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Sun Mar 27 23:52:20 BST 2005

Mohammed

Could you post the summary on the trauma.org website for the rest of us?

Matt Oliver
Bendigo
Australia

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Mohamed al Malik
Sent: 28 March 2005 00:28
To: Trauma & Critical Care mailing list
Subject: Re: TOP KNIFE CONFERENCE

Lee:

The highlights of this course for me were:

1.  Two rapid moving case management sessions, moderated by Dr. Mattox.
The first focused on the rural perspective and the second focused on
urban cases.   The 4 panelist submitted 2 cases each, and the moderator
then put them into a format that no one knew the origin of the cases.
The panel was given bits and pieces of the case and all asked to
comment.   For each session Dr. Mattox selected a volunteer from the
audience to be a guest panelist.   Dynamite.   

2.  The lectures on the infrequent conditions of fat embolism syndrome,
venous air embolism, arterial air embolism, and cardiac herniation
(cause of death in Princess Di), were especially informative.

3.  Dr. Offner talked of the impact of old bank blood on contributing to
SIRS in the ICU.  I found this to be the best lecture of all.

4.  Dr. Mackersie talked about VOMIT syndrome, actually quoted
information from this chat list, and warned that everything that the
radiologist sees on the new imaging technology is not pathologically or
clinically significant.   Well received lecture.

5.  Dr. Mattox had a session about late breaking trauma news.   He cited
recent information from the drug companies on Xigris, without editorial
comment from him.   He then made a very professional comment relating to
the santity of the practice of medicine, how everyone in the room had as
a nurse, doctor, or family member had faced many tough decisions
regarding clinical conditions.   He then pleaded that the practice of
medicine be defined by the professions, state board of medical
examiners, and hospital regulations and credentialling committees.  He
stated that governments and their subdivisions of governors,
legislators, and courts must not tell doctors and nurses what to do,
when to operate, and when to give or withdraw treatment.   That is
between a patient and their doctor.    The audience had a sustained
ovation to these comments.   (everyone I talked to stated that if the
government ordered them to put a tube back into a patient that they and
the patient and family 
 had
 agreed was best practice, they would NOT put it back in just to follow
a governmental order).   Dr. Mattox cited that in Europe during the
1940s doctors followed the orders of a dictator, and that we have been
there, done that, and do not want to return to government telling us
what to do.

6.  I found that the session on using protocols to drive decision making
in the EMS, ER, OR and ICU to be very helpful.   Better results occur
when we follow best practices the same way every time.

7.  The talks by Dr. Johannigman and Dr Rhee were professionally given
and underscore the dedication of our physicians and nurses serving in
the military in Iraq.  The advances of body armor, fluid restriction,
topical hemostatic agents, new tourniquets, damage control surgery in
the field, rapid movement using in flight care, and definitive surgery
in Germany were cited.   The frustrations of medical records was
discussed.    

8.  Dr Offner gave a talk on a new total body image machine which gives
low dose radiation (less than our current x-ray), and can be used as a
very rapid screen upon entry into the emergency room.   It accomidates
very heavy patients.   It was both impressive and expensive.   He stated
that no comparison data exists on impact on decision making.    He
showed some keen images made from the machine.

9.  Dr Tuggle convienced me that I should control high glucose (>200) in
the ICU in post trauma patients.  Great lecture.

10.  Dr. Trunkey in his spleen injury talk and in his liver trauma
debate with Dr. Demetriades pushed for LESS non-operative management of
severe injury to these organs   

11.   Some of the speakers had very fancy powerpoint slides with images
jumping in and out, movies, sounds, and lots of fancy stuff.   I found
these offensive and distracting from the messages of the talk.   Those
speakers were very proud of their ability to make powerpoint into almost
a movie, but the audience got caught up in the mechanics of the
presentation and lost the message.   These speakers could benefit from
one of the messages of the conference, keep it simple and consistent.  

12.   The most amazing thing I have ever seen was the final talk   Dr.
Mattox apparently takes notes on his computer in the back of the room
all during the conference.   He captured the central point of EVERY talk
and summarized each talk on ONE slide.   He was very fair to give the
teaching point of the presenter and not his own views.    When he did
want to editorialize, he would state that these were his views and not
the presenters.   His contrast was not offensive.   In 43 minutes he
summarized the conference of 2.5 days.   I found it a very useful review
and am going to try to get a CD of this summary to give a presentation
to my residents.    

13.   I was able to network with the gurus of surgery as well as doctors
and nurses from around the USA and 18 foreign countries.   This
networking was very helpful as I learned that many of us are facing
identical problems in our hospitals.    

Thank you, Dr. Reed for giving me the opportunity to give more detail on
some of the things I learned from this incredable conference.  

I would hope that some of these discussion points prompt interaction by
the members of this internet discussion group.

Mohamed al Malik

Lee Reed <creedyrniam at sbcglobal.net> wrote:
Thank you, Mohamed, for your critique of the conference...I can't wait
to hear other's reviews...the docs i work with all speak so highly of
the conference, i can't wait for the day i can afford (monetarily) to
attend one myself...
Lee Reed RN

Mohamed al Malik wrote:
I have just returned to LA having attended the most INCREADABLE
educational experience in my life. The Las Vegas Trauma & Critical Care
2005 was a complete sell out, with more than 1250 people in the room (no
other seats available, room full), and the conference starting at 6:30
AM daily and going to 6:00 PM. 62 very very practical talks were given
with the intent to influence my (and everyone's) clinical practice
immediately upon return. Doctor Mattox is the course director, and his
omnipresence is always in the background, but precisely disciplined.
EVERYTHING starrts and stops on the exact time. You can set your watch
by the precision. The room was full for the last talk today, after a
very grueling 2 1/2 days. We listened to a 43 minute review by Doctor
Mattox who summarized on one powerpoint slide each and every talk, with
him taking notes during the conference. Even most of the faculty
remained for this absolutely incredable and very fair summary. 

The British publisher of the Hirshberg/Mattox book, Top Knife, had a
booth at the meeting and sold out of all the books she brought with her.
Doctors Mattox and Hirshberg were very busy signing books. It sold there
for $39.00. The comments from my colleagues and the fellows who were
present bespoke the remarkable nature of this very very practical and
free wheeling style book, with no references, no graphs, and no notation
to evidence based medicine. But it does tell me how to think, how to get
out of a deep and smelly problem. The talk in the hall about this little
paper back was the hottest thing at this meeting, which was full of hot
topics. WOW !

On Tuesday, during a talk called Late Breaking News, Doctor Mattox made
a spontaneous statement from the podium regarding the Schiavo case which
brought repeated and sustained applause from the audience. He
acknowledged differing political and even value issues among all of us,
and then made a tremendously logical statement about the medical and
nursing professoin, our moral and legal contract with society, and the
need for all societies to allow these professions to practice medicine
within current state licensure boards, hospital bylaws, professoinal
standards, and the principles of beneficence and autonomy. He asked a
very provocative question as to why the major professional medical
organizations had remained silent, and pleaded that the patient (or
legal patient surrogate)/physician relationship be maintained. He asked
many of us in a hall conversation after his statement, if we would
reinsert a tube, give a drug, do an operation, or turn off a respirator
if we did
not
believe it was the best medical care, but were ordered to do so by a
judge, legislature, governor, congress, president or military general.
Every doctor and nurse there indicated that they would go to jail before
doing something that was professionally NOT indicated. 

A couple of the 62 talks can be termed very good, but all the rest must
be graded as fantastic and excellent. I had heard some of the California
speakers in the past, but they rose to a much higher level of
expectation and performance at this course. I have never never
experienced anything like this in all my life, from a benficial course
standpoint. Even if CMEs were not required, I would go to this course
because it gave me what I really want to know to help me take care of my
patients, with todays technology and information. Not everything was
clearly black and white, and it was the areas of controversary among the
top knives in trauma around the US, that was the most helpful. They too
struggle with decision making. This course, is THE educational model
against which all other medical courses, meetings, and conferences
should be measured. 

Like many other things I saw in Las Vegas, such as the hotels and shows,
this was just an INCREDABLE experience. I have already filled out my
paperwork to go to next years conference. 

Mohamed

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