# Cervical Spine Injury — GCMD Library living collection

Everything in the library about cervical spine injury — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 76 cited statements

## Episodes
### Diagnosis & Workup
- [#APSA50: Top Educational Content](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625) — podcast · 67:24 · [machine version](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625.md)

### Case-Based Learning
- [Cervical Spine Injury: Update Course 2016](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861) — video · 21:01 · [machine version](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861.md)

### In-Depth Reviews
- [Trauma](https://library.globalcastmd.com/watch/trauma-313) — podcast · 56:05 · [machine version](https://library.globalcastmd.com/watch/trauma-313.md)

## Chapters
- [0:05](https://library.globalcastmd.com/watch/trauma-313?t=5) Introduction and Center Overview (Ep 3)
- [4:06](https://library.globalcastmd.com/watch/trauma-313?t=246) Cervical Spine Clearance in Cooperative Children (Ep 3)
- [15:10](https://library.globalcastmd.com/watch/trauma-313?t=910) Cervical Spine Clearance in Obtunded and Young Children (Ep 3)
- [20:14](https://library.globalcastmd.com/watch/trauma-313?t=1214) Pancreatic Trauma Management (Ep 3)
- [27:46](https://library.globalcastmd.com/watch/trauma-313?t=1666) Non-Accidental Trauma Screening (Ep 3)
- [33:20](https://library.globalcastmd.com/watch/trauma-313?t=2000) Blunt Abdominal Trauma Evaluation (Ep 3)
- [43:49](https://library.globalcastmd.com/watch/trauma-313?t=2629) Solid Organ Injury Management (Ep 3)
- [48:28](https://library.globalcastmd.com/watch/trauma-313?t=2908) Trauma Activation Criteria (Ep 3)
- [54:50](https://library.globalcastmd.com/watch/trauma-313?t=3290) Closing and Conference Announcement (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=0) 18-month-old ejected from motor vehicle: imaging decision in non-verbal child with high mechanism (Ep 1)
- [7:25](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=445) Twin with distracting femur fracture: clearance strategy with normal initial films (Ep 1)
- [10:30](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=630) Institutional protocols and age-stratified imaging algorithms (Ep 1)
- [15:19](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=919) 10-year-old with midline tenderness: next imaging step (Ep 1)
- [18:21](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1101) Neurologically devastated patient: clearance timing and imaging modality (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=0) Cervical Spine Imaging in Pediatric Trauma - Clinical Cases and Guidelines (Ep 2)
- [15:28](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=928) Q&A on Cervical Spine Clearance Protocols (Ep 2)
- [22:48](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1368) Antibiotic Stewardship in Pediatric Surgery (Ep 2)
- [27:06](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1626) Antibiotic Stewardship Implementation and Nuances (Ep 2)
- [39:57](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2397) Sepsis as a Surgical Problem - The SAVE Approach (Ep 2)
- [54:44](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3284) Sepsis Management Details and TED Talk Methodology (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Cincinnati Children's Hospital is a Level 1 pediatric trauma center verified since 1993, seeing approximately 2000 trauma patients annually." — Rich Falcone (clinical) [Ep 3 · 3:08](https://library.globalcastmd.com/watch/trauma-313?t=188)
- "At Cincinnati Children's, the emergency department physician serves as team leader for all traumas, chosen because they are present when every patient arrives." — Rich Falcone (clinical) [Ep 3 · 3:32](https://library.globalcastmd.com/watch/trauma-313?t=212)
- "The ultimate risk of C-spine injury in pediatric trauma is actually pretty low." — Rich Falcone (epidemiological) [Ep 3 · 4:36](https://library.globalcastmd.com/watch/trauma-313?t=276)
- "At Cincinnati, 90% of children left in C-collars overnight can be clinically cleared the next morning when less distracted and not in the trauma bay." — Rich Falcone (clinical) [Ep 3 · 4:50](https://library.globalcastmd.com/watch/trauma-313?t=290)
- "The Trauma Association of Canada Pediatric Subcommittee published evidence-based C-spine clearance recommendations emphasizing clinical examination as the first test, with imaging only if clinical clearance is not possible." — Rich Falcone (host_summary) [Ep 3 · 6:04](https://library.globalcastmd.com/watch/trauma-313?t=364)
- "For children over 8 with normal X-rays and normal neurologic exam, the Canadian guidelines recommend re-examination rather than immediate CT, with CT or MRI reserved only for those with abnormal neurologic exams." — Rich Falcone (host_summary) [Ep 3 · 7:20](https://library.globalcastmd.com/watch/trauma-313?t=440)
- "Getting CT early in kids with normal neurologic exam and C-spine tenderness is not useful because clinicians won't feel comfortable removing the collar based on imaging alone without resolution of clinical tenderness." — Rich Falcone (clinical) [Ep 3 · 9:20](https://library.globalcastmd.com/watch/trauma-313?t=560)
- "There is enough evidence now that truly awake children without distracting injuries and no midline tenderness do not need X-rays for C-spine clearance." — Rich Falcone (clinical) [Ep 3 · 9:50](https://library.globalcastmd.com/watch/trauma-313?t=590)
- "For obtunded patients with severe TBI, Cincinnati's protocol is CT to rule out bony abnormalities followed by MRI if CT is clear, before removing the C-collar." — Rich Falcone (clinical) [Ep 3 · 13:17](https://library.globalcastmd.com/watch/trauma-313?t=797)
- "A multi-site study published in Journal of Trauma 2009 developed a scoring system for children under 3: 3 points for GCS <14, 2 points for GCS injury score of 1, 2 points for motor vehicle collision, 1 point for age 2-3. Scores of 0-1 had 0.0% chance of C-spine injury; scores of 7-8 had 21% chance." — Rich Falcone (host_summary) [Ep 3 · 16:07](https://library.globalcastmd.com/watch/trauma-313?t=967)
- "In the multi-site study of children under 3, pediatric Level 1 centers obtained C-spine CTs only 17% of the time compared to adult centers which obtained them 24-45% of the time, indicating pediatric centers do too many CTs overall." — Rich Falcone (host_summary) [Ep 3 · 18:48](https://library.globalcastmd.com/watch/trauma-313?t=1128)
- "The primary challenge in pancreatic trauma is determining whether there is a pancreatic duct injury, which is the number one concern." — Rich Falcone (clinical) [Ep 3 · 21:35](https://library.globalcastmd.com/watch/trauma-313?t=1295)
- "There is increasing evidence that true pancreatic duct disruption is better treated with early distal pancreatectomy, ideally splenic-preserving, for grade 3 injuries." — Rich Falcone (host_summary) [Ep 3 · 22:00](https://library.globalcastmd.com/watch/trauma-313?t=1320)
- "CT scans can show significant pancreatic injuries with large cracks through the neck, but ERCP or MRCP may still show the duct is intact, and those children will heal without surgery." — Rich Falcone (clinical) [Ep 3 · 22:40](https://library.globalcastmd.com/watch/trauma-313?t=1360)
- "ERCP has the advantage of being potentially therapeutic with stent placement but the disadvantage of injecting dye that can cause pancreatic inflammation, a risk not present with MRCP." — Rich Falcone (clinical) [Ep 3 · 23:20](https://library.globalcastmd.com/watch/trauma-313?t=1400)
- "Conservative management of pancreatic duct disruption can work and pseudocysts are manageable and drainable, but this approach takes longer with more TPN time and longer hospital length of stay compared to early pancreatectomy." — Rich Falcone (host_summary) [Ep 3 · 24:00](https://library.globalcastmd.com/watch/trauma-313?t=1440)
- "Centers that perform frequent pancreatic operations and are comfortable with laparoscopic distal pancreatectomy have better outcomes operating on pancreatic trauma; centers that rarely operate on the pancreas may put patients at more complication risk and should consider non-operative management." — Rich Falcone (opinion) [Ep 3 · 24:40](https://library.globalcastmd.com/watch/trauma-313?t=1480)
- "The literature increasingly agrees that if operating for pancreatic duct disruption, it should be done within the first 24 hours, not as an immediate surgical emergency but within that window." — Rich Falcone (host_summary) [Ep 3 · 26:45](https://library.globalcastmd.com/watch/trauma-313?t=1605)
- "Cincinnati implemented standardized screening where all children under 2 admitted with head injuries from non-publicly-witnessed mechanisms receive skeletal surveys and social work evaluation, eliminating clinician bias in screening decisions." — Rich Falcone (clinical) [Ep 3 · 28:04](https://library.globalcastmd.com/watch/trauma-313?t=1684)
- "Literature shows clinicians are less likely to suspect abuse in families who look like them, are from the same neighborhood, and are from higher socioeconomic groups, even with identical injury patterns, compared to lower SES or minority families." — Rich Falcone (host_summary) [Ep 3 · 29:20](https://library.globalcastmd.com/watch/trauma-313?t=1760)
- "Before implementing standardized screening, Cincinnati was more likely to perform skeletal surveys on low SES or minority children with head injuries than on middle/upper class non-minority families with identical injuries." — Rich Falcone (clinical) [Ep 3 · 30:20](https://library.globalcastmd.com/watch/trauma-313?t=1820)
- "After implementing unbiased standardized screening criteria, Cincinnati's positive abuse rate remained at 50% despite evaluating more children, indicating they were finding abused children who would not have been screened under the previous biased system." — Rich Falcone (epidemiological) [Ep 3 · 31:00](https://library.globalcastmd.com/watch/trauma-313?t=1860)
- "A screening test with nearly 50% positive rate for abuse in admitted children under 2 with head injuries is more productive than most screening tests used for other conditions." — Rich Falcone (opinion) [Ep 3 · 31:40](https://library.globalcastmd.com/watch/trauma-313?t=1900)
- "Families find standardized screening more reassuring because clinicians can explain it is done for every family with this injury type without making judgments about truthfulness." — Rich Falcone (clinical) [Ep 3 · 33:09](https://library.globalcastmd.com/watch/trauma-313?t=1989)
- "Cincinnati does not routinely perform ophthalmologic exams for non-accidental trauma screening, only obtaining them if skeletal survey is positive or there are other concerning findings like bruising or abnormal head findings inconsistent with the given story." — Rich Falcone (clinical) [Ep 3 · 33:20](https://library.globalcastmd.com/watch/trauma-313?t=2000)
- "The PECARN study published in Annals of Emergency Medicine 2013 identified children at very low risk (0.1%) of clinically important blunt abdominal injuries: no abdominal wall trauma, GCS 14-15, no abdominal tenderness, no thoracic wall trauma, no abdominal pain, normal breath sounds, and no vomiting." — Rich Falcone (host_summary) [Ep 3 · 34:48](https://library.globalcastmd.com/watch/trauma-313?t=2088)
- "The PECARN study found that if their very low-risk criteria were followed and everyone else was scanned, it would actually recommend more CTs than pediatric trauma centers currently perform." — Rich Falcone (host_summary) [Ep 3 · 36:24](https://library.globalcastmd.com/watch/trauma-313?t=2184)
- "Abnormal liver function tests greater than 150-200 indicate a good chance of some abdominal injury, but normal LFTs provide very little evidence of safety and may create false security." — Rich Falcone (host_summary) [Ep 3 · 37:00](https://library.globalcastmd.com/watch/trauma-313?t=2220)
- "Cincinnati has gone away from getting LFTs, amylase, and lipase as routine in trauma patients, only obtaining them if there are other indications for CT scan such as abdominal bruising or tenderness." — Rich Falcone (clinical) [Ep 3 · 37:50](https://library.globalcastmd.com/watch/trauma-313?t=2270)
- "FAST ultrasound is very user-dependent and has low sensitivity. Normal FAST in stable healthy children may miss injuries if trusted too much. FAST remains useful for hypotensive patients to identify intra-abdominal blood." — Rich Falcone (host_summary) [Ep 3 · 38:30](https://library.globalcastmd.com/watch/trauma-313?t=2310)
- "Eric Scaife from Utah published that using FAST to screen low-risk children was giving false security due to the test's low sensitivity." — Rich Falcone (host_summary) [Ep 3 · 38:30](https://library.globalcastmd.com/watch/trauma-313?t=2310)
- "In the PECARN data, children with abdominal wall trauma (seatbelt sign, handlebar sign) or GCS <14 had about 5% chance of abdominal injury; those with only abdominal tenderness had 1.4% risk; those with only thoracic wall trauma, vague abdominal pain, or vomiting had 0.7% risk." — Rich Falcone (host_summary) [Ep 3 · 39:39](https://library.globalcastmd.com/watch/trauma-313?t=2379)
- "Cincinnati has not used angioembolization for solid organ injury in the last 4-5 years despite their high trauma volume." — Rich Falcone (clinical) [Ep 3 · 41:34](https://library.globalcastmd.com/watch/trauma-313?t=2494)
- "Adult trauma centers use angiography for solid organ injuries more frequently than pediatric centers, and there has been a trend of embolizing based on seeing a blush or bad injury rather than waiting to see how the patient does." — Rich Falcone (host_summary) [Ep 3 · 42:10](https://library.globalcastmd.com/watch/trauma-313?t=2530)
- "A blush on imaging puts children at higher risk for needing intervention or transfusion but does not mandate intervention. Literature supports that many children with blush do not require intervention." — Rich Falcone (host_summary) [Ep 3 · 43:00](https://library.globalcastmd.com/watch/trauma-313?t=2580)
- "Stylianos' 1999 paper with the American Pediatric Surgical Association Trauma Committee was a landmark that changed solid organ trauma management, with adult trauma surgeons following pediatric surgeons' lead rather than the reverse." — Rich Falcone (host_summary) [Ep 3 · 44:00](https://library.globalcastmd.com/watch/trauma-313?t=2640)
- "Sean St. Peter's group in Kansas City published papers showing grade 1 and 2 solid organ injuries need at most overnight observation (12 hours) and grade 3 or 4 injuries need maybe two nights, significantly shortening length of stay without readmissions or complications." — Rich Falcone (host_summary) [Ep 3 · 44:50](https://library.globalcastmd.com/watch/trauma-313?t=2690)
- "The original Stylianos guidelines recommended slow progression from bed rest to bathroom to ambulation, but current evidence supports mobilizing children much more quickly from solid organ injuries." — Rich Falcone (host_summary) [Ep 3 · 45:50](https://library.globalcastmd.com/watch/trauma-313?t=2750)
- "Very few grade 1 solid organ injuries require transfusion, so the lab draws initially outlined in Stylianos' paper are probably unnecessary." — Rich Falcone (host_summary) [Ep 3 · 46:30](https://library.globalcastmd.com/watch/trauma-313?t=2790)
- "Dennis Bensard's group in Colorado presented at Western Trauma Association proposing no lab draws for solid organ injuries if children are clinically stable without tachycardia, pain, or vital sign changes, using labs only as directed by physical findings." — Rich Falcone (host_summary) [Ep 3 · 47:00](https://library.globalcastmd.com/watch/trauma-313?t=2820)
- "Cincinnati's current protocol for solid organ injuries: grade 1 gets one 12-hour lab check, grade 2 gets two checks, grade 3 may get two or three checks based on clinical exam." — Rich Falcone (clinical) [Ep 3 · 48:08](https://library.globalcastmd.com/watch/trauma-313?t=2888)
- "Isolated grade 1 spleen injuries potentially do not need hospital admission because they never require transfusion and never have problems based on Cincinnati and Kansas City data." — Rich Falcone (host_summary) [Ep 3 · 47:50](https://library.globalcastmd.com/watch/trauma-313?t=2870)
- "A multi-center prospective analysis published in 2012 examined pediatric trauma activation criteria, finding that matching criteria to resources used (rather than injury severity scores) provides better over-triage and under-triage rates." — Rich Falcone (host_summary) [Ep 3 · 48:32](https://library.globalcastmd.com/watch/trauma-313?t=2912)
- "The American College of Surgeons requires 6 trauma activation criteria but they are generic, adult-based, and lack strong evidence. Centers often add 10-20 additional criteria based on individual cases, creating confusion." — Rich Falcone (host_summary) [Ep 3 · 49:40](https://library.globalcastmd.com/watch/trauma-313?t=2980)
- "The multi-center study defined appropriate high-level trauma activation as needing intubation, blood transfusion within 30 minutes, chest tube within 30 minutes, CPR within 30 minutes, or OR within 60 minutes of arrival." — Rich Falcone (host_summary) [Ep 3 · 50:30](https://library.globalcastmd.com/watch/trauma-313?t=3030)
- "Evidence-based trauma activation criteria identified by the multi-center study: penetrating wound to head/neck/torso, age-appropriate tachycardia or poor perfusion, receiving blood prior to arrival, systolic BP <90 or age-appropriate hypotension, 40ml/kg fluid prior to arrival, respiratory distress or failure, and GCS ≤8." — Rich Falcone (host_summary) [Ep 3 · 51:20](https://library.globalcastmd.com/watch/trauma-313?t=3080)
- "Using the evidence-based 8-9 criteria resulted in 39% over-triage rate and 10% under-triage rate. The break point where adding more criteria stops improving under-triage but increases over-triage is around 8 or 9 criteria." — Rich Falcone (host_summary) [Ep 3 · 52:30](https://library.globalcastmd.com/watch/trauma-313?t=3150)
- "A recent Journal of Trauma paper led by Brooke Lerner used the Delphi method to formally define high resources justifying trauma activation, including ICU stay greater than 48 hours among other criteria." — Rich Falcone (host_summary) [Ep 3 · 53:20](https://library.globalcastmd.com/watch/trauma-313?t=3200)
- "One neck CT delivers radiation equivalent to 600 plain films." — Todd Ponsky (clinical) [Ep 1 · 4:05](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=245)
- "The clinical significance of the radiation difference between plain films and CT is unknown; no one knows the true effects." — Todd Ponsky (opinion) [Ep 1 · 4:12](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=252)
- "In children 2 years and younger, a CT scan does not add diagnostic value above an adequate plain radiograph for C-spine evaluation." — Dan (clinical) [Ep 1 · 5:13](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=313)
- "C-spine injuries in the 18-month age group almost always present with the child either dead or paralyzed." — Dan (clinical) [Ep 1 · 5:42](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=342)
- "A case was seen of an 18-month-old with spinal cord contusion and muscle highlighting on MRI that was missed on CT and had equivocal plain films; the child had no neurologic deficit but was not acting normal per mother." — Dan (clinical) [Ep 1 · 5:49](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=349)
- "SCIWORA (spinal cord injury without radiographic abnormality) can manifest hours after injury, with initial findings not present on early imaging." — Sean (clinical) [Ep 1 · 6:44](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=404)
- "The NEXUS trial criteria do not cover pediatric patients." — Dan (guideline) [Ep 1 · 2:22](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=142)
- "By NEXUS trial criteria, an 18-month-old with normal exam and no other risk factors should be clearable clinically, but the child's age makes clinical clearance unreliable." — Dan (clinical) [Ep 1 · 2:22](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=142)
- "C-spine injuries in very young children tend to be high cervical injuries, which may be missed on physical exam even when the child can move the neck and has no obvious tenderness." — Dan (clinical) [Ep 1 · 2:22](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=142)
- "MRI requires anesthesia in an 18-month-old, which is a barrier to obtaining it acutely." — Dan (clinical) [Ep 1 · 3:50](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=230)
- "If a lateral C-spine film is inadequate, a CT will be needed, resulting in radiation exposure from both modalities." — Todd Ponsky (clinical) [Ep 1 · 4:41](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=281)
- "In most institutions, an 18-month-old ejected from a vehicle would arrive as a level 2 trauma and automatically receive protocolized imaging including CT." — Todd Ponsky (clinical) [Ep 1 · 5:24](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=324)
- "Institutional C-spine clearance algorithms typically offer collar immobilization or MRI as reasonable final-step options, with the decision made by the clearing physician (orthopedics or neurosurgery)." — Dan (guideline) [Ep 1 · 9:42](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=582)
- "Local protocol requires two-view (AP and lateral) C-spine films, not three-view; odontoid views are not obtained in young children." — Sean (guideline) [Ep 1 · 11:39](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=699)
- "There are two types of flexion-extension films: voluntary patient-directed movement in cooperative older children, and fluoroscopy-assisted movement performed by a physician (neurosurgery or trauma team) to avoid causing paralysis." — Todd Ponsky (clinical) [Ep 1 · 12:08](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=728)
- "MRI is obtained in young children who cannot cooperate with voluntary flexion-extension films; older children receive either voluntary or assisted flexion-extension films." — Todd Ponsky (clinical) [Ep 1 · 12:08](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=728)
- "Some patients with normal plain films and normal MRI have persistent midline tenderness; neurosurgery typically discharges these patients home in a soft collar for comfort, knowing the patient will remove it after about a week." — Dan (clinical) [Ep 1 · 13:28](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=808)
- "MRI is extremely accurate for ligamentous injury; when present, it is visible on MRI." — Todd Ponsky (clinical) [Ep 1 · 13:57](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=837)
- "MRI is the gold standard for evaluating SCIWORA and ligamentous injury." — Sean (clinical) [Ep 1 · 15:19](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=919)
- "Over the last 5–10 years, work by colleagues has allowed age-stratified C-spine protocols; a 13-year-old is not treated like a 2-year-old." — Steven Rothenberg (clinical) [Ep 1 · 14:30](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=870)
- "Future work from PECARN will help determine which children do not need any C-spine imaging at all." — Steven Rothenberg (clinical) [Ep 1 · 14:30](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=870)
- "Plain films are the next step in a 10-year-old with midline tenderness, no distracting injuries, and GCS 15." — Steven Rothenberg (clinical) [Ep 1 · 16:04](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=964)
- "The degree of midline tenderness, believability of tenderness, and neck muscle spasm guide the astute clinician in deciding whether to proceed to MRI or observe in a collar." — Steven Rothenberg (clinical) [Ep 1 · 16:14](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=974)
- "Children without distracting injuries, without neurologic symptoms, and with minimal or no tenderness have been over-imaged; restraint in imaging this group is an area for improvement." — Steven Rothenberg (opinion) [Ep 1 · 16:14](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=974)
- "In children 8 years and older, high-risk features (midline tenderness, high mechanism) lead to skipping plain films and proceeding directly to CT, especially if a head CT is already indicated." — Sean (guideline) [Ep 1 · 18:21](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1101)
- "MRI is used for C-spine clearance in prolonged intubation or ICU patients despite a clear CT." — Sean (clinical) [Ep 1 · 18:21](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1101)
- "In a neurologically devastated patient, MRI is obtained at an elective time for C-spine clearance." — Dan (clinical) [Ep 1 · 19:20](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1160)
- "Even in an emergency requiring immediate surgery, if the head is scanned, the neck does not need to be scanned at that time; the patient will remain in a collar regardless of imaging results." — Dan (clinical) [Ep 1 · 19:36](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1176)
- "Extending a head CT through the neck takes only an extra 30 seconds and is faster than obtaining a separate plain radiograph." — Todd Ponsky (clinical) [Ep 1 · 19:49](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1189)
- "Radiologists argue that the incremental radiation from extending a head CT through the neck is trivial, comparable to radiation from a transcontinental flight." — Dan (host_summary) [Ep 1 · 20:39](https://library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1239)
- "70,000 children are hospitalized annually in the United States for sepsis, with 7,000 deaths - three times more than pediatric cancers, approximately 20 deaths per day" — Samir Gattapoli (epidemiological) [Ep 2 · 39:57](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2397)
- "Sepsis has a 10% mortality rate (1 in 10), while septic shock has a 40% mortality rate (more than 1 in 3)" — Samir Gattapoli (epidemiological) [Ep 2 · 42:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2520)
- "For each hour delay in antibiotic administration in sepsis, there is an increase in mortality (Kumaral, Critical Care Medicine, 2006)" — Samir Gattapoli (clinical) [Ep 2 · 44:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2680)
- "In abdominal sepsis with adequate source control, antibiotics can be stopped at 4 days based on the STOP-IT trial (randomized multi-center trial)" — Samir Gattapoli (clinical) [Ep 2 · 46:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2760)
- "The Andromeda shock study (2019, Hernandez et al., JAMA) found capillary refill was just as good as or better than lactate levels for guiding resuscitation, with cap refill group showing 35% mortality versus 43% in lactate group (p=0.06)" — Samir Gattapoli (clinical) [Ep 2 · 48:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2900)
- "30 mL/kg of isotonic fluid is the appropriate initial volume resuscitation for sepsis" — Samir Gattapoli (clinical) [Ep 2 · 49:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2960)
- "The FEAST trial in African children with severe infections showed that over-resuscitation increased mortality in pediatric sepsis" — Samir Gattapoli (clinical) [Ep 2 · 49:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2980)
- "The ALBIOS trial showed albumin use in sepsis decreased the amount of fluid needed to achieve resuscitation goals" — Samir Gattapoli (clinical) [Ep 2 · 50:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3020)
- "The TRISS trial identified hemoglobin of 7 g/dL as an adequate transfusion threshold in septic shock" — Samir Gattapoli (clinical) [Ep 2 · 50:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3040)
- "For pediatric septic shock, start with dopamine in babies and norepinephrine in older children; use vasopressin as adjunct in renal failure (VANISH trial)" — Samir Gattapoli (clinical) [Ep 2 · 51:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3080)
- "Milrinone is appropriate for warm shock (adequate blood pressure but inadequate perfusion) to provide inotropic support" — Samir Gattapoli (clinical) [Ep 2 · 52:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3120)
- "Steroids (hydrocortisone 1.5-2 mg/kg every 6 hours) should be started when initiating a second pressor; no data supports doing a stim test in this setting" — Samir Gattapoli (clinical) [Ep 2 · 52:25](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3145)
- "On VA ECMO for septic shock, if SVO2 is 70%, there is adequate flow; further increases in flow are not needed and focus should return to source control and appropriate antibiotics" — Samir Gattapoli (clinical) [Ep 2 · 53:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3220)
- "Children can be clinically cleared without C-spine imaging if they have GCS 14-15, are not intoxicated, have no painful distracting injury, no neurologic deficits, no midline cervical tenderness, and can move head in all directions without limitation" — Aaron Jensen (guideline) [Ep 2 · 6:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=380)
- "Children age 3 and under can be clinically cleared unless they have high-risk mechanism of injury, particularly child abuse where C-spine injury rates are very high" — Aaron Jensen (guideline) [Ep 2 · 7:05](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=425)
- "Boston study of 300 children with normal initial C-spine imaging showed only 2% had ligamentous injury on MRI, none required surgery, and 84% were clinically cleared at first clinic visit 1-2 weeks later" — Aaron Jensen (clinical) [Ep 2 · 10:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=620)
- "Cervical collar pressure ulcers occur in 6-38% of patients, typically on clavicles, back of head, and base of neck; occur in ICU patients who receive significant fluid and have ICP monitors or are ventilated" — Aaron Jensen (clinical) [Ep 2 · 12:10](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=730)
- "Meta-analysis of 5 adult studies with 1,000 patients showed that with completely normal CT scans (no osteophytes, no degenerative disease), 9% had stable injuries on MRI requiring no treatment, and no patient required surgery" — Aaron Jensen (clinical) [Ep 2 · 13:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=800)
- "Adult recommendation is to remove collar with normal CT scan without MRI, but this has not been validated in children who have greater frequency of unstable ligamentous injury" — Aaron Jensen (opinion) [Ep 2 · 14:15](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=855)
- "Over 40% of patients undergoing clean surgical procedures without foreign body implantation at freestanding children's hospitals receive unindicated antibiotic prophylaxis" (host_summary) [Ep 2 · 23:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1420)
- "Over 50% of patients who appropriately receive antibiotic prophylaxis have it extended past incision closure; for colorectal procedures, average duration is 2.5 days" (host_summary) [Ep 2 · 24:10](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1450)
- "Almost 30% of patients receive antibiotics with broader spectrum than recommended guidelines, with double coverage (Flagyl and Zosyn) being common" (host_summary) [Ep 2 · 24:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1480)
- "Three areas account for 85% of inappropriate antibiotic use in pediatric surgery: prophylaxis for clean cases without foreign bodies (50%), prophylaxis after incision closure (30%), and anaerobic coverage for proximal GI procedures (remaining percentage)" (host_summary) [Ep 2 · 26:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1560)
- "About 40% of central venous lines (tunneled CVLs and ports) at freestanding children's hospitals receive prophylaxis, with practice split approximately 50/50" (host_summary) [Ep 2 · 28:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1680)
- "Cochrane reviews on central line infections show disparate data with no strong conclusion, but trend toward reduced infection rates in oncology population" (host_summary) [Ep 2 · 28:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1720)
- "For oncology patients receiving central lines who will undergo induction chemotherapy with expected count decrease, prophylactic antibiotics are recommended based on higher infection risk" (host_summary) [Ep 2 · 29:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1760)
- "Adult literature for colorectal cases shows no benefit to antibiotics past incision closure; pediatric SSI rates are much lower than adults when adjusting for procedure type and RVUs" (host_summary) [Ep 2 · 30:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1820)
- "Bratzler consensus guidelines (from Infectious Disease Society of America, Surgical Infection Society, American Society of Hospital Pharmacists) do not recommend routine fungal coverage for proximal GI procedures as SSI data does not support it" (host_summary) [Ep 2 · 31:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1900)
- "NSQIP collaborative of 84 hospitals will collect data on 85,000 children over one year, relating prophylaxis to surgical site infections and C. difficile using CDC criteria, providing first rigorous pediatric-specific antibiotic stewardship data" (host_summary) [Ep 2 · 36:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2180)
- "For children without perforated appendicitis, avoid anti-pseudomonal agents; start with cefoxitin or ceftriaxone and Flagyl instead of Zosyn" (host_summary) [Ep 2 · 38:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2320)
- "Procalcitonin is a biomarker specific for bacterial infections; trend is more important than absolute value; when it reaches normal levels, antibiotics can be stopped" — Samir Gattapoli (clinical) [Ep 2 · 45:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2720)
- "The sepsis clock starts from time blood pressure is checked and found low to when antibiotics are actually hung, requiring IV access within first hour" — Samir Gattapoli (clinical) [Ep 2 · 46:40](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2800)
- "Three randomized trials (PROCESS, PROMISE, ARISE) showed no difference with goal-directed or protocol-based resuscitation in sepsis, but key principles remain important" — Samir Gattapoli (clinical) [Ep 2 · 43:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2580)
- "Over 2 million patients annually suffer from infections with resistant organisms in hospitals at annual cost of $20 billion, with 23,000 American deaths per year; largest impact is in elderly and children under 1 year" (host_summary) [Ep 2 · 23:05](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1385)
- "For septic shock with renal failure, if SVO2 is 70% on ECMO, adequate flow is present; focus should shift to source control and appropriate antibiotics rather than increasing ECMO flow" — Samir Gattapoli (clinical) [Ep 2 · 60:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3600)
- "CVP monitoring in pediatric sepsis is often intermittent rather than continuous due to limited central line lumens being occupied by sedation drips and other infusions" — Samir Gattapoli (clinical) [Ep 2 · 56:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3380)
- "Bedside ultrasound for sepsis assessment includes checking IVC for respiratory variation and collapse, right atrium for dilation and pulmonary hypertension, and heart function for dynamic contractility" — Samir Gattapoli (clinical) [Ep 2 · 57:20](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3440)
- "In sepsis, diastolic blood pressure typically drops significantly (e.g., 70/30 or 80/20) due to loss of systemic vascular resistance" — Samir Gattapoli (clinical) [Ep 2 · 58:10](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3490)
- "If patient is improving with normal procalcitonin, antibiotics should be stopped rather than continuing for 'a couple more days'; stopping early allows for reculturing if patient worsens and bacteria may have developed resistance" — Samir Gattapoli (clinical) [Ep 2 · 62:00](https://library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3720)

## Changelog
- Sep 16: 3 items added automatically

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