Las Vegas – Trauma/Critical Care/Emergency General Surgery Conference

I’d like to take just a little space on my blog to talk about the 45th annual Las Vegas trauma conference. As usual, the facilities were fabulous. The format is truly remarkable. Unlike most scientific conferences, in this conference the focus is on delivering pertinent information quickly and efficiently. Many conferences drone on and on for hours. Instead, these lectures are confined to 15-20 minutes. That’s it. I’d like to highlight just a few of those lectures that I thought were interesting or particularly informative.

The first lecture was called Admitting the Catastrophic Trauma Patient to the Remote Level IV Hospital. This lecture was given by Doctor Richard Sidwell. He thoughtfully laid out some of the problems encountered at the smaller hospitals. I’ve spent the last 10 years of my career at level II trauma centers. They are directly fed by the smaller hospitals. I’ve seen these hospitals struggle as just one or two patients can quickly overwhelm their systems. I’ve also seen many of these hospitals do a fabulous job at stabilizing patients and transferring them to definitive care. This was an excellent lecture.

The next lecture that I like to highlight was on TEG (thromboelastogram) by Dr. Kenji Inaba. Over the last several years, I’ve listened to several lectures which have suggested that the thromboelastogram should replace pro-time, international normalized ratio (INR) impartial thromboplastin time. I’m still somewhat skeptical, but it sure seems like we can get a lot of information from this one test.

Colorectal CrisisDoctor David Wisner emphasized the problems that internal medicine physicians and acute care surgeons are facing with Clostridium colitis. We’re seeing more and more of this. The question is, who needs surgery? We all understand that the literature suggests operating early is better than operating late, but you don’t want to have to take anything out if you don’t need to. Currently, clinical judgment still plays a huge role.

Doctor Hamed Amani gave a very interesting lecture on burn dressings. It seems to me, nearly once a month, the wound care nurses are suggesting a new burn dressing. This lecture was extremely informative.

Dr. Raul Coimbra suggested using hypertonic saline in patients with track brain injury. He presented, in my opinion, the most rational approach to using hypertonic saline.

Doctor Andre Campbell presented a nice discussion for using TPA in patients with retained hemothoraxes. I still believe that using video-assisted thoracoscopy is the best way to take care of these patients. In spite of my personal opinion, I thought his lecture was excellent.

Possibly, the most disappointing lecture was the New Endpoints of Resuscitation given by Doctor Rao Ivatury. His lecture was good. He did an excellent job reviewing the literature. The problem is that for decades we’ve been looking for a single marker which would tell us that patients have enough fluid or not enough fluid. Something that would tell us yes or no. We still don’t have that. We still have to look at multiple different endpoints in order to figure out if the patient has had enough fluid or not. In my opinion, this is a failure of research. Over the last several years, we’ve seen more and more data which suggests that if we overhydrate the patient, this is bad. On the other hand, we have decades of information suggesting that if we don’t give the patient enough fluid, this is also bad. So, how do we find the sweet spot?

There were other very nice lectures. These the ones that jump out at me. This was a great conference. I highly recommend it.

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Errington C. Thompson, MD

Dr. Thompson is a surgeon, scholar, full-time sports fan and part-time political activist. He is active in a number of community projects and initiatives. Through medicine, he strives to improve the physical health of all he treats.

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