What makes a good surgical leader—and what happens when people are afraid to speak up?

Dr. Paula Ferrada returns to Trauma ICU Rounds for a conversation about leadership in surgery, psychological safety, mentorship, and building teams that put patients first.

We begin with hemorrhage-first trauma resuscitation and the difficulty of challenging established practice, then explore how surgeons earn trust, respond to mistakes, support colleagues, and develop the next generation of leaders.

Topics include:
• Moving beyond blame and shame in surgical training and quality improvement
• Why leadership requires more than a title
• Finding mentors and supporting others as they advance
• Managing your own emotions under pressure
• Addressing gender bias and creating leadership opportunities
• Balancing decisive trauma team leadership with a culture of speaking up
• Approaching a struggling colleague with empathy
• Practical steps to become a better leader tomorrow

A conversation for surgeons, trainees, and anyone leading a team in trauma or critical care.

Resources:
The 5 Levels of Leadership — John C. Maxwell

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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

This is a Visual Rounds episode — a more foundational crossover from the YouTube side of Trauma ICU Rounds.

Shock is not simply hypotension.

In this episode, we work through a physiology-first approach to shock: oxygen delivery, cardiac output, arterial oxygen content, MAP versus perfusion, compensated shock, mixed shock, and the four major shock states — hypovolemic, cardiogenic, obstructive, and distributive.

The goal is to move beyond simply naming a shock category and instead understand what part of the circulation is failing, what physiology is dominant, and how that should shape the first moves in resuscitation.

Topics include:

• Recognizing shock before profound hypotension develops
• Oxygen delivery: DO₂ = cardiac output × arterial oxygen content
• Cardiac output, preload, contractility, and afterload
• The importance of hemoglobin and oxygen-carrying capacity
• MAP versus tissue perfusion
• Compensated and mixed shock
• Hypovolemic, cardiogenic, obstructive, and distributive shock
• Initial resuscitation and mechanism-specific treatment

This episode is intentionally foundational and provides the framework for deeper Trauma ICU Rounds episodes on individual shock states and resuscitation.

If you find this kind of physiology-first critical care teaching useful, subscribe to Trauma ICU Rounds on YouTube for the full Visual Rounds series.

More resources: traumaicurounds.ca

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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

Whole blood has made a remarkable comeback in trauma resuscitation. Physiologically, the rationale is compelling, and observational studies have suggested improved survival. But the recent randomized TOWAR and SWiFT trials have challenged the assumption that whole blood is clearly superior to component therapy.

In this episode of Trauma ICU Rounds, we review the rationale for low-titer group O whole blood (LTOWB), the major observational data supporting its use, what TOWAR and SWiFT actually showed, and how these findings should influence contemporary damage-control resuscitation.

Topics include:

• Low-titer group O whole blood (LTOWB)
• Observational versus randomized evidence
• TOWAR and SWiFT
• Whole blood versus balanced component therapy
• Integrating whole blood into massive hemorrhage protocols
• Calcium, warming, TXA and hemorrhage control
• RhD considerations in females of childbearing potential

The central question: whole blood clearly works as a resuscitation product—but is it actually better than excellent component therapy?

Full notes, graphics and references: traumaicurounds.ca

Follow @traumaicurounds on Instagram and TikTok, and subscribe on YouTube for new trauma and critical care teaching.

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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

After four years away, Trauma ICU Rounds is back.

In this short relaunch episode, I reflect on the journey from California back to Canada, how my clinical and leadership roles have evolved, and why now is the right time to return to the podcast.

We also share what comes next: clear, practical, evidence-informed conversations in trauma, critical care and resuscitation—designed to make complex topics easier to understand and apply at the bedside.

Welcome back to Rounds.

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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

In this episode we sit down with the Chief of Trauma, Surgical Critical Care, Burns, & Acute Care Surgery at the University of Arizona, Dr. Bellal Joseph, who share with us his thoughts and research findings on hot topics including frailty, geriatric trauma, leadership, and more.

Timestamps:
00:12 Introductions
01:30 What is frailty? Your physiologic NOT chronologic body.
06:58 Injured elderly trauma patients can have good outcomes
07:30 Trauma specific frailty index
10:48 Failure to rescue
13:57 Geriatricians and the trauma surgeons
15:08 4Ms-What Matters, Mobility, Mentation, Medication
16:48 Geriatric cohorting/wards
22:24 ACS geriatric centers of excellence
29:35 Brain Injury Guidelines (BIG)
38:17 The importance of teamwork & servant leadership
40:28 Imposter syndrome
43:19 Leadership considerations
45:25 Final thoughts

References:
Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, Wynne J, Tang A, O'Keeffe T, Rhee P. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014 Apr;76(4):965-9. doi: 10.1097/TA.0000000000000161. PMID: 24662858.

Joseph B, Obaid O, Dultz L, Black G, Campbell M, Berndtson AE, Costantini T, Kerwin A, Skarupa D, Burruss S, Delgado L, Gomez M, Mederos DR, Winfield R, Cullinane D; AAST BIG Multi-institutional Study Group. Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28. PMID: 35343931.v

Joseph B, Pandit V, Haider AA, Kulvatunyou N, Zangbar B, Tang A, Aziz H, Vercruysse G, O'Keeffe T, Freise RS, Rhee P. Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury: The Role of Acute Care Surgeons. JAMA Surg. 2015 Sep;150(9):866-72. doi: 10.1001/jamasurg.2015.1134. PMID: 26107247.

Joseph B, Pandit V, Sadoun M, Zangbar B, Fain MJ, Friese RS, Rhee P. Frailty in surgery. J Trauma Acute Care Surg. 2014 Apr;76(4):1151-6. doi: 10.1097/TA.0000000000000103. PMID: 24662884.

Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, Fain M, Mohler MJ, Joseph B. Emergency general surgery specific frailty index: A validation study. J Trauma Acute Care Surg. 2016 Aug;81(2):254-60. doi: 10.1097/TA.0000000000001120. PMID: 27257694.

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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

In this episode, we talk all things critical care the one and only, Dr. Jean-Louis Vincent aka. JLV. This episode is a MUST listen. We touch upon the evolution of early goal directed therapy, measures of fluid responsiveness, optimizing oxygen delivery, and the importance of integrating data points versus examining them in isolation when caring for our critically ill and injured patients. This and MUCH MUCH more in arguably one of my favorite episodes to date!!

Timestamps

00:00 Introduction
01:21 What happened to SG catheters and should we use them?
04:05 What decreases mortality in critical care patients?
05:30 When to transfuse critical care patient? Use your brain!
08:55 Measures of tissue perfusion and fluid responsiveness
09:36 JLV breaks down the Rivers trial
10:36 Recent EGDT papers
10:54 How to optimize O2 delivery? Late ScVO2, dob challenge, and fluid challenges
13:21 Dynamic measures of fluid responsiveness
13:46 CVP as a relative value
15:14 Passive leg raising (PLR) as a measure of fluid responsiveness
21:20 JLV's take on therapeutic nihilism
24:45 Don’t isolate; integrate!
26:46 Navigating the future of critical care – JLV’s thoughts on AI in the ICU
29:55 Rapid fire hot topics in the ICU – Yes or No
-Metabolic cocktail
-Corticosteroids for septic shock
-Albumin and Lasix or Lasix alone
PCT/CRP and sepsis/Abx

Resources:
International Symposium on Intensive Care and Emergency Medicine (ISICEM):
https://www.isicem.org

ISICEM Chats Platform:
https://www.isicem.org/e-chat/index.asp

Articles:
Passive leg raising:five rules, not a drop of fluid! https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0708-5

The fluid challenge
https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03443-y

Blood lactate levels in sepsis: 8 questions
Vincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care. 2021 Jun 1;27(3):298-302. doi: 10.1097/MCC.0000000000000824. PMID: 33852499.

We should avoid the term "fluid overload"
https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2141-7

EGDT in the Treatment of Severe Sepsis and Septic Shock
https://www.nejm.org/doi/full/10.1056/nejmoa010307

A Randomized Trial of Protocol-Based Care for Early Septic Shock
https://www.nejm.org/doi/full/10.1056/nejmoa1401602

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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

In this episode, we discuss the overarching importance of AVOIDING iatrogenic harm in the ICU with arguably one of the world's leading experts in critical care medicine, the one and only, Dr. Jean-Louis Vincent aka. JLV.
Tune in as Dr. Vincent shares with us the importance of having a systematic, problem-based approach to patient care delivery which, of course, involves giving our patients a FAST HUG every day!

Time Stamps:

2:10 LA Critical Care and Differences between Europe versus USA

4:04 COVID, Modern tech and bedside care

5:32 ICU Rounds – How I do it

6:00 Team Based ICU Care

7:56 Modern advances in critical care

9:55 Problem-based approach in the ICU

13:18 FAST HUGS

14:00 Feeding

14:36 Analgesia & Sedation

15:46 Thromboembolic prophylaxis

16:25Head of the bed elevated

17:17Ulcer prophylaxis

19:22Glucose control

20:48 Tube feeds, yes? Ulcer ppx , no.

22:30 Outro

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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.

It's been a while! We are coming to you from our new studio in Victoria on Vancouver Island, BC. This Season is PACKED with incredible content, interviews and educational pearls designed to improve the quality of care that you are deliver daily at the bedside to your patients and their loved ones.

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Trauma ICU Rounds is intended for healthcare education. It does not replace clinical judgment, individualized patient care or local protocols.