Tiger Country: The Trauma Podcast: Recent Episodes
Joseph DuBose & Rishi Kundi
Quick bites of trauma: spend a half hour or less with trauma surgeons from around the world, discussing interesting cases, pearls of wisdom, lessons learned, whether or not a hot dog is a sandwich and whether brushing one's teeth in the shower is economy of motion or a waste of water.
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, DuBose and Milos are sadly deprived of my companionship and commentary, but that's perfectly fine because they're talking to David Feliciano and who's a better guest than that? The three of them discuss the operative treatment of gastric and duodenal ulcer disease, which was once a mainstay of emergency general surgery and is now something rarer than hen's teeth. In addition to proton pumps, those pills inhibit trainee experience. When we started eradicating H. pylori, we started eradicating familiarity with the Kelling-Madlener and Pauchet procedures. I can't think of a third one. Anyway, I'm not there for this episode because I was off on my bachelor weekend, which is apt because Dr. Feliciano talks about what it's like when your spouse is as much a surgical heavyweight as you are. He also talks about his fondness of powerboating and what it was like to train with Michael DeBakey. DuBose and Milos do not ask Dr. Feliciano if Debakey would tell the scrub to, "hand me the me clamp," or snap, "these me forceps are off-center, damn it all!" If I had been there I would have asked that.
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.
In this episode, Milos and DuBose talk to Martin Schreiber, the Division Head of Trauma, Critical Care and Acute Care Surgery at the Oregon Health Sciences University. Professor Schreiber discusses the finer points of resuscitation with whole blood, including how to get a whole blood program started. He also goes on to discuss how to have two weddings at once, and why John Holcomb has used 'tonic-clonic' to describe Dr. Schreiber's dance style. The most notable thing about this episode, of course, is that I am absent.
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.
D. Dante Yeh is the Chief of Emergency General Surgery at Denver Health Medical Center and is the author of an incredibly comprehensive multicenter study with the coolest name you could imagine. The MUSTANG Trial looked at the treatment of appendicitis in America and addressed questions that had, until then, really only been looked at in European studies. Listen as we talk about the honestly fascinating conclusions from that study as well as a discussion about why America is different. Did you know that the nonoperative treatment of appendicitis in Belgium involved mussels? It's the broth that's really important, though. We end by discussing Dr. Yeh's nationally renowned fashion sense. When I told my friend Rich Betzold that we had interviewed Dr. Yeh, his first response was, "You know he wears ascots? They're so cool." And it's true. He wears ascots and they are cool.
When it's healthy, it's yellow and fluffy-looking, like a Golden Retriever puppy. When it's sick, it's the stuff of nightmares. Unless you're Dr. Greg Beilman, who hath tamed the pancreas and its ailments. Dr. Beilman is the Chief of General Surgery at the University of Minnesota; he's also an Associate Dean at the medical school, the SVP of acute care operations for M Health and, because he clearly has a ton of free time, a colonel in the Army with five deployments under his belt. With all that, it's no wonder that the pancreas doesn't scare him. Come and listen to him with us and maybe my nightmares will get better.
I was going to title this episode, "Don't Fuck with the Pancreas," but I was worried Milos would get mad.
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.
In this episode, Milos, DuBose, and I discuss a fascinating topic, Professionalism, with David Spain, MD. Dr. Spain is the David L. Gregg, MD Professor and Chief of Acute Care Surgery at Stanford University, which, I hear, is a pretty good institution. Earlier this year, Dr. Spain and his colleagues published their work in the Annals of Surgery associating patient outcomes with the admitting or consulting services' tendency to accrue complaints about their professionalism. Their results - which are somehow both shocking and not shocking - showed that if a patient was cared for by a service with high incidence of unprofessional behavior, their risk of complications and death was higher. So that begets the question* - what is professionalism? What is unprofessional behavior? How can we make sure that we're being professional, and how can be help our trainees and our colleagues be professional?
We finish by discovering that Dr. Spain is fond of The Weeknd and his wife is a Posty. As it turns out, Milos is really into 6ix9ine and DuBose loves Mac Miller. Me? I'm all about Bladee, baby.
*It's not 'begs the question.' Begging the question is a logical fallacy in which the premise of an argument relies upon the truth of the conclusion.
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.
We're back! At the helm is Miloš Buhavac of Texas Tech, the infamous Joe DuBose of the University of Texas, and Rishi Kundi from the Shock Trauma Center, who is here mostly because he knows the password to the PodBean account. For our first episode, we talk to none other than Dr. David Feliciano and Dr. Greg Magee about Axillosubclavian Injuries. As it turns out, six hours after completing the recording, I had a supraclavicular GSW and transected subclavian. That's the power of manifesting, folks.
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.
DuBose and Dr. Ravi Rajani, Chief of Vascular and Endovascular Surgery at Atlanta's Grady Memorial Hospital and Associate Professor at Emory University, discuss the approach to the patient with extremity injury and how to pick up on indications of vascular injury. Talking points include why there is no such thing as a Doppler pulse, and how we tend to ignore the first word in the name "pulse oximeter." Ravi finishes up by being correctly indignant that we are expected to wash dishes before putting them into a dishwasher. It doesn't make any sense, people.
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.
In this episode, Dr. DuBose talks about facial trauma and how the trauma surgeon can be a good friend and partner to the plastic surgeon taking care of injured patients bearing bony and soft trauma. After a rousing and collegial talk, the three plan to launch a class action lawsuit against Stephen King on behalf of clown-lovers everywhere, and Dr. Liang reveals that she would be entirely lost if she had only a compass and a map.
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.
The eye, as we all know, is a squishy bag filled with magic. I discuss ophthalmic injuries with ocular expert Dr. Bennie Jeng and eventually finds the tables turned when Jeng asks me if cereal is a soup. Fortunately, I am always prepared for this question.
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 interviews your humble servant (me) about DVT, PE and IVC filters in the trauma patient. This is, to nobody's surprise, the best episode yet. We finish by talking about my cats and Kacey Musgraves.
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.
Dr. DuBose discusses blunt thoracic aortic injury with Dr. Pedro Texeira, a trauma and vascular surgeon on faculty at UT-Austin's Dell Seton Medical Center. After covering the detection, management and repair of aortic injury, Dr. Texeira adamantly picks dinosaurs over dragons.
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.
The tables turn as I, your humble servant, interview Col. Joseph DuBose on the subject of chest tubes, a topic that, like the Mandelbrot set, grows increasingly complex as one examines it more closely. Also, barbecue, Django Reinhardt and Post Malone, if you can believe it.
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. DuBose discusses splenic injury with Dr. Ben Zarzaur of the University of Wisconsin and the challenge of both operative and nonoperative management. Finishing the episode, Joe allows Dr. Zarzaur to vent his spleen on the subject of spelling.
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.
Dr. DuBose speaks with yet another giant in the field, Demetrios Demetriades of Keck USC School of Medicine, discussing the management of colonic injuries before ending with the Πνύκα, the ἐκκλησία and what you're missing if you just go to the ἀκρόπολις.
Coronavirus isn't the only medical issue in the world, but it's become the context for everything else, including trauma. Dr. DuBose talks with Sheldon Teperman of Jacobi Medical Center in New York and Matt Martin of Scripps Mercy Hospital, who volunteered to go to New York. Topics include why Sheldon thinks Matt should be played onscreen by Zsa Zsa Gabor, Ms. Gabor's posthumous condition notwithstanding.
Dr. Feliciano is back to discuss management of complex vascular trauma and his real love, powerboating.
The Boss himself discusses the management of liver trauma, including the value of a big, curved needle, the MARS system, and the problem of naked, homeless testudines. Interview conducted by Dr. John Maddox, current fellow at Shock Trauma.
Dr. Jonny Morrison discusses the advent of endovascular trauma surgery, what's worn under a kilt, and what "bawbag" means in Glasgow.
Dr. David Feliciano discusses the management of duodenal trauma, explains why drains aren't as necessary as you might think, and reveals his love for The Village People and I'm not kidding even a little bit about that last one.