Bellal Joseph

Read the article "One incision, complete access: Median sternotomy and aortic occlusion in penetrating chest trauma" journals.lww.com/jtrauma/abstra…

Wonderful opportunity to share our research at #SWSC2026. Grateful for the training, mentorship and the team that shaped us @AZTraumaCats @topknife @DesertTraumaMom @MollyJDouglas @UofAZSurgery @rebekahhuckeby @MyaMahankaliDO

Closing out fellowship on a high note at Southwest Surgical Congress #SWSC2026 All three of us had the opportunity to present our research this year—proud to represent our program #UofA and thankful for the mentorship and teamwork behind it all.

Closing out fellowship on a high note at Southwest Surgical Congress #SWSC2026 All three of us had the opportunity to present our research this year—proud to represent our program #UofA and thankful for the mentorship and teamwork behind it all.

🫀The failing right ventricle: the most misunderstood chamber in critical care For years, we focused on the left ventricle. But in the ICU, the real killer is often the right ventricle. ->What is acute RV failure? 👉 Not just “weak contraction” It’s a hemodynamic collapse syndrome: RV dilation ↓ LV preload ↓ cardiac output ↑ venous congestion ➡️ → multi-organ failure ->The key pathophysiology (the vicious cycle) 1. ↑ Afterload (PE, ARDS, PH) 2. → RV dilation 3. → Septal shift → LV underfilling 4. → ↓ CO → hypotension 5. → ↓ RCA perfusion 6. → RV ischemia 👉 And the cycle accelerates ->The most important concept 👉 The RV does NOT tolerate pressure Handles preload very well Fails rapidly with afterload ➡️ Even small ↑ PVR → collapse ->Main causes you MUST think first 🔴 Pulmonary embolism 🔴 RV myocardial infarction 🔴 ARDS / mechanical ventilation 🔴 Decompensated pulmonary hypertension 🔴 Post-cardiac surgery ->Diagnosis is NOT obvious There is no single sign. 👉 It requires suspicion + integration: Clinical: congestion + hypoperfusion ECG + biomarkers POCUS (your best friend 🤓) Hemodynamics ->Echo mindset (fast ICU approach) 👉 Don’t overcomplicate Look for: ✔ RV dilation ✔ Septal shift (D-sign) ✔ TAPSE ↓ ✔ Venous congestion The real ICU mistake ❌ Treating RV failure like LV failure ->Management principles 👉 Think in 4 pillars: 1. Preload — “not too much, not too little” Hypovolemic → small fluid Congested → REMOVE fluid 👉 CVP is not a target, it’s a warning 2. Afterload, THE key target ✔ Treat PE ✔ Optimize ventilation ✔ Reduce PVR 👉 If afterload stays high → RV will fail 3. Contractility Dobutamine Milrinone Levosimendan 👉 Choose based on context 4. Perfusion pressure 👉 Norepinephrine is your anchor ✔ Maintains coronary perfusion ✔ Supports RV function ->Ventilation: the silent killer ⚠️ Positive pressure = ↑ PVR 👉 Over-ventilate → worsen RV failure ->When nothing works 👉 Think early: VA-ECMO RV assist devices 🤓Key insight This is NOT just a cardiac problem. 👉 It is a ventriculo–arterial coupling failure When: Ees / Ea ↓ → RV collapses 🤓Bottom line ✔ RV failure is preload dependent BUT afterload sensitive ✔ Small mistakes → rapid collapse ✔ Early recognition + physiology-based treatment saves lives ->Clinical mindset 👉 Don’t ask: “Is the RV failing?” 👉 Ask: “Why is the RV failing and, what is driving the afterload?” 📃Reference Giannakoulas G. et al. European Heart Journal (2025) 00, 1–16 doi.org/10.1093/eurhea…