< Back Textbooks General Surgery: Scientific Foundations Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st Edition, 2021. This is the detailed explanation of the science behind the practice of surgery. This is the basic science textbook I used during residency. Mulholland and Greenfield's Surgery: Scientific Principles & Practice. Previously known as "Greenfields". General Surgery: Beyond Basic Science Cameron's Current Surgical Therapy. 13th edition, 2019. Short chapters with high-yield information on every topic in General Surgery. Must-have for later in residency. Trauma Mattox Trauma. 9th edition, 2021. The trauma surgery bible. Highly recommend. Critical Care Marino ICU. 4th edition, 2013. The ICU bible. Highly recommend. Civetta, Taylor, & Kirby's Critical Care Medicine. 5th edition, 2017. A detailed explanation of physiology, diagnosis, and management. Finks Critical Care. 7th edition, 2017. Slightly less detailed than Civetta. Excellent book- not too simplistic and not painfully detailed. Evidence-Based Practice of Critical Care. 3rd edition, 2019. Reviews the literature regarding specific high yield critical care topics. Surgical Critical Care Therapy: A Clinically Oriented Practical Approach. 1st edition, 2018. Essentials of Mechanical Ventilation. 4th edition, 2018. Previous Next

< Back Abdominal Pain- Renal Disease A 72-year-old male with multiple medical co-morbidities presents with several weeks of right-sided abdominal pain. His family reports he hasn't been eating or drinking much. He has a slightly altered mental status and was unable to provide any more detailed history of his symptoms, such as aggravating/ alleviating factors or the relationship of his pain to meals. His medical history is significant for poorly controlled diabetes with neuropathy and renal insufficiency. He has not seen a primary care provider in over 6 months. On exam, he is uncomfortable but not in acute distress. His heart rate is in the 100s, and his blood pressure is normal. He is febrile to 101. He has dry mucous membranes. He has tenderness in the right upper quadrant with a positive Murphys sign. His exam was otherwise unremarkable. Workup? Imaging- right upper quadrant ultrasound Laboratory evaluation- CBC, basic metabolic panel, AST/ALT, bilirubin His labs are remarkable for mild leukocytosis and an elevated Cr (baseline 1.2, currently 2). Imaging was remarkable for cholelithiasis and gallbladder thickening. The EGS team is consulted and the patient is admitted to the surgical ICU given his acute on chronic renal insufficiency. What are the possible etiologies of his renal insufficiency and the initial treatment strategies based on the underlying cause? Pre-renal causes, such as hypovolemia, lead to decreased renal perfusion. Treatment involves volume repletion. Intra-renal causes, such as medication and acute tubular necrosis from sepsis, requires treatment of the underlying cause concurrent with volume repletion, treatment of electrolyte derangements and avoiding further nephrotoxin exposure. Post-renal causes, such as kidney stones or foley catheter malfunction, require relief of the obstruction. Based on the patient's history of decreased oral intake, he is at risk for acute hypovolemia, which can worsen his baseline chronic renal insufficiency. He was treated with volume resuscitation and close monitoring of his urine output. When should he undergo cholecystectomy? If cholecystitis was the precipitating cause, he would likely continue to worsen if his surgery was postponed. If hypovolemia was the precipitating cause, it would benefit from volume resuscitation, which can be administered throughout the operative course. If his renal insufficiency was not an acute change, and it was a slow decline since his last clinic visit, it was unlikely to significantly improve in a short time. The ICU team, EGS team and anesthesiology discussed the risks versus benefits of proceeding with surgery. Regardless of the etiology, postponing his surgery would be unlikely to improve his operative risk profile. We proceeded with laparoscopic cholecystectomy, and he returned to the ICU postoperatively for ongoing resuscitation and monitoring. Management of Renal Failure The causes of renal failure can be categorized into pre-renal, intra-renal, or post-renal. Acute infection can precipitate renal insufficiency, which is associated with poorer outcomes. Pre-Renal Caused by hypovolemia (dehydration) from decreased intake, nausea/ vomiting, excessive diuresis, third-spacing from acute inflammatory processes (pancreatitis), blood loss, inadequate replacement of insensible losses. The common final etiology in pre-renal causes is decreased renal perfusion. Treatment- volume replacement. Intra-Renal Multiple different intra-renal causes, including vascular or micro-vascular etiologies, glomerular disease, and interstitial disease (acute tubular necrosis, medications, and various precipitates such as myoglobin and crystals). The most common acute causes are medication and ATN from ischemic/ sepsis. Treatment involves management of the underlying etiology and supportive care. Post-Renal Caused by any obstruction from the renal pelvis to the urethra, including kidney stones, malignancy (can obstruct anywhere from the ureter to the bladder), retroperitoneal fibrosis, prostate enlargement, blood clots in the bladder or foley catheter malfunction. Treatment involves relief of the obstruction. Acute Cholecystitis with Renal Dysfunction Diabetes and severe cholecystitis (Grade III- organ dysfunction) are risk factors for increased mortality in patients with acute cholecystitis.[1] As noted in the discussion above, it is crucial to weigh the risks and benefits of operative intervention. If there is a modifiable risk factor, such as an acute cardiac event that is amenable to intervention. Escartin A et al. Acute Cholecystitis in Very Elderly Patients: Disease Management, Outcomes, and Risk Factors for Complications. Surgery Research and Practice. 2019;2019:9709242. Previous Next

< Back Ultrasound: Misc Abdomen Assess for intra-abdominal fluid to rule-out an intra-abdominal source of hypotension. Examine the gallbladder- gallstones, wall thickening (>3 mm) and pericholecystic fluid are consistent with cholecystitis Examine the kidneys and bladder- overt hydronephrosis concerning for mechanical obstruction. Distended bladder despite foley suggests obstructed foley. Vascular Presence of DVT- patent veins are fully collapsible with light ultrasound compression- pressure has to be lower than the pressure needed to collapse the artery. Vascular access for arterial and central line placement. Previous Next

Giving Bad News < Back 6 Tips to Be More Comfortable with Uncomfortable Conversations It's not fun to tell families (or patients) that there was a complication, that their loved one died, or that their loved one is not going to survive. But it's a fundamental principle of good patient care, especially in the specialties of trauma and critical care. I didn't become truly comfortable with these conversations until my critical care fellowship. After many years and countless conversations in private rooms, here are my tips on how to develop this skill. 1. Experience. It's uncomfortable, but you should take every opportunity to participate in these conversations, starting as a student/ trainee. - As a young resident, I remember walking with my attending to go talk to a family about an intra-operative complication. I'll never forget the sinking feeling in my chest, the shame that I made a mistake. This was a pivotal moment in my training. My attending didn't have to tell me I messed up. But he knew I needed to see how he handled disclosing to the family members. He showed me that this wasn't something that I should allow to crush my self-confidence. - A few years later, during one of my first trauma rotations, I remember sitting in a small room in the ER as one of my co-residents told a family that their child was the victim of a fatal shooting. I didn't have much experience telling families that their loved one had died. In particular, I didn't have any exposure to telling a family that their loved one died in a trauma bay- a family I'd never met, a family who never had a chance to see their loved one before they died from their injuries. I was initially embarrassed that my co-resident, who was one year younger than me, was more comfortable leading the discussion than I was. But then I realized he had much more exposure to that type of conversation because of his previous trauma rotations. So I took it as an opportunity to learn and prepare myself to lead the conversation the next time. - Two years later, in the ICU waiting room of the same hospital where I watched my (younger) co-resident tell a family their son died, I sat with the mother of a young man who was critically injured. Thankfully, I had much better news. But still, it's not easy to tell a single mother that her oldest son was shot through the chest, and was laying in the ICU, intubated, with an open chest and abdomen. 2. Learn from watching experts. - Everyone has a slightly different style of handling these conversations. I joined my attendings for every conversation I had the opportunity to witness. This included conversations about everything from Code Blue incidents to fatal injuries and end-of-life care. It's important to see different styles, which will allow you to develop your style. Some are more blunt, some are more observant of family dynamics, some are overly talkative. There are some you may choose to not replicate, but it's important to see a spectrum of styles to learn what works for you. - I've watched my MICU attending talk with the wife of a man who came to the hospital with acute cardiac arrest, requiring emergent coronary angiography and intervention, then therapeutic hypothermia. I learned how to succinctly describe a complex situation and support a wife make a crucial decision without pressuring her. - I've watched my trauma attending talk to a family of a young male patient who had died on the operating table. I've watched that talk more than once, unfortunately. And it never got more comfortable. But I learned how to convey devastating news while simultaneously expressing compassion. 3. Practice. - As a fellow, I would often have a pre-brief with my attending and we would discuss key points for the meeting, as well as the goals of the discussion (ie deciding about proceeding with surgery, deciding about comfort care, etc). - When I have younger residents who are having family meetings, particularly one's that I haven't worked with before, I have them rehearse their conversations with me before. I did this as a resident and a fellow, and I still do this with my fellows. 4. Get feedback. Positive feedback is always nice, but true constructive feedback is key to improving. - I've had nurses and chaplains who have joined me for multiple family meetings, and it's always reaffirming to hear them compliment my interaction. - My attendings still occasionally joined me in conversations toward the end of my fellowship. It was always helpful to hear feedback about what was well-received and how I could have been more effective. 5. Once you've practiced, developed your style, and absorbed feedback- don't expect it to always be easy. - Towards the end of my fellowship, I had a particularly challenging case. I had already had countless family discussions and had become very comfortable with being uncomfortable. For a variety of reasons, I was emotionally overwhelmed with this patient's situation- I sat and cried at the nurse's station for a long time. Then I went and talked to my attending and told her I couldn't have the conversation, that I couldn't stop crying. I was hoping she would take over and lead the conversation- I should have known I wouldn't get off that easily. She reassured me that I wouldn't have to say much- I had already established rapport with the patient's family the day before, and they'd be able to tell from my non-verbal communication that I didn't have good news. It was (and still is) the hardest conversation I've had. 6. Don't Stifle Your Emotions (within reason) - Some people would criticize me for expressing emotion when having discussions with families. I do think there has to be a healthy separation, and getting emotionally invested with every case would be paralyzing. I don't cry during the majority of these conversations. However, I'm not a robot, and I still occasionally have patients that affect me on a more personal level. For example, I had one family that came to the very difficult decision to transition their mother to comfort care. Their mother was the matriarch of the family and her children didn't want to disrespect her. She had expressed that she would not want to be kept alive if she couldn't continue to have meaningful interactions and care for the family. I told them that giving them the implicit approval to allow her to die peacefully was probably the greatest gift she could have given them, and I reassured them that they were showing her the ultimate level of respect and kindness by honoring her wishes. That hit me differently because I could feel their pain as I imagined myself in their position. Previous Next

Tackling the expertise bias < Back Overcoming barriers while teaching and being humble as a consultant Why is it so hard to remember what it was like before you knew the things that you now consider fundamental, basic knowledge? If you are a teacher, which includes school teachers as well as everyone responsible for passing knowledge to others, self-reflection on how you relay information and assess comprehension is paramount. One common challenge is overcoming the "curse of knowledge". The curse of knowledge takes hold and becomes a hurdle when the teacher/ instructor assumes that their audience has the same background knowledge and should be "up to speed" without significant delay. In other words, there are many things you do every day that you consider obvious and second nature. It is exceedingly easy to be quick to judge your trainees for not recalling or readily grasping those concepts. How has this manifested itself in my experience as a teacher in the ICU? Caring for patients with a wide breadth of physiologic derangements is a rich environment for interactive real-time learning. Invasive mechanical ventilation is a perfect opportunity to learn about respiratory physiology. Learning how to pick the right mode/ settings and how to make adjustments to optimize each patient's oxygenation and ventilation (while avoiding further lung injury) is key to good critical care for the patient that requires respiratory support. My understanding of mechanical ventilation was the culmination of many hours and long months/ years spent reading, preparing lectures, tinkering bedside with ventilators, engaging in dialogue with experts, and just immersing myself in the weeds. At some point, and I have no idea when it was precisely, it finally clicked. I didn't become an omniscient guru. But after enough practice, the fundamental concepts finally became solidified in my mind, and managing ventilators has become second nature. Ventilator management is a cornerstone of ICU care. Whenever there are patients that require ventilation beyond perioperative indications, I capitalize on the opportunity to teach. Even though I'm acutely aware of how much work (seemingly endless hours of work) went into learning the finer points of ventilators, it's still hard to remember what it was like before I understood. Please note- this phenomenon is NOT limited to in-person teaching. This barrier can infiltrate lectures, manuscript writing, and a variety of other forms of communication and interaction. Another situation relevant to the medical profession- the consultation with a specialist. If you're on the receiving end of the consult, it can be easy to fall into the trap of assuming everyone should have the same knowledge you have. It's crucial to remember that you are an expert in YOUR field- if the physician calling you had the same knowledge, you would be obsolete. So how do you overcome this hurdle? Here are my suggestions 1. The first step is to acknowledge that your interactions can be impacted by your bias. You know more than your students, or the person that's calling you for a consult. More specifically, you know more about what you're teaching your student and you know more about the clinical situation than the person consulting you. That's why you're the teacher and the consultant. 2. Take time to reflect on how you interact when teaching- do you rapidly become impatient, roll your eyes, reply with condescension or snark, or simply look at your students like they're idiots? Pause in real-time: it doesn't have to be awkward, and I'm sure your audience will appreciate a moment to pause and think. 3. Take the opportunity to put the shoe on the other foot. Reflect on what it was like when you were learning- as an intern struggling to remember how to replete electrolytes, a young resident in the ICU struggling to understand ventilators, or even a young attending struggling in a high-stress operative case. How would you want to be approached/ treated? Previous Next

< Back Continuing Med Ed (CME) National Organizations American Association for the Surgery of Trauma [Must log-in to access] Journal of Trauma and Acute Care Surgery articles Archived AAST Virtual Grand Rounds Certain Annual Meeting Master Surgeon Lectures and topic-specific presentations Region VII Sessions Critical Care Committee Journal Reviews American College of Surgeons Journal of the American College of Surgeons [Must log-in to access] Surgical Education and Self-Assessment Program (SESAP®) [$685 for 168 CME credits] Training Courses ATLS Traditional Student Course - 16 AMA PRA credits BEST, ATOM, ASSET ACLS, PALS Annual Medical Conferences Other Sources UpToDate Local conferences at your facility (Morbidity and Mortality, Grand Rounds, etc) Military training courses Previous Next

Critical Care Lectures Vents .pdf Download PDF • 7.24MB Respiratory Failure .pdf Download PDF • 4.85MB Electrolyte Imbalance .pdf Download PDF • 3.88MB Acid Base Basics .pdf Download PDF • 1.14MB Kidney Injury .pdf Download PDF • 8.05MB Hemodynamics .pdf Download PDF • 9.86MB Heart POCUS .pdf Download PDF • 55.03MB Nutrition .pdf Download PDF • 3.52MB Ultrasound .pdf Download PDF • 84.19MB Blood .pdf Download PDF • 4.92MB Pain Delirium Agitation .pdf Download PDF • 16.05MB

< Back Other Resources Radiology Radiopaedia.org . Open-edit radiology resource, compiled by radiologists and other health professionals from across the globe. How to Read a Chest X-Ray: The Graphic Novel and Drawing Book. Download this “Dummies Guide” to reading chest x-rays and brush up on the basics. Appropriateness Criteria. Evidence-based guidelines to assist providers in making the most appropriate imaging or treatment decision for a specific clinical condition. Acute Right Upper Quadrant Pain Acute Right Lower Quadrant Pain Previous Next

Austere Damage Control Surgery < Back Caring for soldiers in the deployed environment “Our general attitude around here is that we want to play par surgery. Par is a live patient.” Several years ago, when I was preparing to apply for trauma fellowship, someone called me a meatball surgeon. I thought it was a lame nickname that meant our job was mindlessly easy. For the first time ever, I recently Googled meatball surgery. The term "meatball surgery" was used to describe the damage control interventions performed in MASH. Yes, I am proud to say I am a meatball surgeon for our soldiers. Telling me I save lives is a compliment…not an insult. Meatball Surgery Military surgeons are frequently deployed to far forward environments to perform damage control surgery- stopping bleeding, stopping gross spillage of bowel contents, stenting vascular injuries, etc. This allows the patient to be evacuated to the next level of care. The goal is NOT definitive repair of injuries. All general surgeons deploy in this role- so maintaining trauma operative skills and the skill of "thinking like a trauma surgeon" is crucial. This is being increasingly provided between deployments with skills labs and military civilian partnerships. There is still a significant gap between recommended case volume and actual case volume. Recently, the suggestion to train non-surgeons to do “just a bit of damage control surgery" in the deployed environment has been proposed in several forums, including on social media. Short version: “You can’t convince me that pelvic packing, laparotomy, vascular control, thoracotomies are difficult.” Why is this a problem? As mentioned, its hard enough to train our general surgeons well-trained to perform in this environment. It would take significant changes in our current training rhythm to get Pas and non-surgeons adequately proficient to provide this skillset. It is NOT easy being a trauma surgeon. A lot of surgery residents are familiar with the oft repeated quote, "you can teach a monkey to operate". It's not meant to insult trainees and compare them to monkeys. It's meant to explain that the difficult skill of being a surgeon is the judgment to decide who needs surgery, what surgery is needed and how to anticipate the next step. There are many algorithms in surgery. They are excellent guides to optimal patient care. But they all have the same caveat (although some might not state it as explicitly)- they are not to be used in isolation, but instead in the setting of sound clinical judgment. To gain this expertise, surgeons endure 4 years of undergraduate education, 4 years in medical school, 5-7 years of surgical residency, and 1-2 years of fellowship. And even after I spent all this time training, I’m still not done learning this art. If you say these are "not difficult” procedures, I encourage you to complete a general surgery followed by a trauma fellowship. The military actually does need more trained trauma surgeons. But no, I’m not interested in training a non-surgeon to do “just a little bit” of trauma surgery. I can't imagine any trauma surgeon who would be willing to teach a watered down version of our skill to a non-surgeon and sign off that they’re qualified to care for our soldiers. Please don't insult our expertise. I would never presume to be an expert in another persons specialty. This would be similar to suggesting that I can be easily trained to be special forces. Anyone can be taught to shoot a weapon, evade the enemy, decide the best tactical approach, etc. You may say that’s an exaggeration. But it’s the absolute truth. A field surgeon is NOT a surgeon. A brigade surgeon is NOT a surgeon. A flight surgeon is NOT a surgeon. A division surgeon is NOT a surgeon. A battalion surgeon is NOT a surgeon. The Surgeon General is NOT a surgeon. Previous Next

How Do I Do It? < Back Practical Tips on Having a Difficult Discussion This blog is complementary to the previous blog about becoming more comfortable with uncomfortable conversations. After many difficult discussions with families during my critical care fellowship, I finally became comfortable with uncomfortable conversations. It's impossible to develop a script to use for every conversation, but here are some of the techniques I've adopted over the years. Sit down in a private room, have tissues if appropriate. Make sure your phone/ pager won't interrupt the conversation. Have someone else with you. It’s always good to bring the patient's nurse, and there is often spiritual support staff (ie chaplains) who can accompany you and provide support for the family. Introduce yourself, and ask who everyone in the room is, specifically how they're related to the patient. "Nice to meet you, I'm really sorry it's under these circumstances." If it's your first conversation with the family, it's important to establish a foundation to build on (or establish the absence of a foundation). You can ask "what do you know so far" or "what's your current understanding of the situation"? This also allows them to express their current questions/ concerns. Judge their level of comprehension and adjust as needed. This does NOT mean being patronizing or imposing stereotypes. Pay attention to facial expressions and listen to their questions/ responses. It's easy to fall back into speaking medical jargon- you need to deliberately focus on using easily understandable words. Words that we use every day are meaningless to most people who aren't in the medical field. Keep the conversation brief and take frequent pauses. They don't hear everything you say, and they'll hear even less if you talk non-stop. Allow them time to process what you’ve shared, and allow them to ask any questions they have. Acknowledge that it’s common to be overwhelmed by the discussion. You can validate them by offering "I know I just told you a lot of information" or "I know this can all be overwhelming". It’s also helpful to say, “I’m sure you will think of other questions, please write them down so we can discuss them later” Encourage them to discuss things amongst themselves and provide them a quiet private place to regroup after the meeting. It’s also helpful to say, “I’m sure you will think of other questions, please write them down so we can discuss them later.” This validates their feeling and reassures them that they don't have to worry about remembering every detail. Specific difficult topics - Death and dying. Acknowledge that what they are feeling is normal- regardless of what they feel, it's normal. Denial, angry, scared, guilty, confused, conflicted, exhausted, numb. - When they are wrestling with the decision about transitioning to comfort care (colloquially known as "withdrawal of care", or crassly, "pulling the plug") and they've verbalized that they know it's what their family member would want, acknowledge how difficult that decision can be but also reaffirm that they are doing the kindest thing by honoring their family members wishes. For other helpful tips, check out "Sunburn". "For patients who are alive, concentrate on the ‘big picture’ and avoid the inclination to catalog every injury during this initial encounter. The primary concern in these settings often consists of survival, brain damage, paralyzation and other major morbidities. Again, an overabundance of information can be overwhelming." Velez D et al. SUNBURN: a protocol for delivering bad news in trauma and acute care surgery. Trauma Surg Acute Care Open. 2022 Feb 9;7(1):e000851. Previous Next

Code Blue: Who's in Charge? < Back Advanced Practice Nurses to begin coming to Code Blues and supervising residents I recently came across this article on Twitter and wrote my reply as soon as I read it. But as I was preparing to post this, I did a little more background research on the article. Let's start with the source- the website is called "MidlevelWTF ". The tagline is- "Exposing midlevel incompetence in the fight to ensure patient safety and preserve physician-led, physician-supervised medicine." The author's user name/ Twitter handle is MidlevelWTF; motto: "an actual doctor, with an actual MD." In light of this, the tone of the article makes much more sense. I'm disgusted to discover that a physician has dedicated their time/ energy to specifically target and defame APPs. Reply I disagree with a policy that formally designates a nurse practitioner to supervise any resident who runs a code. It's not appropriate to assign anyone else the authority to unilaterally overrule the decisions of the code leader. Codes need 1 leader- this is typically not the most junior person in the room, but someone in the middle or upper level of their training- a midlevel or senior resident. This doesn’t mean leaders can’t get recommendations from others. The more senior personnel in the room are welcome to provide advice- if there is egregious incompetence, which I would guess is the exception far more than the rule, someone, such as an attending or fellow or senior resident, can take over the role as leader. Working with the premise that the leader is competent, correcting a mistaken dose, helping develop a differential and general troubleshooting are all in the patient's best interest. These are also integral to closed-loop communication, and shouldn't be considered undermining or met with resistance. Team members should be able to speak up freely without having to worry about being yelled at for correcting another provider who is potentially more senior. The problem with this policy lies in the disruption of the team dynamics- adding another layer of "leadership" by formally assigning someone to have authority over the team leader creates confusion. If there is a contradiction, does the team listen to the leader or the "assigned" supervisor, who could reasonably have less experience than the resident? I've gladly welcomed advice from those with more experience than me during a difficult situation, and I trust them to speak up if they see something amiss. I trust all the non-physicians who care for our patients in my absence, and I trust them to call me if there is any concern; I hope they will feel empowered to do this in a code situation as well. So I support the author's general stance that the policy is inappropriate. However...I take great offense at this article. Implying that nurse practitioners (NPs) are minimally qualified and poorly educated is insulting and severely erroneous. Worst of all, the writer implied that a midlevel might decide to call it quits on a code “because they didn't feel like doing it anymore.” Absolutely inflammatory. Implying that any healthcare professional would be lazy or bored and just give up is preposterous. I have worked with many APPs (advanced practice providers), which includes NPs and PAs (physicians assistants) in the ER, on the inpatient wards, in the operating room, in the ICU, and in clinic. I have found them to be phenomenal teammates, motivated and eager to continually learn about how to best care for patients. Yes, some are less competent than others. But this is equally true of all healthcare professionals. I would gladly have a competent NP run a code if they were at the bedside at felt comfortable/ empowered to do so. While I would never designate a non-physician to oversee a resident running a code, I would similarly never expect a resident to take over the role of team leader from a competent NP or PA. As a fellow, during my time in the ICU, I would gladly let either an APP or a resident run the code, depending on availability and comfort level. I would be readily available and provide input when needed such as when the decision-making process extends past the algorithm of ACLS and into specific patient scenarios. In addition, if the patient needed an emergent/ urgent procedure, I was free to perform or assist while those procedures were being performed, as the NP/PA or resident continued to manage the overall code situation (meds, compressions, US to examine for cardiac activity, calling for MTP, etc). So I disagree with the policy, but I am deeply disappointed in the way the author chose to make petty accusations to undermine APPs and justify their disagreement with the policy. It's disappointing that a professional would stoop low enough to attack the character of our teammates. Previous Next

< Back Thai Chicken Enchiladas Ingredients 8 flour tortillas 2 cooked and shredded chicken breasts 1 Tbsp canola oil 1/2 sweet onion, chopped 1/3 C chopped/shredded carrots 1/2 C chopped/shredded cabbage (premade coleslaw mix works well) 4 garlic cloves, minced 1/2 tsp salt 1/2 tsp pepper 4 green onions, sliced 1/3 C chopped peanuts (more for garnish) 1/4 C chopped fresh cilantro (more for garnish) 2 1/2 C light coconut milk 1/3 C + 1/2 C sweet chili sauce Instructions 1. Preheat oven to 350 degrees F. 2. Heat oil in large skillet over medium heat. Add onions, cabbage, carrots, garlic and 1/4 tsp salt and stir to mix. Stir occasionally and cool until vegetables are soft (6-8 min). Add in chicken, green onions, peanuts, cilantro, remaining salt and pepper, tossing to coat, cook for 1-2 min. Add 3/4 c coconut milk and 1/3 c sweet chili sauce, mixing thoroughly to combine. Turn off heat. 3. Spray 9×13 dish with nonstick spray. Whisk together remaining coconut milk and sweet chili sauce. Pour about 1/2 C on the bottom of the dish. Slightly warm tortillas, then place a few spoonfuls of the chicken mixture in each, roll up tightly and place in the dish. Use a spoon to cover the tortillas with remaining coconut milk and chili sauce mix. 4. Bake for 20 minutes, remove and garnish with peanuts and cilantro. Spoon sauce from the bottom of the dish all over the tortillas. The vegetables cooling and softening Previous Rolled up and ready to head into the oven Final product! Next