Airway Assessment for Trauma Patient
Nicholas Ludmer, MD
Assistant Professor of Emergency Medicine
UChicago Medicine
Abdullah Hasan Pratt, MD
Assistant Professor of Emergency Medicine
UChicago Medicine
Stephen Estime, MD
Assistant Professor of Anesthesia and Trauma Critical Care
UChicago Medicine
In this video, Dr. Ludmer at UChicago Medicine describes the airway assessment for a trauma patient.
Carpal Tunnel Release (Cadaver)
Asif M. Ilyas, MD
Professor of Orthopaedic Surgery
Program Director of Hand Surgery
Rothman Institute, Thomas Jefferson University
Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy and results in symptoms of numbness and paresthesia in the thumb, index finger, middle finger, and half of the ring finger. When CTS symptoms progress and can no longer be managed with nonoperative measures, carpal tunnel release (CTR) surgery is indicated.
In this case, Dr. Asif Ilyas at the Rothman Institute performs CTR surgery on a cadaveric arm via the mini-open CTR technique. A 2-cm longitudinal incision was placed directly over the carpal tunnel, the transverse carpal ligament was exposed and then released, and the wound was closed. Patients are typically sent home with instructions to use their hand immediately postoperatively, while avoiding strenuous use until the incision has healed. Splinting and therapy are not required postoperatively.
Robotic eTEP Retrorectus Rives-Stoppa Repair for Ventral Hernia
Alta Bates Summit Medical Center
Rockson C. Liu, MD, FACS
General Surgery, Epic Care, Alta Bates Summit Medical Center
In this case, Dr. Rockson Liu performs a robotic eTEP retrorectus Rives-Stoppa repair of an upper midline primary ventral hernia that was partially reducible but mostly incarcerated, and greater than 6 cm in a 63-year-old female. Robotic ports were placed directly into the retrorectus space. Using the crossover technique, the retrorectus spaces were combined with a preperitoneal bridge of the peritoneum. The defects were closed robotically, and a medium-weight, macroporous polypropylene mesh was placed within the retrorectus space.
Pharmacology for Rapid Sequence Intubation (RSI) Airway Management in Trauma Patients
UChicago Medicine
Laura Celmins, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
Emergency Medicine
In this video, Laura Celmins, a clinical pharmacist in the emergency department at UChicago Medicine, discusses rapid sequence intubation (RSI) medications as part of the airway management for trauma patients.
Microscope Drape for Aerosol-Generating Procedures During COVID-19 Pandemic
Bascom Palmer Eye Institute
C. Scott Brown, MD
Neurotology and Lateral Skull Base Surgery Fellow
University of Miami Miller School of Medicine
Fred F. Telischi, MEE, MD, FACS
James R. Chandler Chair in Otolaryngology
Chairman of Otolaryngology and Professor, Neurological Surgery and Biomedical Engineering
University of Miami Miller School of Medicine
During the COVID-19 pandemic, viral transmission via aerosolized particles poses the risk of infecting operating room staff. In this video, Dr. Telischi at the University of Miami demonstrates one of several techniques for draping the microscope during cochlear implant surgery.
Pancreatic Debridement via Sinus Tract Endoscopy
Massachusetts General Hospital
Peter Fagenholz, MD
Assistant Professor of Surgery
Massachusetts General Hospital
Harvard Medical School
This patient is a 58-year-old male who was in a motor vehicle accident and developed a persistent necrotic collection adjacent to the pancreatic tail that did not improve with percutaneous drainage. Here, Dr. Peter Fagenholz at MGH performs a pancreatic debridement using sinus tract endoscopy (STE), a minimally-invasive technique for debridement of dead or infected tissue.
STE and other minimally-invasive techniques have significantly decreased morbidity and mortality for patients undergoing intervention for infected pancreatic necrosis. Common management principles include early non-interventional management to allow the necrosis to wall off, initial intervention with minimally-invasive drainage, and minimally-invasive necrosectomy addressing clearly demarcated necrosis.
STE involves the placement of a percutaneous drain followed by fluoroscopically-guided dilation of the drain tract to allow for placement of a working sheath, through which an endoscope can be introduced to debride the peripancreatic necrosis. After debridement, a drain is then replaced through the same tract.
Prophylactic Laparoscopic Bilateral Gonadectomy for Complete Androgen Insensitivity Syndrome
University of Arkansas for Medical Sciences
J. Corbin Norton, MD
Department of Urology
University of Arkansas for Medical Sciences
Stephen J. Canon, MD
Department of Pediatric Urology
Arkansas Children’s Hospital
Amrit Singh, MD
Department of Pathology
University of Arkansas for Medical Sciences / Arkansas Children’s Hospital
Laura L. Hollenbach, MD
Department of Obstetrics and Gynecology
University of Arkansas for Medical Sciences
Georgia Gamble, MD
Department of Obstetrics and Gynecology
University of Arkansas for Medical Sciences
Laura A. Gonzalez-Krellwitz, MD
Department of Pathology
University of Arkansas for Medical Sciences / Arkansas Children’s Hospital
The patient, in this case, is a 15-year-old female who presented with primary amenorrhea and who on work-up was found to have complete androgen insensitivity syndrome. Here, Dr. Canon at the University of Arkansas for Medical Sciences performs a prophylactic laparoscopic bilateral gonadectomy to reduce her future risk for intra-abdominal testicular malignancies. Final pathology results showed a rare case of bilateral germ cell neoplasia in situ and bilateral paratesticular leiomyomas and reinforced the decision to intervene early allowing for the removal of the gonads prior to their conversion to formal germ cell tumors.
Less Invasive Stabilization System (LISS) for Distal Femur Fracture Repair
Brigham and Women’s Hospital
Michael J. Weaver, MD
Associate Orthopaedic Surgeon, Brigham and Women’s Hospital
Assistant Professor of Orthopedic Surgery, Harvard Medical School
Brigham and Women’s Hospital
The patient in this case is an 81-year-old male with dementia who sustained an unwitnessed fall that resulted in a displaced intra-articular distal femur fracture. Here, Dr. Weaver at Brigham and Women’s Hospital repairs the fracture by performing an open reduction and internal fixation with a LISS plate. An anterolateral approach was used to visualize the joint surface and obtain an anatomic reduction of the articular surface, and a percutaneously-placed lateral lock plate was used to bridge the area of comminution while restoring length, alignment, and rotation to hopefully allow for biologic fixation that permits the bone to heal well.
Creation of a Radial-Cephalic Arteriovenous Fistula
Nahel Elias, MD FACS
Surgical Director
Kidney Transplantation
Massachusetts General Hospital
AV fistulas provide the crucial vascular access required for patients receiving hemodialysis, a life-saving procedure for end-stage renal disease. Such patients have irreversible kidney damage and must receive a new kidney. While waiting, patients rely on hemodialysis to filter their blood to stay alive, and AV fistulas provide the sustainable vascular access required for hemodialysis.
Trauma Resuscitation Demonstration in a Stable Patient with a Minor Perforating Wound
UChicago Medicine
Priya Prakash, MD
Assistant Professor of Surgery
Trauma, Critical Care, and Emergency Surgery
UChicago Medicine
The patient in this case is a 17-year-old male who presented in stable condition with a minor, superficial, perforating saber wound. In this video article, Dr. Priya Prakash at UChicago Medicine demonstrates a trauma resuscitation and removes the saber.