Podcast 174: The Abdominal Aortic Junctional Tourniquet with the Inventors, John and Paul
In this episode, Dennis interviews John and Paul about the Abdominal Aortic and Junctional Tourniquet (AAJT). They discuss the background and reasons for inventing the AAJT, including the need to control bleeding in the pelvis. They also talk about the first application of the AAJT and the positive results seen in combat situations. The conversation then moves on to study data and research on the device, including some negative studies that have been conducted. They also discuss the pressure levels used with the AAJT and the potential for extending the application time. Finally, they address the negative consequences of high pressure and the comfort level of wearing the device. The conversation explores the application and function of the Abdominal Aortic Junctional Tourniquet (AAJT) and its potential use in pre-hospital care. It discusses the challenges of prolonged application and the risks associated with it. The conversation also delves into alternative techniques and future developments in the field. The importance of reperfusion and monitoring is highlighted, along with the impact of the AAJT on breathing and inspiratory pressure. The discussion touches on the considerations for reducing pressure during reperfusion and the duration of application. The risk-benefit analysis of heroic interventions is examined, emphasizing the need for rapid hemorrhage control. The limitations and risks of Roboa are discussed, and a cadaveric study on the AHAT is presented. The conversation concludes with the role of the AHAT in preparing for future wars and its potential use in traumatic cardiac arrest.
Podcast 173: Pelvic Binders and a Deep Dive Into Pelvic Injuries with Alex
In this episode, Dennis and Alex discuss the truth about pelvic binders and their relevance in trauma care. They explore the background and experience of Alex, who has extensive knowledge in trauma surgery. They delve into the anatomy and injury patterns of pelvic fractures, as well as the different phases of damage control surgery. They also discuss the importance of understanding research and the levels of evidence. The conversation highlights the contradictory evidence surrounding the use of pelvic binders and emphasizes the need to critically evaluate citations and research findings. This conversation covers blast injuries, types of pelvic fractures, mortality rates, considerations for prolonged field care (PFC), the flow of care in PFC, normalization and observation, initial stabilization, massive transfusion protocol, futile transfusions, clinical decision making, pelvic binder design, imaging challenges, ultrasound for pelvic fracture assessment, duration of pelvic binder use, preventing pressure sores, consulting with medical professionals, proper application of pelvic binder, retroperitoneal hemorrhage, the role of telemedicine, critical care and decision making, and resources for further learning.
Podcast 171: Chest Trauma with John
In this conversation, Dennis and John discuss chest trauma management, specifically the use of chest seals and the sequence of interventions. They explore the overuse of chest seals and the potential complications they can cause. They also discuss the importance of assessing the patient and determining if a chest seal is necessary. John shares his insights on the use of finger thoracostomy and the technique for performing it. They also touch on the revision of the TCCC algorithm and the need to prioritize hemorrhage control. The conversation explores the challenges and approaches in operational medicine, emphasizing the need to align policy and guidelines with the experiences of field practitioners. It highlights the importance of preserving the rich experience and lessons learned by experienced personnel. The discussion also delves into the management of chest trauma, specifically focusing on emergent situations and the challenges in current practices. The conversation concludes with the anticipation of future discussions and the potential for further exploration of the topics.
Podcast 166: JR Pickett on Excited Delerium
In this podcast episode, Dennis interviews JR Pickett, an ER physician and EMS medical director, about excited delirium. They discuss the definition and history of excited delirium, the challenges faced by law enforcement and medical providers in managing these cases, and the importance of timely intervention. They also explore the differences between excited delirium and other conditions, such as combative patients in combat situations. The conversation highlights the need for proper assessment and observation of patients exhibiting excited delirium and the selection of appropriate medications for sedation. The podcast concludes with a discussion on the criminalization of medical care and the impact it may have on patient outcomes.
Podcast 163: pREBOA with Prytime Medical?!
ituations where immediate surgical intervention is not possible.
Training for the P-REBOA catheter involves a combination of didactic instruction and hands-on practice with simulation devices.
The P-REBOA catheter has a semi-compliant balloon that allows for partial occlusion, maintaining some blood flow below the balloon and reducing the risk of reperfusion injury.
The P-REBOA catheter can be used to extend the time window for surgical intervention, allowing for stabilization and transport of critically injured patients.
Securing the P-REBOA catheter during transport involves suturing or using a catheter clamp to prevent dislodgement.
Podcast 162: Sean McKay on Subterranean Rescue
In this episode, Sean McKay discusses the challenges and considerations of subterranean mobility and rescue. He emphasizes the importance of understanding the geology and environmental pathology of underground environments, as well as the need for continuous training and innovation in equipment usage. McKay also highlights the significance of risk assessment and uncertainty management in rescue operations. Additionally, he explores the complexities of communication and coordination in subterranean environments. In this conversation, Sean discusses the complexity of rescue operations and emphasizes that there is no one-size-fits-all approach. He highlights the importance of considering various factors, such as team capabilities, training, and environmental conditions. Sean also emphasizes the need for continuous training and seeking weaknesses in order to improve. He encourages rescuers to innovate and find solutions that fit their specific mission and team. Additionally, he emphasizes the importance of knowing and understanding the equipment and being comfortable with improvisation when necessary.