Sleeptalker - January 2020

James P. Dilger, PhD

    Hailing from UCLA Department of Anesthesiology & Perioperative Medicine, our Visiting Professor this month is Maxime Cannesson, MD, PhD. Dr. Cannesson wears several hats in his department: Professor of Clinical Anesthesiology, Vice Chair for Perioperative Medicine, Director of Clinical Research, and Vice Chair for Research. His research specialty is Perioperative Medicine.

    Dr. Cannesson received his MD from Denis Diderot University, Saint Louis Hospital in Paris, France. HIs residency in anesthesiology was at Claude Bernard University, Hospices Civils de Lyon Medical Center in Lyon, France. Subsequently, he received a PhD in Cardiovascular Physiology from Claude Bernard University. In 2004, he came to the US and did a fellowship at the University of Pittsburgh Medical Center.

    Dr. Cannesson's research is focused on phenomics, the study of the interaction of genes and the environment, and how it can shape the management of critically ill patients. His group uses computing and informatics to develop novel monitoring systems, and to develop predictive physiological tools.

    Dr. Cannesson will be at Stony Brook on Tuesday, January 21 when he will speak to the residents at 5 pm and on Wednesday, January 22 when he will address the department at 7:00 am. Welcome to Stony Brook Dr. Cannesson!

Joseph Gnolfo III, DNP, MS, ACNP, CRNA

   I received an email from a patient commenting on the care he received. "I had the pleasure of being a patient of Nancy Perez, CRNA on November 4th. I was having a hip replacement and was quite anxious but fortunately, Nancy was the CRNA on my case. She is pleasant, caring and professional. I cannot tell you how much of a difference it made for me to have her take care of me! "

Patient comments about our Ambulatory Surgery Center staff compiled from the Press Ganey questionnaires by Marisa Barone-Citrano, MA

   Everyone at the facility was excellent. The care and professionalism was very impressive. I was well informed of every procedure and even received follow up calls. Thank you!

   Everyone at the surgical center were nice, kind, caring, compassionate. What a great group of people. From check in to checkout. Superb!!

   Every person I encountered was friendly, helpful and knowledgeable. Facility was extremely clean and nice.

   Love SB Ambulatory Surgery Unit - Nice people and very neat & clean

   Although they have been in the department since late summer 2019, two new employees managed to slip under the radar of Sleeptalker. We belatedly welcome Dr. Ana Mavarez-Martinez, a postdoc working with Dr. Sergio Bergese and Mr. Norman Correa, Assistant Administrator. We really are pleased that you joined the departmental family!

Melissa A. Day, MS, CRNA, CCRN

   Please join me in welcoming two new Anesthesia Technicians: Meagan Rodriguez and Megan Baas. Meagan, who started in November, has over 5 years experience working as an Emergency Medical Technician and as an Emergency Department Technician. She has also worked as an Executive Assistant and in Medical Marketing. Megan, who started in December, graduated from Stony Brook University with a Bachelor of Health Science, Anesthesia Technology Concentration in May 2017. She then completed the Anesthesia Technology PostBac Clinical Internship from September 2017 - June 2018. She has spent the past 1.5 years working as a Medical Assistant and Surgical Tech in a busy Plastic Surgery Group. We are delighted to welcome Meagan and Megan to the Anesthesia Technician Team!

Daryn Moller, MD

    “Code T Level four Critical Care ER”. The words echoing over the hospital PA system make many a call resident cringe at the thought of what lay in store for their night…

    What does it mean to be a Trauma Center? Trauma Centers are categorized in Levels 1 through 4; a Level 1 Trauma Center has the most resources and a level 4 the least. In areas of sparse resources such as a rural setting, level 4 facilities provide stabilization of injured patients and expedited transfer to a facility that can provide definitive care. Level 4 trauma facilities may only be staffed by a mid-level provider such a as Physician Assistant or Nurse Practitioner where Level 3 trauma facilities are capable of providing some rudimentary damage control surgical procedures. Both Level 3 & 4 Trauma Centers lack many resources that we take for granted, yet they are a vital part of a functional trauma system network. It allows the most rapid access to care possible, regardless of the geographic location the injury occurred.

    Both Level 1 and Level 2 centers have a breadth of resources to allow for all aspects of definitive care of the injured patient such as neurosurgery, complex orthopedics and cardiothoracic surgery. Level 2 centers may be either private or academic centers, but frequently lack specialized resources such as the capability to replant digits, oral-maxillofacial or ophthalmologic services. In both Level 1 & 2 Trauma Centers, resources must be available in a timely fashion to the injured patient: An trauma surgeon must be available at the bedside within 15 minutes. Ancillary services such as neurosurgery, interventional radiology must also be available within 30 minutes of activation. (Please remember to sign and date the Trauma flow sheet for every Code T, it documents the timely presence of Anesthesia Services.)

    Stony Brook is one of 18 Level 1 Trauma Centers in New York State that have been verified by the American College of Surgeons. Our re-verification visit occurred in October 2019 and typically occurs every three years. Every Level 1 trauma center is expected to have a minimum volume of trauma admissions (1200/yr) including 240 admissions with an Injury Severity Score (ISS) greater than 15. (ISS is a scoring system that tallies the severity of the injury in different regions of the body). At Stony Brook, there is a graded system of activation based on the severity or injury the patient received. Here are a few of the commonly encountered activation criteria for higher level actions.

CODE T
Trauma Alert

    Another one of the differences between a Level 1 and Level 2 trauma center lay both at the bedside and behind the scenes. Performance Improvement and Patient Safety requires a Level 1 trauma center to focus in on specific issues that it encounters and develop a solution that functions within its existing hospital workflow. At Stony Brook, low level falls in the elderly are one of the most common injuries for adults with over 250 hip fractures per year. The current standard is to have a door to fixation time of less than 48 hours. Stony Brook has been a high outlier for several years and a push was made to expedite the trauma a medical workup of these patients including echocardiograms and cardiology consults. In order to decrease the patients pain while awaiting hip fixation, the Acute Pain Service has been placing fascia Iliaca blocks. With the increased attention and new processes, almost every hip fracture is currently fixed within 48 hours of ED arrival time. To prevent these injuries from happening in the first place, Level 1 Trauma centers need to have a community outreach role. The Trauma Center has provided Tai Chi lessons at senior centers and nursing homes to improve patients balance and strength to prevent falls. Other community outreach has included “Stop the Bleed” classes that have been held at schools and community centers throughout the county. For adolescent drivers, the trauma center has worked with local high schools and defensive driving classes to bring attention to distracted and impaired driving while pediatric community outreach has included traffic safety and helmet safety in schools

    All behind the scenes as well as direct clinical activities are monitored and reported to Trauma Quality Improvement Program that tracks a programs performance in comparison to its peers. This risk adjusted data base reports back to each of the institutions how they are doing in comparison to their peer group. Stony Brook has received a “better than expected” response for 30 day trauma mortality for at least the past year. So when someone sees a hip fracture for a pre-operative block or sees the same patient in the late afternoon as an add on case, please understand that there is a reason behind it all; as members of the trauma group, we are all trying to provide the most timely and optimal care of the injured patient.

Residents Dr. Shuran Ma, Dr. Usama Siddique, Dr. Robert Chojnowski,
Dr. Kathleen Cervo, Dr. Ramanjot Kang, and Dr. Ravi Shah at their PGA posters.
Click here for more photos from the PGA meeting.

Scenes from our departmental holiday party.
Click here for more pictures from the evening.

• Borrell-Vega J, Uribe AA, Palettas M, Bergese SD. Clevidipine use after first-line treatment failure for perioperative hypertension in neurosurgical patients: A single-center experience. Medicine (Baltimore). 2020 Jan;99(1):e18541
• Liu H, Dilger JP, Lin J. The Role of Transient Receptor Potential Melastatin 7 (TRPM7) in Cell Viability: A Potential Target to Suppress Breast Cancer Cell Cycle. Cancers 2020, 12(1), 131