Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.

Welcome back to Behind the Knife and another installment of the Big T-Trauma series.

This series offers clinically oriented material that focuses on how best to care for dramatically injured and critically ill patients.

The information presented in this podcast is designed for surgical trainees, but it's appropriate for anyone with an interest in trauma surgery.

This includes medical students, advanced practice providers and nurses.

My name is Patrick George off and I'm an acute care surgeon at Wake Med Hospital in Raleigh, North Carolina.

Joining me today are two of my good friends and former co-fellows at the home of Big T-Trauma, the University of Texas in Houston.

First, we've got Dr. Teddy Puzio, who's currently faculty at UT, and an assistant program director for the acute care fellowship.

We've also got Dr. Jason Brill, who has way too many titles to mention in the Navy, but he is also trauma medical director for the United States Indo-Pacific Command,

and probably more importantly, a baller part-time barber.

In fact, he gave many a haircut in the call room during the peak of COVID keeping us all looking good and sharp throughout the pandemic.

So I'm excited for this episode. Brill, why don't you give us a little intro into what we're talking about.

Yeah, sure. So this is part one of a two-part series on the ED Thoracotomy, aka resuscitative Thoracotomy.

This first episode covers the who, and our next episode covers the how.

The most important decision you'll make when it comes to an ED Thoracotomy is who gets one.

That's right. So even though it's the most important, it's probably the most overwhelming decisions you can make, right?

The patient rolls in, they're an extremist. People are kind of everywhere. The entire team is looking at you because you're the captain.

The Thoracotomy tray is prepped and ready. So the question becomes, do you pick up the knife and start making the cut?

Right, Teddy, you're absolutely right. This can be a harrowing decision. The ED Thoracotomy lives in an entity all of its own.

And it is extraordinarily complex. So are you giving up on the patient? Are you letting them die if you don't do it?

Or if you do, are you performing a frivolous procedure that's putting other people at risk and wasting precious resources at your institution?

Now, there's a certain amount of art and patient-specific decision making that goes into these decisions.

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