The Martlet; a newsletter where Surgery, Culture, Innovation, Finance and Informatics cohabitate
April 12, 2021
The year has been off to an incredible start

The InterTrauma crew has found itself at the crossroads of surgery and culture, while still doing its part doing safety net COVID ICU care.

Abigail Shirley, one of our nurses at the Dr. Oz Show was ON the Dr. Oz show and Alex Guerrero was recently a guest on Desus & Mero. Obama and Dr. Fauci were a tough act to follow, but the interview went alright. Check out a clip from the show. Though just to address all the comments from the YouTube page, it was actually Dr. Guerrero, not Lin-Manuel Miranda posing as a physician.

Boxing matches are restarting in New York this month, and we are eager to return to the ringside.
Science and Art spring from the same source
-Theodor Billroth
Vienna in the last half of the 19th century was the place to be. It was here that Johannes Brahms, the composer, and Theodor Billroth, who many consider the father of Abdominal Surgery, became dear friends. Billroth hosted many premieres of Brahms' chamber pieces. So in 1873 Brahms dedicated his two Opus 51 string quartets in A minor and C minor to Billroth. These are known as Billroth I and Billroth II, respectively.

Billroth I: Gastric remnant to duodenal stump AND Brahms' String Quartet Op 51 No 1 in A minor

Billroth II: Gastric remnant with Gastro-Jejunostomy AND Brahms' String Quartet Op 51 No 2 in C minor
Ever wanted to be an insider? This is your chance to participate in an exclusive sneak preview of a film before the public gets to see it
As a subscriber to The Martlet, you are invited to a virtual private film screening!

Burden of Genius, the story of Dr. Thomas Starzl, the father of Liver Transplantation

This is an incredible story of a larger than life surgeon. We're pretty sure this story will resonate with everyone that reads this newsletter

Dress code: Black Tie optional

Thursday, April 29, 2021

6:45pm Technical check

7:00pm Introduction and Screening
via Zoom or link emailed to registrants

8:30pm Live Q&A with distinguished panelist
Panelists include:

+Tjardus “T.J.” Greidanus
Film Director, Burden of Genius
+Robert Montgomery, MD, DPhil
Director, NYU Langone Transplant Center
+Lewis Teperman, MD, FACS
Director, Northwell Transplant Institute
+Andrew Peitzman, MD, FACS
System Chairman of Trauma, UPMC
+Alex Guerrero, MD, FACS
Surgeon-in-Chief, InterTrauma Surgical

Submit questions in advanced to guerrero@InterTrauma.com
or type in the chat during the Q&A
Register at this site:
Easy Money: Do you bill Critical Care for Trauma Activations?
This IS a controversial question with no clear cut answer. That is probably why it is the most common question we get when it comes to trauma finance.
There are really 4 opinions. Here they are from most conservative to most liberal:
1) Never bill Critical Care professional fee because the patient is not in the ICU
2) Bill it if they end up going to a critical care unit. So, CC time is billed from the moment they arrive until they get to the ICU
3) Case-by-case: Basically if it "sounds" serious enough CC time is billed
4) On every trauma activation because by definition, trauma activations are to manage or exclude a life threatening injury.
Which should you do? The key is to be deliberate about your approach and be ready to defend it.
Stab wound to the neck? Here's a little tip
You get called to the trauma bay and there's a stab wound to the neck. Some poor medical student is holding pressure and the dressings are soaking through and the blood pressure is dropping. What to do?
Insert a Foley catheter into the stab wound and inflate. This compresses the artery or vein allows you to start your resuscitation and get to the Operating Theatre.
A few tips:
  1. Intubate before inflating, or you'll have a tough time due to the displacement by the balloon
  2. If the wound is huge, place horizonal mattress sutures with #2 nylon to hold the balloon in place. Just don't pop your balloon.
  3. Use an umbilical clip to keep the depth exactly where you want it, and keep the lumen closed.
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