Just published in Trauma Surgery & Acute Care Open (TSACO):

'Current approaches to treating appendicitis in the 3rd trimester' by Dr. Kleinertz et al.

➡️bit.ly/4c7CUjM

Nice overview of initial trauma care, suitable for medical students starting out on a trauma rotation, and delivered in Dr. Georgoff’s unmistakeable ‘Morgan Freeman after a double espresso’ style. 😎

Meet Rob Brookshire PA. Rob has been with Legacy for 21 years! He began his Legacy texture with trauma I 2003 before transitioning to ECMO in 2015. He is not only the first and only APP on our ECMo team but is also the Clinical Program Director.

To emphasize the point, I'll leave this here again. When you can no longer draw blood back it is almost always the case that *pulling back* on the syringe will help you salvage the line.

I've seen this many, many times, both in my own lines and for countless residents.
⬛️

A central line (of average difficulty) needs to be placed, which you will be supervising.

The call team includes trainees at several different levels.

Which is the *most junior* person you would allow to try placing the line?

𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗖𝗼𝗺𝗺𝗼𝗻 𝗕𝗶𝗹𝗲 𝗗𝘂𝗰𝘁 𝗘𝘅𝗽𝗹𝗼𝗿𝗮𝘁𝗶𝗼𝗻 𝗣𝗼𝘀𝘁 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆

Patient Presentation:
🔵Previous cholecystectomy
🔵2 previous ERCPs
🔵Recurrent large stone
➡️1.7 x 1.1 cm
➡️Failed endoscopic clearance
➡️Requirement for EHL
🔵MDT

Our final guideline from the AAST Critical Care Committee gives recommendations on surgical and procedural antibiotic prophylaxis in the surgical ICU

This includes guidance for open fractures, craniotomy, drains, chest tubes and much more. 😎

➡️bit.ly/4chKAjb

“All in favor of the motion to keep changing the coagulation cascade every few years until we retire, say aye…”

A patient with BMI 35 has a laparotomy for perforated viscus, with moderate contamination. The skin was left open with a woundvac. The wound looks good when examined during Vac changes.

You are considering doing a delayed primary closure. When would you proceed?

Deadline is coming up Monday ⏰

The term “Intern” is a bit unfortunate here because it’s not being used in the classic sense…the positions have usually been held by fellows (PGY-6+). Also, the workload is fairly evenly split. The role is not analogous to a surgery ‘intern’.

Next up in the newest guidelines from the AAST Critical Care Committee:

Antibiotic prophylaxis in injury: a AAST Critical Care Committee clinical consensus document

➡️bit.ly/45b4UAk

Techniques to relocate the needle in the needle holder to perform forwards and backwards sutures ⤵️💥🔬🔪! #SoMe4Surgery #AortaEd Ron Barbosa MD FACS Christian de Virgilio MD FACS Tom Varghese Jr. MD, MS, MBA, FACS, MAMSE 🇺🇸 Paula Ferrada MD FACS FCCM MAMSE Steven D Wexner MD, PhD Cirbosque #SoMe4Surgery

Now available (and open-access):

There are 3 important new guidelines from the AMOS DRIVE Critical Care Committee. The first of these that we will highlight covers the evaluation and workup of fevers and infections in the SICU.

Click here (not the photo)
➡️bit.ly/4enWo5x

Online first. “Be efficient to Be Fast in the Operating Room”
Ron Barbosa MD FACS Caroline Park MD, MPH Vahagn C. Nikolian, MD Michael J. Pucci Omar M Ghanem SAGES is in Long Beach in 2025! Cirbosque #SoMe4Surgery MISIRG Steven D Wexner MD, PhD SESC & The American Surgeon