# Splenic Laceration — GCMD Library living collection

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

Updated: n/a · 3 episodes · 46 cited statements

## Episodes
### Acute Management
- [Update Course 2023 - Rapid Updates in Pediatric Trauma](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266) — video · 46:42 · [machine version](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266.md)
- [Update Course Rewind: Updates in Solid Organ Injury Management 2023](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098.md)

### Emerging & Future Directions
- [The Future of Surgical Education: A King, an Ox, & Elon Musk](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425) — podcast · 26:21 · [machine version](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425.md)

## Chapters
- [0:03](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=3) Solid Organ Injury Management - Disposition and Activity Restrictions (Ep 1)
- [7:41](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=461) Discharge Protocols and Hemoglobin Monitoring in Solid Organ Injury (Ep 1)
- [16:48](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=1008) Massive Transfusion Protocol Activation and Balanced Resuscitation (Ep 1)
- [29:02](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=1742) Blunt Cerebrovascular Injury Screening (Ep 1)
- [35:16](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2116) Firearm Injury Prevention and Screening (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=0) Introduction and Case Presentation (Ep 2)
- [0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=53) Admission Decisions and APSA Guidelines (Ep 2)
- [3:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=224) Emergency Department Discharge for Low-Grade Injuries (Ep 2)
- [4:55](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=295) CT Scanning Rationale and Discharge Protocols (Ep 2)
- [7:17](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=437) Hemoglobin Monitoring and Contrast-Enhanced Ultrasound (Ep 2)
- [8:51](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=531) Summary and Closing (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=0) Introduction and Context Setting (Ep 3)
- [1:57](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=117) The Problem: Exponential Knowledge Growth (Ep 3)
- [4:46](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=286) Obsolescence of Traditional Publishing Models (Ep 3)
- [6:38](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=398) Solution Part 1: Machine Learning for Content Filtration (Ep 3)
- [9:19](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=559) Solution Part 2: Crowd-Sourcing as Editorial Board (Ep 3)
- [11:48](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=708) Solution Part 3: Digital Platforms and Media Conversion (Ep 3)
- [20:03](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=1203) Interactive Learning: The Storycast Model (Ep 3)
- [25:01](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=1501) Future Training and Summary (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- APSA guidelines include four basic categories for solid organ injury management: where patients should be admitted, procedures, when to discharge them, and what to do after discharge. (guideline) [Ep 2 · 1:45](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=105)
- In kids, the data doesn't support the need for angioembolization, even if you see active arterial extravasation on CT. (clinical) [Ep 2 · 2:10](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=130)
- APSA guidelines indicate discharge when patients are clinically doing well, with no indication for repeat imaging after discharge. (guideline) [Ep 2 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=145)
- Activity restrictions have moved towards shorter duration; previously grade 4 spleen lacerations required 12 weeks or longer out of activity. (guideline) [Ep 2 · 2:45](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=165)
- Cincinnati Children's Hospital guideline states only hemodynamically abnormal patients go to the ICU. (guideline) [Ep 2 · 3:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=224)
- Cincinnati has started discharging isolated grade 1 or 2 splenic injuries from the emergency department. (clinical) [Ep 2 · 3:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=224)
- In a study of grade 1 and 2 injuries with no other major organ injured, not a single patient got an intervention during hospitalization, including transfusion. (epidemiological) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=240)
- Grade 1-2 injuries are discharged from ED if patients are watched for 4 hours and able to tolerate a PO challenge. (clinical) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=240)
- CT scanning serves two purposes: making a diagnosis overall and determining appropriate discharge activity restrictions, which differ between splenic laceration and small bowel contusion. (clinical) [Ep 2 · 4:55](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=295)
- In the blunt abdominal trauma guideline at Cincinnati, not all patients are scanned; AST and lipase are used to decide who needs a scan. (clinical) [Ep 2 · 5:37](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=337)
- Standardized discharge instructions are created and given to all patients in collaboration with the emergency department. (clinical) [Ep 2 · 6:42](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=402)
- Every patient discharged with solid organ injury is seen in trauma clinic within the week to ensure the child is doing well and to provide continued counseling about activity restrictions. (clinical) [Ep 2 · 6:42](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=402)
- At the Utah practice, 80% of pediatric trauma patients are transfers and most have already had a CBC at the referring hospital. (epidemiological) [Ep 2 · 7:17](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=437)
- For hemodynamically normal children with solid organ injury going to the floor, CBC is not repeated. (clinical) [Ep 2 · 7:39](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=459)
- Data suggests that patients more likely to fail non-operative management have an initial hemoglobin less than 9.25. (epidemiological) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=480)
- Cincinnati protocol: if initial hemoglobin is less than 9.25, patient gets one repeat hemoglobin; if greater than 9.25, no repeats unless clinically indicated. (clinical) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=480)
- Contrast-enhanced ultrasound for grading solid organ injuries is not done routinely because radiologists and ultrasonographers comfortable with the technique are not available at 2:00 in the morning. (clinical) [Ep 2 · 8:24](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=504)
- Contrast-enhanced ultrasound has not been found to be very reliable yet as an alternative to CT for solid organ injury grading. (opinion) [Ep 2 · 8:24](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=504)
- In resource-constrained settings like Uganda, grade 4 splenic laceration patients would be placed in ICU due to limited monitoring capacity on the floor, where there may not be monitors and minimal staff. (clinical) [Ep 2 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=53)
- Management of splenic lacerations is a reflection of available resources; ICU admission decisions differ between resource-constrained and well-resourced settings. (opinion) [Ep 2 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=53)
- Cincinnati Children's is now discharging isolated grade 1 and 2 solid organ injuries from the emergency department after 4 hours of observation if patients can tolerate oral intake. — Meera Kotagal (clinical) [Ep 1 · 6:39](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=399)
- Cincinnati Children's protocol eliminates repeat hemoglobin checks in solid organ injury patients with initial hemoglobin greater than 9.25 g/dL unless there is clinical concern. — Meera Kotagal (clinical) [Ep 1 · 13:34](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=814)
- Bed rest is only used for ICU-level patients who are hemodynamically abnormal, at least overnight until hemodynamics stabilize; all other solid organ injury patients do not require bed rest. — Meera Kotagal (clinical) [Ep 1 · 15:36](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=936)
- After implementing an MTP team at Primary Children's Hospital, balanced resuscitation compliance improved from 25% to 85% in approximately 50 patients. — Katie Russell (clinical) [Ep 1 · 28:14](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=1694)
- Blunt cerebrovascular injury occurs in approximately 1.3% of pediatric trauma patients, similar to the rate of cervical spine injuries. — Katie Russell (epidemiological) [Ep 1 · 33:42](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2022)
- About one-third of pediatric patients with BCVI will have a stroke, and mortality can be as high as 20% if stroke occurs. — Katie Russell (epidemiological) [Ep 1 · 33:42](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2022)
- Cincinnati Children's implemented routine BCVI screening approximately one year ago and has not had any delayed diagnoses since, after having at least 2 children with strokes from missed BCVI in the previous year. — Meera Kotagal (clinical) [Ep 1 · 32:53](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=1973)
- Firearm-related injury is now the leading cause of death for children in the United States. — Meera Kotagal (epidemiological) [Ep 1 · 35:16](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2116)
- In the American College of Surgeons non-fatal firearm study data, approximately 50-60% of pediatric firearm injuries are assault-related, about 30% are unintentional, and the remainder are self-inflicted. — Meera Kotagal (epidemiological) [Ep 1 · 38:45](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2325)
- In rural populations, self-inflicted firearm injuries are much more common, while in urban populations, assaults remain the predominant source of pediatric firearm injury. — Meera Kotagal (epidemiological) [Ep 1 · 39:16](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2356)
- School shootings represent a tiny percentage of pediatric firearm deaths. — Meera Kotagal (epidemiological) [Ep 1 · 38:30](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2310)
- In 1982, knowledge was doubling every 12 to 13 months. — Todd Ponsky (epidemiological) [Ep 3 · 2:59](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=179)
- In 2020, IBM predicts that knowledge will be doubling every 11 to 12 hours. — Todd Ponsky (epidemiological) [Ep 3 · 3:04](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=184)
- Textbooks are published about every 10 years or so. — Todd Ponsky (clinical) [Ep 3 · 4:48](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=288)
- Textbooks don't work because they're always going to be outdated now. — Todd Ponsky (opinion) [Ep 3 · 5:14](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=314)
- When a great article is published, it's impossible to identify because it's camouflaged by so much other stuff. — Todd Ponsky (opinion) [Ep 3 · 5:20](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=320)
- A natural language processing algorithm applied to 520 abstracts achieved an 85% negative predictive value for predicting when an article was rejected by the editorial board. — Todd Ponsky (clinical) [Ep 3 · 9:00](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=540)
- On Who Wants to Be a Millionaire, using the 50/50 option gives 50% odds of getting the answer right. — Todd Ponsky (epidemiological) [Ep 3 · 9:49](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=589)
- On Who Wants to Be a Millionaire, calling an expert friend gives 66% odds of getting the answer right. — Todd Ponsky (epidemiological) [Ep 3 · 9:54](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=594)
- Francis Galton asked 800 random people at a state fair to guess the weight of an ox; the average guess was 1,197 pounds and the actual weight was 1,198 pounds. — Todd Ponsky (epidemiological) [Ep 3 · 10:13](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=613)
- The traditional publishing process takes about a year from submission to publication. — Todd Ponsky (clinical) [Ep 3 · 11:12](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=672)
- There are more audiobooks being downloaded than digital print books from Amazon. — Todd Ponsky (epidemiological) [Ep 3 · 12:22](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=742)
- Nick Bruns presented at a SAGES conference to hundreds of people in the audience, but a week later when the content was published on social media, it reached 50,000 people. — Todd Ponsky (epidemiological) [Ep 3 · 14:30](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=870)
- People can listen to audio content while multitasking—driving, working out, or between cases—which fits into the lifestyle of a busy surgeon. — Todd Ponsky (opinion) [Ep 3 · 17:42](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=1062)
- Educational content duration preferences have shortened over time: from multi-day courses to half days, then 2 hours or 1 hour, and now people want content that's 1 minute long. — Todd Ponsky (opinion) [Ep 3 · 15:32](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=932)
- TikTok is the fastest growing social media network because it delivers information in bytes of 30 seconds to 1 minute long. — Todd Ponsky (epidemiological) [Ep 3 · 15:24](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=924)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- APSA guidelines recommend that hemodynamically normal patients with solid organ injuries should be admitted to the floor rather than ICU, regardless of injury grade. — Meera Kotagal summarizes what Dr. Katie Russell said [Ep 1 · 3:57](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=237)
- APSA guidelines recommend activity restrictions of grade plus 2 weeks for solid organ injuries, which is shorter than the previous practice of 12 weeks for grade 4 injuries. — Meera Kotagal summarizes what Dr. Katie Russell said [Ep 1 · 5:44](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=344)
- In Chris Strack's study of grade 1 and 2 solid organ injuries with no other major organ injury, not a single patient required intervention including transfusion during hospitalization. — Meera Kotagal summarizes what Dr. Katie Russell said [Ep 1 · 7:13](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=433)
- Patients who are more likely to fail non-operative management of solid organ injury have an initial hemoglobin less than 9.25 g/dL. — Meera Kotagal summarizes what Dr. Katie Russell said [Ep 1 · 13:23](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=803)
- The definition of massive transfusion in pediatrics is 40 mL/kg or more of any blood product over 24 hours. — Katie Russell summarizes what Dr. Meera Kotagal said [Ep 1 · 24:40](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=1480)
- New data from the blood investigators (Maddock trial group) suggests activating massive transfusion protocol after 20 mL/kg of blood within an hour if the patient remains unstable. — Katie Russell summarizes what Dr. Meera Kotagal said [Ep 1 · 26:07](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=1567)
- Balanced resuscitation with more FFP (closer to 1:1:1 ratio) is associated with lower mortality in pediatric massive transfusion. — Katie Russell summarizes what Dr. Meera Kotagal said [Ep 1 · 25:26](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=1526)
- The Memphis criteria is the most sensitive screening tool for BCVI according to the ATOMC study. — Katie Russell summarizes what Dr. Meera Kotagal said [Ep 1 · 34:30](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2070)
- Data on TXA use in traumatic brain injury from the TikTok trial does not support that TXA is contraindicated in pediatric traumatic brain injury. — Meera Kotagal summarizes what Dr. Katie Russell said [Ep 1 · 41:56](https://library.globalcastmd.com/watch/update-course-2023-rapid-updates-in-pediatric-trauma-7266?t=2516)
- In the 1950s, the doubling time of medical information was about 50 years. — Rod Gerardo summarizes what Dr. Sundar Pichai said [Ep 3 · 3:20](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=200)
- Today, it takes about 70 days for the amount of medical information to double. — Rod Gerardo summarizes what Dr. Sundar Pichai said [Ep 3 · 3:25](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=205)
- At the current rate of knowledge growth, you would have to update a textbook every day. — Rod Gerardo summarizes what Dr. Sundar Pichai said [Ep 3 · 5:11](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=311)
- On Who Wants to Be a Millionaire, asking the audience gives 91% odds of getting the answer right. — Rod Gerardo summarizes what Dr. Sundar Pichai said [Ep 3 · 10:00](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=600)
- A study of approximately 11,800 appendectomies found that resident involvement was associated with significantly increased cost (about $600) and operative time (about 10 minutes), but there was no significant difference in post-operative complications. — Rod Gerardo summarizes what Dr. Sundar Pichai said [Ep 3 · 16:20](https://library.globalcastmd.com/watch/the-future-of-surgical-education-a-king-an-ox-elon-musk-13425?t=980)

## Changelog
- Oct 15: 3 items added automatically

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