 15K. I have learned more about the science of running (HR training zones, different paces for tempo/ interval/ long runs/ short runs) and I've learned how to adapt training schedules to fit my life. Unfortunately, I have suffered my share of injuries, including most recently nerve impingement in my foot. While I may have scaled back, running will always be part of my identity. Did you really build this website yourself? Yes, I did. No, I didn't do all the intricate coding by myself. But I did design, format, and create the content. So are you a computer/ technology guru? Whatever I know about technology, I learned from my brother and from spending many hours researching problems online. While my parents might consider me an expert, I literally just search online to solve most issues. When I get to the end of the internet and still haven't found the solution, my next step is Apple tech support (obviously only if the problem is with my iPhone or Mac). What did you learn while making this website? - Formatting the working space on a website - URL redirect - Domains and subdomains - Search engine optimization (SEO) - Establishing custom domains - Which text/ background colors are easiest to read - Anchors If you weren't an Acute Care Surgeon, what would you do? I'd be a chef. I love cooking! Is there anything that is overwhelmingly gross in your job? I have had almost every body fluid on me- stool, urine, blood, etc. So very little grosses me out. But I can't stand oral or nasal secretions (aka saliva, slobber, snot, etc.).

< Back Ultrasound: Cardiac Exam Purpose: identify possible causes of hemodynamic instability, respiratory distress, assessment of volume status. Probe The phased array can be used for the entire exam. The curvilinear can also be used for the subxiphoid and IVC views. Views There are 4 basic views, including the parasternal long axis, parasternal short axis, the apical four chamber and the subcostal view. Additionally, the inferior vena cava can be visualized. Cardiac ultrasound is more challenging to learn than most other ultrasound studies, because probe usage (position, angle, rotation, translation, etc) have drastic impact on visualization. It’s necessary to understand what is shown in each view, so take time reviewing these so you can have a better appreciation for what you are seeing when you perform a study on a real patient. One recommendation, if it is difficult to visualize the heart, moving the patient into the lateral decubitus with their left side down can significantly improve visualization as the heart is closer to the chest wall in this position. For video and pictorial explanations of the views, please refer to these sites. Basic Cardiac Views, #1 Basic Cardiac Views, #2 Findings Gross abnormalities- decreased ventricular function, arrhythmias Profound hypovolemia Small hyperdynamic left ventricle with end-systolic collapse Inferior vena cava- assess volume status, either static measurement of diameter or calculation of collapsibility (>50% correlates with volume responsiveness). Respiratory variation (collapsibility/distensibility index). Takotsubo cardiomyopathy Akinesia of the apical and mid-ventricular segment, hypercontractile basal segments. Apical sparing (dilated). Acute cor pulmonale Respiratory disorder→ pulmonary hypertension→ right heart failure. Dilated right heart. Cardiac tamponade Effusion with end-diastolic collapse of the right atrium, effusion in front of the aorta Pulmonary embolism Free-floating thrombus in the right ventricle or pulmonary artery; right ventricular dilation/ systolic dysfunction; septal bowing into the left ventricle; dilated IVC without inspiratory collapse. Most sensitive/ specific indirect sign- right ventricular apical sparing (McConnell's sign). References Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography Previous Next

< Back Cardiac Physiology Cardiovascular Physiology Oxygen Delivery Adequate cardiovascular function is vital to maintaining perfusion to the organs and tissues in the body. Perfusion drives oxygen delivery (O2) and removal of byproducts of cell metabolism (CO2). The amount of oxygen that is delivered (DO2) is a function of cardiac output (CO; the volume of blood ejected from the heart every minute) and the arterial oxygen content (amount of oxygen in the blood). Cardiac output is determined by the volume of blood the heart pumps out into the body with each heartbeat (stroke volume, SV) and the frequency of the heartbeat (heart rate, HR). Stroke volume depends on preload (blood volume returned to the heart), contractility (effectiveness of cardiac muscle activity), and afterload (pressure in the peripheral vasculature that the heart has to overcome to eject blood). Arterial oxygen content (CaO2) is the amount of O2 in the blood that is ejected from the heart. This is determined by dissolved O2 + O2 bound to hemoglobin. Hemoglobin carries O2, and the percentage of Hgb molecules that are saturated (bound) with O2 is determined by arterial blood gas (SaO2, arterial oxygen concentration) or pulse oximetry (SpO2, peripheral arterial oxygen concentration). Pulse oximetry is non-invasive and is a reliable surrogate (as long as SaO2 >90%). The O2 carrying capacity of one gram of hemoglobin is 1.38 (this is a constant in the equation). So this is the first part of the equation: the number of hemoglobin molecules x the % of those molecules that are saturated with O2 x how much O2 saturated hemoglobin can carry . The second part of the equation is the dissolved oxygen (partial pressure of arterial oxygen, PaO2, reported as mmHg). This value is multiplied by the constant 0.003, which is the mL of O2 dissolved per mmHg plasma. This number is infinitesimally small relative to the other half of the equation and it is typically ignored when determining oxygen concentration. This means that the significant modifiable factor in CaO2 is Hgb. Oxygen has to have something to bind to (Hgb) because dissolved oxygen has minimal oxygen-carrying capacity. Oxygen delivery (DO2)= CO x CaO2 Cardiac Output (CO)= heart rate (HR) x SV Stroke volume (SV)= the volume of blood ejected from the heart each heartbeat. Arterial oxygen concentration (CaO2)= [1.38 x Hgb x SaO2] + [PaO2 x 0.003] How can oxygen delivery be increased? One of the components of the equation has to be adjusted. Increase cardiac output. Increase SV- use of an inotropic agent (* medication that increases the strength of the heart contraction), ensure adequate preload (volume resuscitation). Increase HR- use of a chronotropic agent (* medication that increases heart rate). Increase arterial oxygen content Increase blood hemoglobin concentration *See pharmacology below Oxygen Consumption Oxygen consumption (VO2) is determined by how much oxygen the peripheral tissues extract and use. It is the difference between oxygen delivery (DO2) and oxygen return(ed) (SvO2). Oxygen consumption (VO2)= DO2 - SvO2. Oxygen consumption is calculated by subtracting SvO2 or ScVO2 from the amount of oxygen delivered. Venous oxygen saturation (SvO2 or ScVO2)- concentration of oxygen in the blood returning to the heart. Measured with a central venous catheter. *See below under CV monitoring for more details. Cardiovascular Monitoring There are several techniques for monitoring cardiovascular parameters, ranging from non-invasive to maximally invasive. Non-invasive methods include telemetry, pulse oximetry, and blood pressure monitoring. The benefit of these devices is their simplicity of use and interpretation. But these are error-prone, and regarding blood pressure, it doesn't provide continuous monitoring. For more info, see lecture entitled " Hemodynamics ". Arterial lines can be placed to provide continuous cardiac monitoring. The arterial waveform can indicate specific pathology (see Edwards Quick Guide to Cardiovascular Care ). In addition, an arterial line can report stroke volume variation. Stroke volume variation (SVV) is a surrogate of arterial pressure changes with inspiration/ expiration. If the change in pressure with respiratory cycles is >10-15%, it suggests the patient is fluid responsive, meaning they are likely to improve their preload (and cardiac output and blood pressure) with IV fluid administration. Central venous catheters can be placed to deliver intravenous medication as well as provide cardiac monitoring. A central venous catheter can measure the pressure of the blood returned to the right atrium (central venous pressure, CVP), which is a crude measurement of preload and right heart function. In addition, the oxygenation of the blood returning to the right heart (from the head and upper body) is reported as Central venous oxygenation saturation (ScVO2). ScVO2 reflects the balance between oxygen delivery and consumption. Arterial lines and central venous catheters are considered "minimally invasive". A pulmonary artery (PA) catheter is the most invasive device for cardiac monitoring. Similar to a central venous catheter, a PA catheter can determine the oxygenation of the blood returning to the right heart, which is the mixed venous oxygen saturation (SvO2). However, in contrast to the central venous catheter which is located in the superior vena cava (proximal to the right atria), this device is measuring blood oxygenation in the pulmonary artery (from the right ventricle), so it accounts for the blood from the entire body (unlike the ScVO2). Cardiac Pharmacology Vasoactive medications are frequently used in the ICU for the management of shock, heart failure, and other acute pathology. There are several key receptors, and understanding the function of each receptor is the key to using these different agents correctly. Receptors * α (alpha) 1- vasoconstriction * α2- inhibit norepinephrine release from presynaptic neurons * β (beta) 1- chronotrope (↑HR), inotrope (↑Ca in cardiac myocytes ↑contractility), dromotrope (↑cardiac impulse conduction velocity) * β2- vasodilation * Dopa 1- vasodilation * Dopa 2- neurotransmitter release Pharmacologic Agent Classification Each medication has a specific physiologic effect based on its particular mechanism of action. Agents may stimulate or inhibit receptors (see above) or alter the concentration of a key substance (cAMP, calcium, potassium, nitric oxide (NO)). Previous Next

11 < Back Board Examinations American Board of Surgery: General Surgery Boards Exam Prep Master the General Surgery Oral Boards by Dr Hassan Aziz . Dr Aziz reviews key surgical topics, including trauma, thoracic, pediatric, HPB, GI, breast cancer, endocrine, vascular. [Reference courtesy of Hassan Aziz, MD @Sharpknife_Aziz ] Surgical Education and Self-Assessment Program (SESAP). Resource for general surgeons- stay current with the latest surgical knowledge and prepare for examinations. American Board of Surgery: Surgical Critical Care Boards Exam Prep Evidence-Based Practice of Critical Care. 3rd edition, 2019. Reviews the literature regarding specific high yield critical care topics. Trauma, Critical Care, and Surgical Emergencies: A Case and Evidence-Based Textbook. 1st edition, 2010. 64 cases that review the basic principles of ACS. Previous Next

2 < Back Operating General Surgery Texts Chassin's Operative Strategy in General Surgery: An Expositive Atlas. 5th Edition, 2022. Zollinger's Atlas of Surgical Operations. 11th Edition, 2021. Operative Dictations in General and Vascular Surgery. 2012. Acute Care Surgery Texts Operative Techniques and Recent Advances in Acute Care and Emergency Surgery (Aseni). 1st edition, 2019. Surgical Decision Making in Acute Care Surgery. Atlas of Trauma/Emergency Surgical Techniques. Top Knife (Mattox). 1st edition, 2004. High yield of trauma operative management. Back to the basics. Atlas of Surgical Techniques in Trauma (Demetriades). 2nd edition, 2020. Anatomic Exposures in Vascular Surgery (Wind). 3rd edition, 2013. Key anatomic exposures for less commonly encountered injury patterns. Recommended by Dr. Feliciano at AAST 2020 Conference. Videos Surgical Stabilization of Rib Fractures and Cryoablation. Collection of videos of different surgical approaches. WebSurg. Free access to expert videos of minimally invasive surgery. Highly recommend. The Toronto Video Atlas of Surgery. Free access to expert videos of GI operative procedures. [Reference courtesy of EJS @ElliotJScottMD] Difficult Cholecystectomy: A learning module for laparoscopic cholecystectomy How to Tie Knots Like a Heart Surgeon How to Secure Chest Tubes (Soweto Tie) Previous Next