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I’d like to thank @Me4Trauma for their support in starting a real dialogue re: #racism, #AntiBlackRacism, #PoliceBrutality and the role of medicine and trauma in addressing this public health issue. The lack of engagement with this long thread tells me a couple of things:
1. We are not ready. Past the statements and the symbolisms of solidarity, we’re not ready to deal with it just yet. This is an emotional process and it’s exhausting. Look at the #BlackintheIvory thread to see what it’s like to live with racism your whole life.
2. There’s a fear of making a misstep and being offensive on such a public platform especially during this time. I get it. It’s too risky to speak on this right now.
Personally speaking, it’s too risky for me to not speak on this right now and fix this system.
Personally speaking, it’s too risky for me to not speak on this right now and fix this system.
To the Trauma and Medical community,
First, I’d like to thank the @SoMe4Trauma team for graciously hosting this discussion on #racism and #AntiBlackRacism in medicine and the role trauma plays.
#SoMe4Trauma
First, I’d like to thank the @SoMe4Trauma team for graciously hosting this discussion on #racism and #AntiBlackRacism in medicine and the role trauma plays.
#SoMe4Trauma
The recent #GeorgeFloydMurder in Mnpls, MN has galvanized the world to protest in support of the #BlackLivesMatter movement.
Cause of death: "asphyxiation from sustained pressure" when his neck and back were compressed by Minneapolis police officers”
cnn.com/2020/06/01/us/…
Cause of death: "asphyxiation from sustained pressure" when his neck and back were compressed by Minneapolis police officers”
cnn.com/2020/06/01/us/…
It didn’t have to take a second autopsy to confirm what the entire world saw on that video. A video I, and many Black parents, still can’t bear to watch.
But the fact that a second autopsy was performed at the request of Mr. Floyd’s family is pertinent to this discussion.
But the fact that a second autopsy was performed at the request of Mr. Floyd’s family is pertinent to this discussion.
1/
Hello @Me4Trauma and @me4_so. Welcome to my tweetorial on Palliative Care for the trauma patient.
To start, palliative care as defined by @WHO. Palliative care is often delivered along side disease modifying treatment.
@Surgpallcare #SoMe4Trauma #SoMe4Surgery
Hello @Me4Trauma and @me4_so. Welcome to my tweetorial on Palliative Care for the trauma patient.
To start, palliative care as defined by @WHO. Palliative care is often delivered along side disease modifying treatment.
@Surgpallcare #SoMe4Trauma #SoMe4Surgery
2/
What is Surgical Palliative Care? As defined by Dr. Geoffrey Dunn, it is "interdisciplinary care whose goal is to relieve suffering and improve quality of life of the surgical patient and their family." More info here:
ncbi.nlm.nih.gov/pubmed/21419251
#SoMe4Trauma #SoMe4Surgery
What is Surgical Palliative Care? As defined by Dr. Geoffrey Dunn, it is "interdisciplinary care whose goal is to relieve suffering and improve quality of life of the surgical patient and their family." More info here:
ncbi.nlm.nih.gov/pubmed/21419251
#SoMe4Trauma #SoMe4Surgery
3/
While the practice of Surgical Palliative Care may include palliative procedures (venting G tubes, intestinal bypass, etc) it definitely includes family meetings, goals of care & code status discussions, prognostication & skilled symptom management. #SoMe4Trauma #SoMe4Surgery
While the practice of Surgical Palliative Care may include palliative procedures (venting G tubes, intestinal bypass, etc) it definitely includes family meetings, goals of care & code status discussions, prognostication & skilled symptom management. #SoMe4Trauma #SoMe4Surgery
Welcome to the first tweetorial in our Critical Care Corner. Stay tuned for this spooky Halloween thread, hosted by none other than the Addams Family.
We have kept it simple here. Links provided for further reading.
No sensitive images in this thread
#SoMe4Trauma
#SoMe4Surgery
We have kept it simple here. Links provided for further reading.
No sensitive images in this thread
#SoMe4Trauma
#SoMe4Surgery
Our topic for today is the “festering” problem of necrotizing fasciitis (NF) otherwise known as “flesh eating bacteria syndrome”. It is a life threatening soft tissue infection,with a mortality rate ranging from 8.6-76% in the literature(median 32.2%)
#SoMe4Trauma
#SoMe4Surgery
#SoMe4Trauma
#SoMe4Surgery
It commonly affects the perineum and scrotum (Fournier’s gangrene), the abdominal wall & extremities. Trauma pts, & pts with surgical wounds, are particularly susceptible as the site of trauma can act as a portal of entry for bacteria.
#SoMe4Trauma
#SoMe4Surgery
#SoMe4Trauma
#SoMe4Surgery
@Me4Trauma Another great question. Starts with a mindset. For surgeons in uniform, no matter how subspecialized you are, you will be called upon to deploy and be a facile trauma surgeon #Q5 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma First step was alluded to in #Q4. Training must be high quality but brief. To that end, the Emergency War Surgery course has undergone significant revision in recent years. Still work to do there though #Q5 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma EWS has partnered with @AmCollSurgeons @ACSTrauma and incorporated the ASSET course into the curriculum. Vascular exposure is possibly the most important refresher prior to deployment #Q5 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma Absolutely! My predeployment training pipeline was 5 months, I was deployed for 7, and had a month after returning before I resumed practice. Skill atrophy is a real phemonenon. #Q4 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma Several of us have a grant to look at this as it applies to robotics for military surgeons (who are already lower volume than private sector). Proud to be working with Rob Lim, @Averywalker21 @Doc_Brown44 and others on this project #Q4 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma @Averywalker21 @Doc_Brown44 We address this in a twofold manner:
1) military predeployment training must be high quality, but also done quickly. 5 months to train and not operate, followed by a low volume deployment is not the way forward #Q4 #SoMe4Trauma #SoMe4Surgery
1) military predeployment training must be high quality, but also done quickly. 5 months to train and not operate, followed by a low volume deployment is not the way forward #Q4 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma Great question! The military actually developed some of our robotic technology that has evolved into robotic surgery as we know it today #Q3 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma As we’d all agree, there’s essentially no role for robotics in damage control trauma surgery. That isn’t the time for small incisions and finesse #Q3 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma That said, I see near- and long-term application of robotics in deployed setting. Near term, military surgeons having access to robotics in our non-deployed practice will help us recruit and retain surgeons, which are both essential for readiness #Q3 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma I think being a high volume CR surgeon helps with trauma, given that I am frequently in all 4 quadrants of the abdomen and still do many trauma mobilizations routinely in my elective practice
#Q2 #SoMe4Trauma #SoMe4Surgery
#Q2 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma Although, the majority of my deployed cases were orthopedic in nature. Much of this comes down to judgement, anatomy, and sound technique. Pre-deployment courses incorporating good splinting principles and ex-fix use for non-ortho also important #Q2 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma #colorectalsurgery background also extremely helpful with intestinal injury and good damage control principles, especially after damage control when resuscitation is complete and it is time for reconstruction/restoration of continuity #Q2 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma Military subspecialty surgeons are often low volume compared to our private sector peers. Luckily the military also has Training Affiliation Agreements (TAAs) my partner @Doc_Brown44 and I have which let’s us work in private sector to ⬆️ volume
#Q1 #SoMe4Trauma #SoMe4Surgery
#Q1 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma @Doc_Brown44 I think the single best way for surgeons to be prepared for deployed trauma is to be busy when not deployed #Q1 #SoMe4Trauma #SoMe4Surgery
@Me4Trauma @Doc_Brown44 Similarly, even though the bulk of my practice is #colorectalsurgery, I’ve always got to retain the mindset that I need to retain my trauma skill set and keep up with the trauma literature. This is critical for military-bound surgery residents #Q1 #SoMe4Trauma #SoMe4Surgery
Hi @Me4Trauma and #SoME4Trauma people. Let's get started with our first tweetorial covering needle decompression of the chest for tension pneumothorax.
#SoMe4Surgery
#SoMe4Surgery
9th ed of ATLS recommended using a 5cm long cath in the 2nd IC space on the midclavicular line. The 10th ed recommends using an 8 cm cath in the 4th or 5th IC space anterior to the midaxillary line. What led to these changes?
#SoMe4Surgery
#SoMe4Trauma
@Me4Trauma
@MedTweetorials
#SoMe4Surgery
#SoMe4Trauma
@Me4Trauma
@MedTweetorials
Several papers looked at chest wall thickness(CWT) and found that the 2nd IC space led to high failure rates. Comparing CWT at the 2nd IC space MCL and 4/5th IC space AAL found decreased CWT at the 4/5th space meaning lower failure rates. Let's look at some of them
#SoMe4Trauma
#SoMe4Trauma
