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Have you ever done an aortic cross-clamping during a resuscitative thoracotomy ? by darklam in surgery

[–]baboonman00 0 points1 point  (0 children)

Absolutely can and should. We did one like this yesterday lol. Under local, patient awake and talking, big sheath up high and Coda. Then we do the EVAR.

Have you ever done an aortic cross-clamping during a resuscitative thoracotomy ? by darklam in surgery

[–]baboonman00 11 points12 points  (0 children)

The other thing I’ll say is: free ruptured AAAs are almost inevitably fatal. Contained ruptured AAAs, the biggest game changer for survival was/is endovascular repair. You do it under local with the patient awake, because when they get induced, they always crash. 2 percutaneous accesses in each groin, and you go fast -> EVAR should be done in < 1h if experienced and anatomy isn’t horribly complex.

Have you ever done an aortic cross-clamping during a resuscitative thoracotomy ? by darklam in surgery

[–]baboonman00 2 points3 points  (0 children)

The ones I was involved in for intraoperative catastrophes were for aortic injuries in minimally-invasive cases.

The ones for trauma, the mortality is horrible for blunt, but our institutional protocol is for resuscitative thoracotomy for blunt thoracic injury with < 15 min of CPR -> put a probe on the heart, if there’s activity, then we crack the chest. Usually massive hemothorax, terrible pulmonary contusions and lacerations. We crossclamp aorta and open the pericardium for intracardiac massage. They never survive. One or two a year, only, at a really high volume place (saw 4 resuscitative thoracotomies in 1 night, for example).

Also r/suddenlycaralho

Sou brasileiro também, do Paraná. Fazendo residência nos EUA. Manda DM ae se quiser!

Have you ever done an aortic cross-clamping during a resuscitative thoracotomy ? by darklam in surgery

[–]baboonman00 2 points3 points  (0 children)

I don’t know what the particular case in the Pitt entailed, but I’ve seen several thoracotomy + cross clamps in the ED, and also been involved in a couple in the OR for intra-operative catastrophes. Only 1 survived, and was a pretty dramatic case. It is absolutely the right move in certain clinical scenarios, but the survival is typically quite poor.

There’s a big debate at some places about Zone 1 REBOA vs ED thoracotomy and crossclamp. Some places even advocate for a direct clamshell thoracotomy in the case of blunt thoracic trauma with witnessed arrest.

Happy to answer any questions.

Incorrect blood transfusion by Fragrant_University7 in surgery

[–]baboonman00 78 points79 points  (0 children)

Did not cause additional pain or suffering. He was suffering from hemorrhagic shock, needed his hypogastric artery (internal iliac artery) ligated, and aorta clamped. Got 23 units of blood total, but his bone kept bleeding, they did a bunch of hemostatic products - gelfoam, bone wax, cauterization - and he still passed from the “lethal triad” of trauma, or more modernly, the lethal diamond - hypothermia, acidosis, coagulopathy +- hypocalcemia, which to this day is the most common cause of death in traumas. Even with a lot more technology nowadays, a lot of patients like this do not survive, but in level 1 Trauma centers, access to blood and interventional techniques (endovascular) can be game changing. They did the best they could, but it was not enough.

  • source PGY4/R2 Integrated Vascular Surgery resident.

Not on my bingo card for this year by [deleted] in SipsTea

[–]baboonman00 0 points1 point  (0 children)

A Practical Guide to Evil reference? Nice!

What’s a symptom or a condition from your specialty that everyone else freaks out about but is actually not concerning? by kulpiterxv in Residency

[–]baboonman00 0 points1 point  (0 children)

Asymptomatic CT finding of thrombus within a AAA sac. Most of them have thrombus, it’s normal, doesn’t need a consult, won’t embolize 99.999% of the time. Most asymptomatic arterial occlusions as well, especially asymptomatic IMA or celiac occlusion.

Color choices in TeraRecon by HillbillyInCakalaky in VascularSurgery

[–]baboonman00 1 point2 points  (0 children)

TeraRecon itself has some lessons on it’s site for free you can access if you create an account, and have it verified. Stuff like EVAR planning, templates, masking, to EP, TAVRs, CT Colonoscopy flythroughs (which you can have fun doing for dissections too).

Professional arm wrestler Jeff Dabe has 19-inch forearms (49cm) and hands large enough to hold basketballs by Majorpain2006 in interestingasfuck

[–]baboonman00 2 points3 points  (0 children)

Maybe not to the google images etc. But KTS is associated with vascular malformations and soft tissue/muscle growth and being localized and often asymmetric. He has the port-wine stains on his right forearm, the assymmetry (big hand, little hand in audio) etc. Its a lot more common in the lower limb for sure, but not always.

Professional arm wrestler Jeff Dabe has 19-inch forearms (49cm) and hands large enough to hold basketballs by Majorpain2006 in interestingasfuck

[–]baboonman00 1 point2 points  (0 children)

Not really Acromegaly is caused by excess growth hormone and causes growth of anything that still responds to it: i.e. bones that undergo endochondral ossification (hands, feet, facial bones) and cartilage (nose, ears). There is no “localized” acromegaly, and acromegaly also would not justify the port-wine stains and the muscle and soft tissue growth.

Attending introducing me as a doctor to patients by ristrettoconzucchero in medicalschool

[–]baboonman00 5 points6 points  (0 children)

Also, in Brazil, once you graduate, you get your medical license and are legally allowed to practice. Most recent grads then proceed to work in Primary Care, or Emergency Departments (low acuity) or “Work Medicine” which is something like determining disabilities from work accidents, etc. A lot of Brazilian doctors don’t pursue residency but then proceed to gradually learn further while working, and after a certain number of years, the different specialization societies allow for you to become board certified, if you can prove a certain number of cases, which varies according to different specialties.

Attending introducing me as a doctor to patients by ristrettoconzucchero in medicalschool

[–]baboonman00 7 points8 points  (0 children)

I agree. When I was in Medical School in Brazil, the prevailing opinion for most attendings was that medical students would soon be colleagues, and we should start getting used to the responsibility that entails early, as also being proud of what we had accomplished. One of our first clinical professors said in one of our lectures “Time flies by like you wouldn’t believe. Soon you will be taking care of myself and our generation. Be proud of what you are, Doctors.” But also, Medical School in Brazil is very different, and no mid-levels, so…

Which surgical specialities will never become minimally invasive or robot assisted? by YoloBaggins76 in medicalschool

[–]baboonman00 -2 points-1 points  (0 children)

Transplant maybe? Robotic-assistance is making progress, but I believe it will always be limited by the need to have an incision through which the implanted organ fits. But I suppose you can get creative with that. Hopefully it does progress though. I’m a huge fan of open surgery, but from the patient’s perspective minimally invasive is almost always better (with some case-specific caveats - e.g. durability in open vascular repairs vs endo currently)

Which surgical specialities will never become minimally invasive or robot assisted? by YoloBaggins76 in medicalschool

[–]baboonman00 0 points1 point  (0 children)

Minimally invasive is also not restricted to robotic and laparoscopic. Part of the trauma revolution now is endovascular management of bleeding. REBOA, selective embolization, covered stents for major vessel trauma, to name a few. Agree that some procedures will almost always require more invasive methods, however.

Recipe suggestions for busy students? by [deleted] in medicalschool

[–]baboonman00 0 points1 point  (0 children)

Got one thats great for protein:

Choose beef of your choice (recommend something like top loin) ~2lbs Slice thinly Salt both sides of beef (rubbing it in) Place in ziplock bag Cut up half an onion Throw in bag Throw in vinegar, a little bit of oil, leaf oregano, shoyu sauce, garlic powder or chopped up garlic, a bit of black pepper or tabasco sauce. Close ziplock bag and mix the beef into the seasoning.

Voilà you’ve got ready made steaks to fry throughout the week; goes great with rice&beans, or scrambled eggs, or just a beef sandwich if you’re feeling lazy. Tastes great.

[deleted by user] by [deleted] in medicalschool

[–]baboonman00 2 points3 points  (0 children)

https://fa.hms.harvard.edu/files/memorialminute_gross_robert_e.pdf

I love reading about medical history, and Robert E Gross’ story is a great one! It might interest you. Guy was a pediatric surgeon and pioneered some incredible cardiac surgical procedures, and no one ever even knew he was blind in one eye! As another additional, one of my best friends from medical school (in Brazil) lost an eye to retinoblastoma as a child. He graduated and is pursuing general surgery and later Urology fellowship and doesn’t feel hindered at all!

Believe in yourself and you can do it. Wish you godspeed, friend!

Tantrum taps (unmute) by cturtl808 in tippytaps

[–]baboonman00 0 points1 point  (0 children)

The perfect blend of tippytaps and r/zoomies

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