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In-depth Review: Penetrating Truncal Injury
Release and Expiration Dates
Released: 6/18/21
Expires:    12/31/2026
Last Reviewed Date
6.18.2021, 03/20/2024
In-depth Review: Penetrating Truncal Injury

Access the best of clinical expertise in TCAA's Trauma University. Session II, In-depth Review: Penetrating Truncal Injury, reviews a rural trauma case and its corresponding decisions surrounding law enforcement and EMS coordination, levels of trauma care, transport options, MTP and quality management. 

Estimated completion time:
105 minutes
Target Audience: The trauma healthcare team and other clinical departments

Learning Objectives:
At the conclusion of this course, the learner should be better able to:
1. Describe the principals of damage control surgery 
2. Define best practices utilized in pre-hospital and inter-facility transfers 
3. Describe the differences in care/resources between a level I and level III 

Moderator: Dr. Charles Mains

Dr. Mains is currently the Trauma Medical Director for Centura Health Trauma System which includes 18 designated trauma centers in Colorado. Additionally, he provides trauma program consultation for 18 additional rural centers caring for trauma patients across Colorado & Kansas. He served as the Trauma Medical Director at St. Anthony Hospital, a Level I trauma center, for sixteen years and served as a member of the medical staff for almost twenty years, most recently as the Vice President of Medical Staff. Dr. Mains graduated from Duke University Medical School and received his post graduate education at the University of Colorado Surgical Residency Program. He is a fellow of the American College of Surgeons, a member of the Western Trauma Association, American Association for the Surgery of Trauma and The Society of Critical Care Medicine. In addition, he has authored numerous peer reviewed publications and speaks both nationally & internationally on a variety trauma related topics. Dr. Mains is actively involved in the State trauma system, currently serving as a governor appointed member of State Emergency Medical and Trauma Services Advisory Council, Chairman of the State Trauma Advisory Council and Chairman of Mile High Regional Emergency Medicine and Trauma Advisory Council. Dr. Mains is committed to trauma education across the state and frequently provides trauma lectures at facilities, EMS departments, and ski patrols. He is a course director for the Advanced Trauma Life Support course, Rural Trauma Team Development course (both through the American College of Surgeons) and an instructor for Fundamentals of Critical Care Support (supported by the Society of Critical Care Medicine).


Thomas Resignolo

Thomas (TR) has been involved in emergency medical services for almost 40 years.  He has worked as a firefighter, paramedic, ski patroller, search and rescue paramedic, SAR dog handler and EMS educator.  TR developed the first wilderness paramedic program in the country and continues to provide medical coverage for various backcountry events throughout the year such as the Colorado 500, 600 and Project Healing Waters.  He is currently the EMS Coordinator for St. Anthony Summit Medical Center in Frisco Colorado.   When not working you will find him camping and fly fishing in the Everglades and Southwest Florida.

Marco Bonta
Marco J. Bonta, MD, MBA, FACS is Trauma Medical Director at OhioHealth Riverside Methodist Hospital in Columbus, Ohio. Dr. Bonta is board certified in surgery and fellowship trained in vascular surgery. His research interests are trauma performance improvement, triage accuracy, simulation training for residents and APPs, and limitation of radiation exposure in trauma. Dr. Bonta served two terms on the Verification Review Committee of the American College of Surgeons Committee on Trauma, and has conducted more than 200 trauma verification site surveys for the ACS and various states. He has been an invited trauma visiting professor to the Russian Federation and to the Kingdom of Saudi Arabia, and has presented at international trauma meetings in England, Norway, Russia, Italy, Slovenia, Czech Republic, France, and Germany. 

Kyle Cunningham
Dr. Kyle Cunningham graduated from the University of Cincinnati School of Medicine in 2009, and subsequently completed his residency in general surgery at the University of Tennessee—Chattanooga in 2014. Following residency, Dr. Cunningham completed a trauma and surgical critical care fellowship at the University of Maryland R Adams Cowley Shock Trauma Center. He sought additional study in the area of health policy and management at the Bloomberg School of Public Health at Johns Hopkins University, focusing on healthcare leadership and management. Dr. Cunningham serves as Director of Surgical Simulation at the Carolinas Simulation Center, Specialty Medical Director for the Surgical Critical Care Fellowship through the Center for Advanced Practice, and serves as Associate Trauma Medical Director for Quality and Process Improvement. Aside from clinical practice, he also conducts research in the areas of trauma resuscitation, trauma systems planning, quality and process improvement, injury prevention, and health policy. 

Marco Hidalgo
Marco Hidalgo, MD, specializes in general elective, trauma and robotic surgery. He joined Northshore Surgical Specialists in 2015.He provides an individualized approach to each patient, focusing on returning patients to their active lives as quickly, safely and pain-free as possible. Dr. Hidalgo has earned several degrees from Tulane University, including a bachelor’s degree in philosophy, a bachelor’s degree in cell and molecular biology, and a master’s degree in cell and molecular biology. He earned his medical degree from the Tulane School of Medicine, where he also completed his residency in general surgery. He was chief administrative resident and was awarded the prestigious Elmo Cherise Chief Resident of the Year award. He serves on the board of Lakeview Regional medical center where he is also the director of surgery department and truama medical director. He is a staff surgeon at Lakeview Regional Medical Center, Covington. When he’s not wearing scrubs, Dr. Hidalgo enjoys playing tennis, competing in triathlons and keeping up with his two young sons. 

Peer Reviewer
Christopher Hogan
Allan D. Lamb
Stephen Johnson
Armand R.; Hess JR. Treating coagulopathy in trauma patients. Transfus Med Rev. 2003 Jul;17(3):223-31.

Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;33:1105-9.

Champion, H. R.; Lombardo, Louis V.; Wade, Charles E.; Kalin, Ellen J.; Lawnick, Mary M.; Holcomb, John B. (2016, September). Time and Place of Death from Automobile Crashes: Research Endpoint Implications. Journal of Trauma and Acute Care Surgery, 81(3), 420-426.

Davis DP, Hoyt DB, Ochs M, Fortlage D, Holbrook T, Marshall LK, Rosen P. The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma. 54(3):444-53, March 2003.

Demetri L, Martinez Aguilar MM, Bohnen JD, Whitesell R, Yeh DD, King D, de Moya M. Is observation for traumatic hemothorax safe? J Trauma Acute Care Surg. 2018 Mar;84(3):454-458.

Dennis BM, Gondek SP, Guyer RA, Hamblin SE, Gunter OL, Guillamondegui OD. Use of an evidence-based algorithm for patients with traumatic hemothorax reduces need for additional interventions. J Trauma Acute Care Surg. 2017 Apr;82(4):728-732.

Drew B, Auten JD, Cap AP, Deaton TG, Donham B, Dorlac WC, DuBose JJ, Fisher AD, Ginn AJ, Hancock J, Holcomb JB, Knight J, Koerner AK, Littlejohn LF, Martin MJ, Morey JK, Morrison J, Schreiber MA, Spinella PC, Walrath B, Butler FK Jr. The Use of Tranexamic Acid in Tactical Combat Casualty Care: TCCC Proposed Change 20-02. J Spec Oper Med. 2020 Fall;20(3):36-43.

Inaba K, Aksoy H, Seamon MJ, Marks JA, Duchesne J, Schroll R, Fox CJ, Pieracci FM, Moore EE, Joseph B, Haider AA, Harvin JA, Lawless RA, Cannon J, Holland SR, Demetriades D; Multicenter Shunt Study Group. Multicenter evaluation of temporary intravascular shunt use in vascular trauma. J Trauma Acute Care Surg. 2016 Mar;80(3):359-64; discussion 364-5.

Mathew S, Smith BP, Cannon JW, Reilly PM, Schwab CW, Seamon MJ. Temporary arterial shunts in damage control: Experience and outcomes. J Trauma Acute Care Surg. 2017 Mar;82(3):512-517.

Meizoso, Jonathan P.; Ray, Juliet J.; Karcutskie, Charles A. IV; Allen CJ, Zakrison TL, Pust GD, Koru-Sengul T, Ginzburg E, Pizano LR, Schulman CI, Livingstone AS, Proctor KG, Namias N. Effect of time to operation on mortality for hypotensive patients with gunshot wounds to the torso: The golden 10 minutes. Journal of Trauma and Acute Care Surgery. 81(4):685-691, October 2016.

Mowery NT, Gunter OL, Collier BR, Diaz JJ Jr, Haut E, Hildreth A, Holevar M, Mayberry J, Streib E. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma. 2011 Feb;70(2):510-8.

Plurad DS, Chiu W, Raja AS, Galvagno SM, Khan U, Kim DY, Tisherman SA, Ward J, Hamill ME, Bennett V, Williams B, Robinson B. Monitoring modalities and assessment of fluid status: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2018 Jan;84(1):37-49.

Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, Cook L, Kawahara T, Perel P, Prieto-Merino D, Ramos M, Cairns J, Guerriero C. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013 Mar;17(10):1-79.

Subramanian A, Vercruysse G, Dente C, Wyrzykowski A, King E, Feliciano DV. A decade's experience with temporary intravascular shunts at a civilian level I trauma center. J Trauma. 2008 Aug;65(2):316-24; discussion 324-6.

Williams J, Merutka N, Meyer D, Bai Y, Prater S, Cabrera R, Holcomb JB, Wade CE, Love JD, Cotton BA. Safety profile and impact of low-titer group O whole blood for emergency use in trauma. J Trauma Acute Care Surg. 2020 Jan;88(1):87-93.

Wlodarczyk JR, Thomas AS, Schroll R, Campion EM, Croyle C, Menaker J, Bradley M, Harvin JA, Collum ML, Cho J, Seamon MJ, Leonard J, Tiller M, Inaba K, Moore MM. To shunt or not to shunt in combined orthopedic and vascular extremity trauma. J Trauma Acute Care Surg. 2018 Dec;85(6):1038-1042.
Availability: On-Demand
Cost: FREE
Credit Offered:
1.75 CE Credits
1.75 COP Credits
1.75 TCAA CME Credits
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