# Gastroparesis — GCMD Library living collection

Everything in the library about gastroparesis — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 25 cited statements

## Episodes
### Surgical Management
- [Gastric Neurostimulators: Update Course 2017](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410) — video · 35:22 · [machine version](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410.md)

### Evidence & Research
- [Top Ten Things to Remember from the 2017 Stay Current Annual Update Course...](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400) — podcast · 25:04 · [machine version](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400.md)
- [Top Ten Things to Remember: Update Course 2017](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401) — video · 25:04 · [machine version](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) Introduction and Updates 10-9: Gastric Stimulation and Cardiac Sympathectomy (Ep 1)
- [3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) Updates 8-6: Diaphragm Pacing, Abdominal Wall Reconstruction, and Gastroesophageal Disconnection (Ep 1)
- [7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) Updates 5-4: Blunt Abdominal Trauma CT Criteria and ATOMAC Solid Organ Protocol (Ep 1)
- [13:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) Update 3: Radiology Advances - Volumetric CT and Contrast Use (Ep 1)
- [18:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080) Update 2: Top Three Journal of Pediatric Surgery Papers (Ep 1)
- [21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260) Update 1: Minimally Invasive Pilonidal Disease Treatment (Ep 1)
- [22:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) Thoracoscopic Lobectomy Technique with Steven Rothenberg (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0) Introduction and Topic #10: Gastric Stimulation (Ep 2)
- [2:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=120) Topic #9: Cardiac Sympathectomy for Arrhythmia (Ep 2)
- [6:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=360) Topic #8: Diaphragm Pacing (Ep 2)
- [8:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480) Topic #7: Abdominal Wall Reconstruction (Ep 2)
- [11:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660) Topic #6: Gastroesophageal Disconnection (Ep 2)
- [14:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840) Topic #5: CT Imaging for Blunt Abdominal Trauma (Ep 2)
- [17:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) Topic #4: ATOMAC Solid Organ Injury Protocol (Ep 2)
- [21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260) Topic #3: Radiology Updates - Foreign Body CT, Oral Contrast, Intussusception (Ep 2)
- [24:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) Topic #2: Top Three Journal of Pediatric Surgery Papers (Ep 2)
- [25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504) Topic #1: Minimally Invasive Pilonidal Disease Treatment (Ep 2)
- [25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504) Bonus: Thoracoscopic Lobectomy Technique with Dr. Rothenberg (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=0) Case 1: 17-year-old with autoimmune gastroparesis—workup and treatment decision (Ep 3)
- [5:27](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=327) Gastric stimulation mechanism and temporary trial rationale (Ep 3)
- [14:24](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=864) Stimulation parameters and device implantation technique (Ep 3)
- [21:56](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1316) Case 2: Post-Nissen wretching in neurologically impaired child (Ep 3)
- [28:45](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1725) Trial duration, placebo effect, and mechanism of action (Ep 3)
- [33:44](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2024) Safety, insurance coverage, and institutional experience (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Gastric stimulation for pediatric gastroparesis can be tested temporarily via endoscopic placement before permanent laparoscopic or open implantation" — Todd Ponsky (host_summary) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- "Reynaldo Garcia from Akron Children's Hospital presented gastric stimulation results showing significant symptom improvement in patients with persistent nausea and vomiting unresponsive to medical therapy" — Todd Ponsky (host_summary) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- "Cardiac sympathectomy for CPVT (catecholaminergic polymorphic ventricular tachycardia) and hypertrophic cardiomyopathy involves high thoracoscopic approach to the lower stellate ganglion to prevent fatal arrhythmias" — Todd Ponsky (host_summary) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- "Sophia Abdulhai and John Clark presented cardiac sympathectomy technique using clips and scissors for partial stellate ganglion resection, avoiding electrocautery to prevent Horner's syndrome" — Todd Ponsky (host_summary) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- "Sympathectomy provides 100% compliance for arrhythmia management as patients cannot skip the intervention once performed" — Todd Ponsky (host_summary) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- "Ray Anders from University Hospitals of Cleveland demonstrated diaphragm pacing for spinal cord injury, transverse myelitis, acute flaccid myelitis, and brain stem tumors, with youngest implant at one year of age" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "Diaphragm pacing requires intact phrenic nerve and motor neurons; diaphragm contraction with neurostimulation must be confirmed before implantation" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "Dave Carpata from Cleveland Clinic stated biologic mesh is not appropriate for bridging gaps in ventral hernia repair, only for temporary solution or reinforcement" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "The best mesh for ventral hernia repair is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in retromuscular space" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "Retrorectus repair with mesh is superior to laparoscopic underlay for ventral hernia repair" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "David Lanning from Virginia Commonwealth presented gastroesophageal disconnection (esophageal division with Roux-en-Y jejunal interposition) for severe reflux after failed Nissen fundoplication" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "Gastroesophageal disconnection may be appropriate as primary repair for high-risk patients predicted to fail fundoplication" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "Laparoscopic gastroesophageal disconnection can take 6 to 8 hours" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "Patients who took full feeds by mouth preoperatively can continue oral feeding after gastroesophageal disconnection" — Todd Ponsky (host_summary) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- "Chris Druck published a five-variable prediction rule identifying low-risk population for intra-abdominal injury after blunt trauma to guide CT scan decisions" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "Patients with only abdominal pain after trauma have approximately 5% risk of abdominal injury and nearly 0% chance of requiring intervention" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "Patients with abnormal physical exam findings such as handlebar injury have approximately 15% chance of abdominal injury" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "The low-risk group (55% of trauma population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "Patients without abdominal wall trauma, tenderness or distention, with normal chest X-ray, no abdominal pain complaints, normal AST, and normal pancreatic enzymes probably do not need CT scan and can be sent home" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "The ATOMAC prospective multi-institutional solid organ injury protocol de-emphasizes injury grade in favor of clinical predictive factors" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "Patients with solid organ injury who do not respond to 20 cc/kg crystalloid bolus should receive 10-20 cc/kg blood bolus rather than second crystalloid bolus" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "Patients requiring 40 cc/kg blood (4 units) or with hemoglobin less than 7 after blood transfusion should go to the operating room as this indicates non-operative management failure" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "Stable solid organ injury patients can be admitted to the floor with vitals every 2-4 hours and hemoglobin at 6 hours, and discharged the next day if they never required blood transfusion" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "Sean Saint Peter's group demonstrated stable solid organ injury patients can be discharged much more quickly than traditional prolonged admissions based on injury grade" — Todd Ponsky (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- "Mike Rubin from Akron Children's Hospital recommends chest CT for suspected airway foreign bodies in unclear cases, with nearly 100% sensitivity for detecting radiolucent and radiopaque foreign bodies" — Todd Ponsky (host_summary) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- "CT scan for suspected airway foreign body eliminates unnecessary bronchoscopies in children with respiratory virus symptoms" — Todd Ponsky (host_summary) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- "Oral contrast is unnecessary for suspected bowel obstruction CT scans as intraluminal fluid serves as adequate contrast" — Todd Ponsky (host_summary) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- "Eliminating oral contrast speeds up CT acquisition time and prevents nausea and vomiting in bowel obstruction patients" — Todd Ponsky (host_summary) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- "Unsuccessful intussusception reduction should be reattempted if there is movement to the ileocecal valve, with second attempts mostly successful" — Todd Ponsky (host_summary) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- "Modern pediatric hospital CT scans deliver 1-10 millisieverts of radiation, equivalent to one year of natural background radiation on Earth" — Todd Ponsky (host_summary) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- "Dalton's pyloric stenosis resuscitation protocol: chloride less than 85 requires 3 fluid boluses, chloride less than 97 requires 2 boluses, chloride greater than 97 with bicarbonate less than 33 requires 1 bolus" — Todd Ponsky (host_summary) [Ep 1 · 18:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- "Richer's paper showed traumatic or non-traumatic pneumomediastinum requires only chest X-ray without further imaging" — Todd Ponsky (host_summary) [Ep 1 · 18:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- "Vella's randomized trial of 42 patients with post-TEF repair leaks showed glycopyrrolate group had 124 mL chest tube output versus 370 mL in placebo group" — Todd Ponsky (host_summary) [Ep 1 · 18:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- "Glycopyrrolate achieved leak resolution in 76% of treatment group versus 29% of placebo group after TEF repair" — Todd Ponsky (host_summary) [Ep 1 · 18:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- "The Gips procedure for pilonidal disease involves trephine excision of pits, mosquito extraction of granulation tissue and hair, curettage with smaller trephine, and irrigation with saline then peroxide" — Todd Ponsky (host_summary) [Ep 1 · 21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260)
- "Pilonidal disease Gips procedure takes 3-5 minutes with no packing, no sutures, no drains, and no activity restrictions except avoiding swimming for 2 weeks" — Todd Ponsky (host_summary) [Ep 1 · 21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260)
- "Steven Rothenberg recommends thoracoscopic lobectomy scope placement anterior to scapula tip at mid-axillary line, not posterior, to avoid working in paradox during anterior fissure dissection" — Todd Ponsky (host_summary) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- "For thoracoscopic lobectomy vessel division, seal proximally and distally separately, make test incision between seals to confirm hemostasis, then complete division rather than using seal-and-divide device" — Todd Ponsky (host_summary) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- "Understanding segmental pulmonary anatomy allows prediction of vessel relationships to bronchus, such as superior segmental artery location above lower lobe bronchus" — Todd Ponsky (host_summary) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- "Incomplete fissure during thoracoscopic lobectomy should be managed by layer-by-layer sealing like finger fracture technique until structures are identified" — Todd Ponsky (host_summary) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- "Contralateral main stem intubation is the best and easiest technique for single lung ventilation during thoracoscopic lobectomy, superior to double lumen tube, bronchial blocker, or CO2 collapse" — Todd Ponsky (host_summary) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- "Gastric emptying scan showing 90% retention at 2 hours indicates severe gastroparesis." — Ronaldo (clinical) [Ep 3 · 3:54](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=234)
- "The stomach's intrinsic pacemaker (interstitial cells of Cajal) generates electrical activity at 3 cycles per minute, 20–40 millivolts." — Ronaldo (clinical) [Ep 3 · 14:49](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=889)
- "Gastric electrical activity sets the pace for contractions but does not initiate them; a stomach with 3 waves/min cannot contract more than 3 times/min." — Ronaldo (clinical) [Ep 3 · 15:50](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=950)
- "Gastric stimulation uses low voltage (≤7V) and low current (≤10 mA) to reorganize gastric electrical conductivity, not to directly pace the stomach." — Ronaldo (clinical) [Ep 3 · 17:15](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1035)
- "Temporary gastric stimulation can be performed via nasal leads (cardiac pacing wires clipped endoscopically) or via G-tube using fetal scalp electrodes." — Ronaldo (clinical) [Ep 3 · 26:25](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1585)
- "Approximately 30% of patients do not respond to permanent gastric stimulation; temporary trial predicts response." — Todd Ponsky (clinical) [Ep 3 · 19:51](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1191)
- "Post-Nissen wretching in patients with intact fundoplication and delayed gastric emptying may respond to gastric stimulation." — Todd Ponsky (clinical) [Ep 3 · 11:42](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=702)
- "Performing Nissen fundoplication in a chronic vomiter may convert vomiting to wretching if gastroparesis is present." — Todd Ponsky (clinical) [Ep 3 · 11:59](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=719)
- "Tom Abel's blinded crossover study showed 100% of patients improved on day 1 (placebo effect), but by day 3 only the stimulation-on group sustained benefit." — Todd Ponsky (host_summary) [Ep 3 · 29:25](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1765)
- "Temporary gastric stimulation trials should last more than 2–3 days to distinguish placebo effect from true response." — Todd Ponsky (clinical) [Ep 3 · 29:25](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1765)
- "Gastric stimulation likely works via vagal afferent modulation affecting brainstem nausea centers, not by improving gastric emptying." — Ronaldo (opinion) [Ep 3 · 32:18](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1938)
- "Adult studies have not shown significant improvement in gastric emptying with gastric stimulation." — Todd Ponsky (clinical) [Ep 3 · 32:42](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1962)
- "Tom Abel demonstrated more coordinated gastric electrical waves after stimulation." — Ronaldo (host_summary) [Ep 3 · 32:52](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1972)
- "Patients reliably report symptom recurrence when gastric stimulator batteries fail." — Ronaldo (clinical) [Ep 3 · 31:31](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1891)
- "Laparoscopic gastric stimulator implantation takes approximately 5 minutes in experienced hands." — Ronaldo (clinical) [Ep 3 · 21:56](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1316)
- "Stimulation parameters: 14 Hz frequency, on 3 seconds / off 2 seconds, ≤10 mA current, ≤7V voltage." — Ronaldo (clinical) [Ep 3 · 20:25](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1225)
- "Some patients feel transient sensation ("butterflies") when stimulator settings are changed, but most adapt within 1–2 days." — Todd Ponsky (clinical) [Ep 3 · 18:18](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1098)
- "The implantable pulse generator (anode) can cause sensation if placed too close to the dermis, especially in thin children with little subcutaneous fat." — Ronaldo (clinical) [Ep 3 · 18:45](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1125)
- "Jejunal feeding is not a long-term solution for gastroparesis; it is a diagnostic test to assess symptom response to bypassing the stomach." — Todd Ponsky (opinion) [Ep 3 · 7:23](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=443)
- "Performing Nissen fundoplication often improves delayed gastric emptying in pediatric patients." — Todd Ponsky (clinical) [Ep 3 · 10:43](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=643)
- "Post-Nissen wretching is the most exciting outcome for gastric stimulation, with dramatic symptom relief." — Todd Ponsky (opinion) [Ep 3 · 11:42](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=702)
- "Performing fundoplication for nausea alone (without reflux) is the wrong operation." — Todd Ponsky (opinion) [Ep 3 · 11:47](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=707)
- "Peroral pyloromyotomy (endoscopic) is now used in adults for gastroparesis and may change management, though pediatric experience is limited." (clinical) [Ep 3 · 13:00](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=780)
- "Pediatric insurance denials for gastric stimulation are rare, unlike in adult populations." — Todd Ponsky (clinical) [Ep 3 · 34:29](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2069)
- "No patients who responded to temporary stimulation failed permanent implantation at the presenters' institution." — Ronaldo (clinical) [Ep 3 · 34:29](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2069)
- "Some patients have initial response to gastric stimulation but experience symptom recurrence long-term, possibly due to psychosocial or other factors." — David (clinical) [Ep 3 · 30:40](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1840)
- "Gastric stimulation for obesity has passed FDA trials and is approved in Europe." — Ronaldo (clinical) [Ep 3 · 33:28](https://library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2008)
- "Gastric stimulation is now being used in children with persistent gastroparesis who do not respond to medical therapy." — Todd Ponsky (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0)
- "Patients can receive a temporary endoscopic gastric stimulating test, and if symptoms improve, they can proceed to permanent laparoscopic or open gastric stimulator placement." — Todd Ponsky (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0)
- "Thoracoscopic sympathectomy extending to the lower stellate ganglion can reduce arrhythmias in patients with CPVT (catecholaminergic polymorphic ventricular tachycardia) and hypertrophic cardiomyopathy who have ICDs." — Todd Ponsky (host_summary) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=120)
- "Partial resection of the stellate ganglion should be performed using clips and scissors; electric cautery should be avoided as it may damage the remaining ganglion and cause Horner's syndrome." — Todd Ponsky (host_summary) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=120)
- "Sympathectomy provides 100% compliance as an intervention because once performed, the effect cannot be reversed or skipped like medication." — Todd Ponsky (host_summary) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=120)
- "Diaphragm pacing is a reasonable option for children with spinal cord injury, transverse myelitis, acute flaccid myelitis, or brain stem tumors, with the youngest implant performed at one year of age." — Todd Ponsky (host_summary) [Ep 2 · 6:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=360)
- "Diaphragm pacing requires an intact phrenic nerve and phrenic motor neurons; diaphragm contraction with neurostimulation must be verified prior to implantation." — Todd Ponsky (host_summary) [Ep 2 · 6:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=360)
- "Biologic mesh is not appropriate for bridging gaps in abdominal wall reconstruction; it is only a temporary solution or reinforcement." — Todd Ponsky (host_summary) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480)
- "The best mesh for abdominal wall reconstruction is macroporous monofilament, lightweight polypropylene synthetic mesh such as Marlex, which performs well even in contaminated fields when placed in the retromuscular space." — Todd Ponsky (host_summary) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480)
- "Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation." — Todd Ponsky (host_summary) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480)
- "The current best repair for ventral hernias is retro-rectus repair with mesh, not laparoscopic underlay." — Todd Ponsky (host_summary) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480)
- "Gastroesophageal disconnection with Roux-en-Y esophagojejunostomy is effective for children with severe reflux who have failed Nissen fundoplication." — Todd Ponsky (host_summary) [Ep 2 · 11:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660)
- "Gastroesophageal disconnection may be considered as a primary repair in patients thought to be at high risk for fundoplication failure." — Todd Ponsky (host_summary) [Ep 2 · 11:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660)
- "Laparoscopic gastroesophageal disconnection can be a long and difficult operation, taking 6 to 8 hours." — Todd Ponsky (host_summary) [Ep 2 · 11:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660)
- "Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection." — Todd Ponsky (host_summary) [Ep 2 · 11:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660)
- "A five-variable prediction rule can identify children at low risk for intra-abdominal injury after blunt trauma: abdominal pain, physical exam findings, chest X-ray, AST level, and pancreatic enzymes." — Todd Ponsky (host_summary) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- "Children with only abdominal pain after trauma have approximately 5% risk of abdominal injury and almost 0% chance of needing intervention." — Todd Ponsky (host_summary) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- "Children with abnormal physical exam findings such as handlebar injury have about 15% chance of abdominal injury." — Todd Ponsky (host_summary) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- "A low-risk group comprising 55% of trauma patients has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention." — Todd Ponsky (host_summary) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- "Children with no abdominal wall trauma, tenderness or distention, normal chest X-ray, no abdominal pain complaints, normal AST, and normal pancreatic enzymes probably do not need CT scan and can be sent home." — Todd Ponsky (host_summary) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- "In the ATOMAC solid organ injury protocol, injury grade is de-emphasized in favor of clinical predictive factors." — Todd Ponsky (host_summary) [Ep 2 · 17:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- "Patients who do not respond to initial 20cc/kg crystalloid bolus should receive 10-20cc/kg blood bolus rather than additional crystalloid." — Todd Ponsky (host_summary) [Ep 2 · 17:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- "Patients requiring 40cc/kg total blood transfusion (4 units) likely cannot be managed non-operatively and should go to the operating room." — Todd Ponsky (host_summary) [Ep 2 · 17:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- "Stable solid organ injury patients who never required blood transfusion can be discharged the next day." — Todd Ponsky (host_summary) [Ep 2 · 17:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- "Chest CT has nearly 100% sensitivity for airway foreign bodies, including radiolucent objects." — Todd Ponsky (host_summary) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- "Using chest CT to screen for airway foreign bodies can eliminate many unnecessary bronchoscopies in children with unclear history." — Todd Ponsky (host_summary) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- "Oral contrast is not needed for suspected bowel obstruction; luminal fluid serves as adequate contrast material." — Todd Ponsky (host_summary) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- "Eliminating oral contrast speeds up CT acquisition time and prevents nausea and vomiting in patients with bowel obstruction." — Todd Ponsky (host_summary) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- "Repeat attempts at intussusception reduction are worthwhile if there is movement all the way to the ileocecal valve." — Todd Ponsky (host_summary) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- "Modern pediatric hospital CT scans deliver 1-10 millisieverts of radiation, equivalent to one year of background radiation exposure on Earth." — Todd Ponsky (host_summary) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- "For pyloric stenosis resuscitation, if chloride is less than 85, give 3 fluid boluses; if less than 97, give 2 boluses; if greater than 97 but bicarbonate less than 33, give 1 bolus." — Todd Ponsky (host_summary) [Ep 2 · 24:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- "Pneumomediastinum (traumatic or non-traumatic) requires only chest X-ray for imaging; further imaging is not necessary." — Todd Ponsky (host_summary) [Ep 2 · 24:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- "Intravenous glycopyrrolate (Robinol) significantly improves leak closure rates after tracheoesophageal fistula repair: 76% resolution in treatment group versus 29% in placebo group." — Todd Ponsky (host_summary) [Ep 2 · 24:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- "Glycopyrrolate reduces chest tube output in TEF leak patients from 370mL (placebo) to 124mL (treatment)." — Todd Ponsky (host_summary) [Ep 2 · 24:00](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- "The Gips procedure for pilonidal disease involves coring out pits with trephine, extracting granulation tissue and hair, curettage with smaller trephine, and flushing with saline then hydrogen peroxide, leaving wounds open and unpacked." — Todd Ponsky (host_summary) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- "The Gips procedure for pilonidal disease is minimally invasive, takes 3-5 minutes, requires no activity restrictions except avoiding swimming for two weeks, and has superior results to traditional approaches." — Todd Ponsky (host_summary) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- "For thoracoscopic lobectomy, the scope should be positioned anterior to the scapula tip, nearly at the mid-axillary line, directly over the major fissure, not posterior to the scapula." — Todd Ponsky (host_summary) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- "Placing the thoracoscope posterior to the scapula tip causes the surgeon to look back on themselves when working in the anterior fissure, creating a paradoxical working angle." — Todd Ponsky (host_summary) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- "When dividing vessels during thoracoscopic lobectomy, use a sealing device (not seal-divider) to seal proximally and distally, make a small nick between seals to verify hemostasis, then complete the division." — Todd Ponsky (host_summary) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- "Understanding segmental pulmonary anatomy allows prediction of vessel locations and their relationship to bronchi during thoracoscopic lobectomy." — Todd Ponsky (host_summary) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- "Incomplete fissures during thoracoscopic lobectomy should be approached layer-by-layer with a sealing device until structures are identified." — Todd Ponsky (host_summary) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- "Contralateral mainstem intubation is the best and easiest technique for single-lung ventilation during thoracoscopic lobectomy." — Todd Ponsky (host_summary) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)

## Changelog
- Sep 16: 3 items added automatically

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