I am an associate professor of Surgery at Vanderbilt University in Nashville, Tennessee. My specialty training is in burn surgery, trauma surgery, and critical care. I established this web site to serve as an educational tool for residents. I post articles, lectures, an links to this site that would be useful to anyone interested in topical of burns, trauma, critical care, or prehospital care.
11.18.08 I've posted a new article that discusses where are we currently in the treatment of toxic epidermal necrolysis. (click here to see article)
11.13.08 Often on rounds I am talking about the when we put people on mechanical ventilation we are spinning the physiology 180 degrees with profound implications. Here is a neat article that articulates many of these points. Remember, we "suck" and ventilators "blow." (click here to see article.)
11.9.08 Since the Van Den Berghe paper in 2001, there is been a considerable interest in the control of blood glucose in the critically ill patient. Advocates of tight control of blood glucose have desired glucose in the range of 80 to 110, despite the risks of hypoglycemia. Those of us who were skeptical of such tight control, wanted more RCT data, or worried about hypoglycemia were quickly labeled as heretics. I am of the opinion the glucose should be controlled in the critically ill (BS<150), but I want more data prior to determining that all patients should be clamped between 80 to 110. Included is a recent article from JAMA that performs a meta-analysis on all the trials on tight glucose control. Yes, a meta-analysis. But look at the paper prior prior to making your judgements. The results of the meta-analysis are not subtle. (Click to view paper) (click to hear the podcast)
11.5.08 What is the real situation in American Health Care? This is an amazing lecture that Congressman Jim Cooper (D-TN) gave on health care recently at the Owen School of Management at Vanderbilt University. I am a republican, and I was blown away by the intellect and honesty of Congressman Cooper. The people of Nashville are truly fortunate to have him representing them. (Click here listen to lecture)
11.4.08 A few comments from rounds today. We talked about some of the "evils" or dangers or RBC transfusions. (click to view article). Also we I am including an article on prone ventilation. As I mentioned on rounds, the use of prone ventilation improves oxygenation but does NOT improve mortality. (click to view article) However, I would argue that if you cannot get oxygen saturation up, prone does allow you to fight another day.
11.2.08 Last evening we had a discussion in the ICU about the role of therapeutic hypothermia following cardiac arrest. See enclosed article.
10.31.08 Enclosed is a recent article on the critical care management of the major burn patient. This appears in the current edition of Current Anesthesia and Critical Care. I think this general over view papers are great for the resident rotating on the burn service for a month.
10.25.08 Congressman Cooper takes Greenspan and financial regulators to task.
10.24.08 The New York Times prints an opinion piece by Newt Gingrich and John Kerry comparing evidence based medicine to major league baseball. I am a strong advocate of evidence based medicine, but let's be intellectually honest about it's application. Too often, clinicians embrace the evidence when it supports their bias and ignore elements of the same article or that evidence that does not support their position.
10.23.08 Due to the nature of burn injuries, we have a close working relationship with our palliative care team. This group of professionals provide compassionate and multifaceted care to our patients and their families. A recent report also details that palliative care teams also save money, which is important in today's health care environment.
10.22.08 For the residents on the service, there are some podcasts that you can review in regards to current issues on the service. Review podcasts on topics recently covered on rounds: steroids and post extubation stridor, or one of the several podcast on sepsis. Also read the article on the surviving sepsis guidelines.
10.21.08 Please read this article on the consequences of poor sign-out. This article discusses what elements one should cover to provide an adequate sign out.
10.20.08 A new podcast is placed on the ICU rounds podcast. The topic for this week is part 2 on the discussion on myocardial infarction.
10.19.08 The web site is getting relaunched to try to keep all the educational materials and the protocols in one place. Residents are encouraged to check the site daily to keep up to date with what is happening on the burn service.