we had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late
we had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late
we had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late
we had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late
we did put in our protocol for our nursing college as well as our families that emesis is expected we put that within our written protocol to make that expectation known that it's okay it's okay they're going to throw up we'll just keep working through it
we did put in our protocol for our nursing college as well as our families that emesis is expected we put that within our written protocol to make that expectation known that it's okay it's okay they're going to throw up we'll just keep working through it
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 29 · 6:52
clinicalCincinnati Children's protocol includes standardized feed advancement and sham feeding to address poor oral feeding skills in gastroschisis patients.↗
▶Ep 29 · 7:40
quotewe introduced sham feeding because what we realized is a lot of our gastroschesis babies have very poor oral feeding skills from you know delayed access to feeding↗
▶Ep 29 · 8:10
clinicalCincinnati Children's attempted ad-lib feeding for gastroschisis but abandoned it after one year due to poor results, including delayed NG tube removal and starting feeds too late.↗
▶Ep 29 · 8:10
quotewe had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late↗
▶Ep 29 · 8:40
clinicalCincinnati Children's current gastroschisis feeding protocol has been in place for approximately four years.↗
▶Ep 29 · 10:01
host_summaryIn a multi-institutional study, protocol-fed gastroschisis infants had fewer surgical site infections compared to non-protocol-fed infants.↗
▶Ep 29 · 10:01
quotethe protocol fed infants had fewer surgical site infections↗
▶Ep 29 · 13:51
clinicalCincinnati Children's protocol includes both intermittent feeds and sham feeds, with sham feeds implemented for approximately one year.↗
▶Ep 29 · 13:51
epidemiologicalApproximately two-thirds of Cincinnati Children's gastroschisis patients are discharged home with an NG tube or G-tube for continued feeding support.↗
▶Ep 29 · 13:51
quoteour rate of sending gastroschisis babies home with an ng or a g tube it's like two thirds of them go home with some sort of tube to help them continue feeding which is crazy↗
▶Ep 29 · 16:58
clinicalCincinnati Children's written protocol explicitly states that emesis is expected during gastroschisis feeding to set appropriate expectations for nursing staff and families.↗
▶Ep 29 · 16:58
quotewe did put in our protocol for our nursing college as well as our families that emesis is expected we put that within our written protocol to make that expectation known that it's okay it's okay they're going to throw up we'll just keep working through it↗
quoteI think this is like a nightmare in clinic, honestly, this is the patient that no one wants to see, right? I mean, rectal prolapses. I it's very distressing to the patient and the family, and we don't really have a lot of, of great options.↗
▶Ep 92 · 1:34
quoteI think this is like a nightmare in clinic, honestly, this is the patient that no one wants to see, right? I mean, rectal prolapses. I it's very distressing to the patient and the family, and we don't really have a lot of, of great options.↗
▶Ep 92 · 1:54
quoteIf it's a patient that I've never met before, I typically will address, you know, concerns about the constipation first and sort of prove or disprove whether or not this patient is significantly constipated.↗
▶Ep 92 · 1:54
quoteIf it's a patient that I've never met before, I typically will address, you know, concerns about the constipation first and sort of prove or disprove whether or not this patient is significantly constipated.↗
▶Ep 92 · 2:07
quoteI think if they are constipated, that's like the easier patient to deal with, but every once in a while, you get a kid who is well managed on whatever their regimen is, and they're still prolapsing, and then I think the question is, what do you do?↗
▶Ep 92 · 2:07
quoteI think if they are constipated, that's like the easier patient to deal with, but every once in a while, you get a kid who is well managed on whatever their regimen is, and they're still prolapsing, and then I think the question is, what do you do?↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 135 · 7:09
opinionThe Sheffield Hirschsprung management sequence does not reflect typical practice in the United States↗
▶Ep 135 · 7:09
quoteThat it does not seem reflective at all of the type of things that that we see in our practice here, and I think that would be seen in a lot of practices in the United States.↗
▶Ep 135 · 7:09
quoteThat it does not seem reflective at all of the type of things that that we see in our practice here, and I think that would be seen in a lot of practices in the United States.↗
▶Ep 135 · 7:09
opinionThe Sheffield Hirschsprung management sequence does not reflect typical practice in the United States↗
▶Ep 135 · 7:20
clinicalIn US practice, most Hirschsprung patients undergo either neonatal pull-through or are sent home on irrigations for pull-through in the first couple of months of life↗
▶Ep 135 · 7:20
clinicalIn US practice, most Hirschsprung patients undergo either neonatal pull-through or are sent home on irrigations for pull-through in the first couple of months of life↗
▶Ep 135 · 7:39
clinicalIn US practice, pre-pull-through diversion is only done for delayed presentation with perforation or complicated cardiac babies↗
▶Ep 135 · 7:39
clinicalIn US practice, pre-pull-through diversion is only done for delayed presentation with perforation or complicated cardiac babies↗
▶Ep 135 · 10:41
clinicalBefore implementing preoperative bathing in Tanzania, almost every pediatric surgery patient developed a wound infection↗
▶Ep 135 · 10:41
quoteYeah, I mean, the first year that we operated there, almost every kid got a wound infection, and then we started the next year we had the nurses do pre-op baths up on the floor the day before, and that year we had like 0 wound infections.↗
▶Ep 135 · 10:41
clinicalBefore implementing preoperative bathing in Tanzania, almost every pediatric surgery patient developed a wound infection↗
▶Ep 135 · 10:41
quoteYeah, I mean, the first year that we operated there, almost every kid got a wound infection, and then we started the next year we had the nurses do pre-op baths up on the floor the day before, and that year we had like 0 wound infections.↗
▶Ep 135 · 10:56
clinicalAfter implementing preoperative baths in Tanzania, wound infection rates dropped to nearly zero↗
▶Ep 135 · 10:56
clinicalAfter implementing preoperative baths in Tanzania, wound infection rates dropped to nearly zero↗
quoteYeah, we've had a couple unrepaired CDH's valvulize their stomach and need to get fixed more urgently. It's not common, but it's happened.↗
▶Ep 7 · 2:38
clinicalKey presentation findings in gastric volvulus include a weird looking fixed bubble in the chest that cannot be decompressed and inability to advance the NG tube.↗
▶Ep 7 · 2:38
quoteHad a weird looking sort of fixed bubble in the chest that was not able to be decompressed, couldn't advance the repogal.↗
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
▶Ep 11 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 11 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 11 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus.↗
▶Ep 11 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 11 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus.↗
▶Ep 11 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 11 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 11 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 11 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 11 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 11 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 11 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 11 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 11 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 11 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 11 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 11 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 11 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 11 · 1:58
clinicalThe epiglottis is a key landmark to locate when navigating to the trachea.↗
▶Ep 11 · 1:58
clinicalThe epiglottis is a key landmark to locate when navigating to the trachea.↗
▶Ep 11 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 11 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 11 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 11 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 11 · 2:36
clinicalThe scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus.↗
▶Ep 11 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 11 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 11 · 2:36
clinicalThe scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus.↗
▶Ep 11 · 2:39
quoteThat tells you both where you are in the trachea.↗
▶Ep 11 · 2:39
quoteThat tells you both where you are in the trachea.↗
▶Ep 11 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 11 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 11 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
▶Ep 11 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
▶Ep 11 · 3:29
clinicalThe balloon contains a little metal ball that can be visualized.↗
▶Ep 11 · 3:29
clinicalThe balloon contains a little metal ball that can be visualized.↗
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
▶Ep 12 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 12 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 12 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus.↗
▶Ep 12 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 12 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 12 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 12 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 12 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 12 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 12 · 1:58
clinicalThe epiglottis is a key landmark to identify when navigating toward the trachea.↗
▶Ep 12 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 12 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the trocar goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 12 · 2:36
clinicalThe scope should always be advanced until the carina is visualized to confirm position in the trachea and determine location within the trachea.↗
▶Ep 12 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 12 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 12 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 4 · 7:09
quoteThat it does not seem reflective at all of the type of things that that we see in our practice here, and I think that would be seen in a lot of practices in the United States.↗
▶Ep 4 · 7:09
opinionThe Sheffield Hirschsprung management sequence does not reflect typical practice in the United States↗
▶Ep 4 · 7:20
clinicalIn US practice, most Hirschsprung patients undergo either neonatal pull-through or are sent home on irrigations for pull-through in the first couple of months of life↗
▶Ep 4 · 7:39
clinicalIn US practice, pre-pull-through diversion is only done for delayed presentation with perforation or complicated cardiac babies↗
▶Ep 4 · 10:41
quoteYeah, I mean, the first year that we operated there, almost every kid got a wound infection, and then we started the next year we had the nurses do pre-op baths up on the floor the day before, and that year we had like 0 wound infections.↗
▶Ep 4 · 10:41
clinicalBefore implementing preoperative bathing in Tanzania, almost every pediatric surgery patient developed a wound infection↗
▶Ep 4 · 10:56
clinicalAfter implementing preoperative baths in Tanzania, wound infection rates dropped to nearly zero↗
quoteYeah, we've had a couple unrepaired CDH's valvulize their stomach and need to get fixed more urgently. It's not common, but it's happened.↗
▶Ep 43 · 2:38
quoteHad a weird looking sort of fixed bubble in the chest that was not able to be decompressed, couldn't advance the repogal.↗
▶Ep 43 · 2:38
clinicalKey presentation findings in gastric volvulus include a weird looking fixed bubble in the chest that cannot be decompressed and inability to advance the NG tube.↗
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 46 · 6:52
clinicalCincinnati Children's protocol includes standardized feed advancement and sham feeding to address poor oral feeding skills in gastroschisis patients.↗
▶Ep 46 · 7:40
quotewe introduced sham feeding because what we realized is a lot of our gastroschesis babies have very poor oral feeding skills from you know delayed access to feeding↗
▶Ep 46 · 8:10
quotewe had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late↗
▶Ep 46 · 8:10
clinicalCincinnati Children's attempted ad-lib feeding for gastroschisis but abandoned it after one year due to poor results, including delayed NG tube removal and starting feeds too late.↗
▶Ep 46 · 8:40
clinicalCincinnati Children's current gastroschisis feeding protocol has been in place for approximately four years.↗
▶Ep 46 · 10:01
host_summaryIn a multi-institutional study, protocol-fed gastroschisis infants had fewer surgical site infections compared to non-protocol-fed infants.↗
▶Ep 46 · 10:01
quotethe protocol fed infants had fewer surgical site infections↗
▶Ep 46 · 13:51
clinicalCincinnati Children's protocol includes both intermittent feeds and sham feeds, with sham feeds implemented for approximately one year.↗
▶Ep 46 · 13:51
quoteour rate of sending gastroschisis babies home with an ng or a g tube it's like two thirds of them go home with some sort of tube to help them continue feeding which is crazy↗
▶Ep 46 · 13:51
epidemiologicalApproximately two-thirds of Cincinnati Children's gastroschisis patients are discharged home with an NG tube or G-tube for continued feeding support.↗
▶Ep 46 · 16:58
quotewe did put in our protocol for our nursing college as well as our families that emesis is expected we put that within our written protocol to make that expectation known that it's okay it's okay they're going to throw up we'll just keep working through it↗
▶Ep 46 · 16:58
clinicalCincinnati Children's written protocol explicitly states that emesis is expected during gastroschisis feeding to set appropriate expectations for nursing staff and families.↗
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
▶Ep 29 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 29 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 29 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 29 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus.↗
▶Ep 29 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus.↗
▶Ep 29 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 29 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 29 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 29 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 29 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 29 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 29 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 29 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 29 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 29 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 29 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 29 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 29 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 29 · 1:58
clinicalThe epiglottis is a key landmark to locate when navigating to the trachea.↗
▶Ep 29 · 1:58
clinicalThe epiglottis is a key landmark to locate when navigating to the trachea.↗
▶Ep 29 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 29 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 29 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 29 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 29 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 29 · 2:36
clinicalThe scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus.↗
▶Ep 29 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 29 · 2:36
clinicalThe scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus.↗
▶Ep 29 · 2:39
quoteThat tells you both where you are in the trachea.↗
▶Ep 29 · 2:39
quoteThat tells you both where you are in the trachea.↗
▶Ep 29 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 29 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 29 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
▶Ep 29 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
▶Ep 29 · 3:29
clinicalThe balloon contains a little metal ball that can be visualized.↗
▶Ep 29 · 3:29
clinicalThe balloon contains a little metal ball that can be visualized.↗
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
▶Ep 30 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 30 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 30 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 30 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus.↗
▶Ep 30 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 30 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus.↗
▶Ep 30 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 30 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 30 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 30 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 30 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 30 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 30 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 30 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 30 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 30 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 30 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 30 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 30 · 1:58
clinicalThe epiglottis is a key landmark to identify when navigating toward the trachea.↗
▶Ep 30 · 1:58
clinicalThe epiglottis is a key landmark to identify when navigating toward the trachea.↗
▶Ep 30 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the trocar goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 30 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 30 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 30 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the trocar goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 30 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 30 · 2:36
clinicalThe scope should always be advanced until the carina is visualized to confirm position in the trachea and determine location within the trachea.↗
▶Ep 30 · 2:36
clinicalThe scope should always be advanced until the carina is visualized to confirm position in the trachea and determine location within the trachea.↗
▶Ep 30 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 30 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 30 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 30 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
▶Ep 30 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 18 · 6:52
clinicalCincinnati Children's protocol includes standardized feed advancement and sham feeding to address poor oral feeding skills in gastroschisis patients.↗
▶Ep 18 · 7:40
quotewe introduced sham feeding because what we realized is a lot of our gastroschesis babies have very poor oral feeding skills from you know delayed access to feeding↗
▶Ep 18 · 8:10
quotewe had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late↗
▶Ep 18 · 8:10
clinicalCincinnati Children's attempted ad-lib feeding for gastroschisis but abandoned it after one year due to poor results, including delayed NG tube removal and starting feeds too late.↗
▶Ep 18 · 8:40
clinicalCincinnati Children's current gastroschisis feeding protocol has been in place for approximately four years.↗
▶Ep 18 · 10:01
host_summaryIn a multi-institutional study, protocol-fed gastroschisis infants had fewer surgical site infections compared to non-protocol-fed infants.↗
▶Ep 18 · 10:01
quotethe protocol fed infants had fewer surgical site infections↗
▶Ep 18 · 13:51
quoteour rate of sending gastroschisis babies home with an ng or a g tube it's like two thirds of them go home with some sort of tube to help them continue feeding which is crazy↗
▶Ep 18 · 13:51
epidemiologicalApproximately two-thirds of Cincinnati Children's gastroschisis patients are discharged home with an NG tube or G-tube for continued feeding support.↗
▶Ep 18 · 13:51
clinicalCincinnati Children's protocol includes both intermittent feeds and sham feeds, with sham feeds implemented for approximately one year.↗
▶Ep 18 · 16:58
clinicalCincinnati Children's written protocol explicitly states that emesis is expected during gastroschisis feeding to set appropriate expectations for nursing staff and families.↗
▶Ep 18 · 16:58
quotewe did put in our protocol for our nursing college as well as our families that emesis is expected we put that within our written protocol to make that expectation known that it's okay it's okay they're going to throw up we'll just keep working through it↗
quoteI think this is like a nightmare in clinic, honestly, this is the patient that no one wants to see, right? I mean, rectal prolapses. I it's very distressing to the patient and the family, and we don't really have a lot of, of great options.↗
▶Ep 40 · 1:34
quoteI think this is like a nightmare in clinic, honestly, this is the patient that no one wants to see, right? I mean, rectal prolapses. I it's very distressing to the patient and the family, and we don't really have a lot of, of great options.↗
▶Ep 40 · 1:54
quoteIf it's a patient that I've never met before, I typically will address, you know, concerns about the constipation first and sort of prove or disprove whether or not this patient is significantly constipated.↗
▶Ep 40 · 1:54
quoteIf it's a patient that I've never met before, I typically will address, you know, concerns about the constipation first and sort of prove or disprove whether or not this patient is significantly constipated.↗
▶Ep 40 · 2:07
quoteI think if they are constipated, that's like the easier patient to deal with, but every once in a while, you get a kid who is well managed on whatever their regimen is, and they're still prolapsing, and then I think the question is, what do you do?↗
▶Ep 40 · 2:07
quoteI think if they are constipated, that's like the easier patient to deal with, but every once in a while, you get a kid who is well managed on whatever their regimen is, and they're still prolapsing, and then I think the question is, what do you do?↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 55 · 7:09
opinionThe Sheffield Hirschsprung management sequence does not reflect typical practice in the United States↗
▶Ep 55 · 7:09
quoteThat it does not seem reflective at all of the type of things that that we see in our practice here, and I think that would be seen in a lot of practices in the United States.↗
▶Ep 55 · 7:09
opinionThe Sheffield Hirschsprung management sequence does not reflect typical practice in the United States↗
▶Ep 55 · 7:09
quoteThat it does not seem reflective at all of the type of things that that we see in our practice here, and I think that would be seen in a lot of practices in the United States.↗
▶Ep 55 · 7:20
clinicalIn US practice, most Hirschsprung patients undergo either neonatal pull-through or are sent home on irrigations for pull-through in the first couple of months of life↗
▶Ep 55 · 7:20
clinicalIn US practice, most Hirschsprung patients undergo either neonatal pull-through or are sent home on irrigations for pull-through in the first couple of months of life↗
▶Ep 55 · 7:39
clinicalIn US practice, pre-pull-through diversion is only done for delayed presentation with perforation or complicated cardiac babies↗
▶Ep 55 · 7:39
clinicalIn US practice, pre-pull-through diversion is only done for delayed presentation with perforation or complicated cardiac babies↗
▶Ep 55 · 10:41
quoteYeah, I mean, the first year that we operated there, almost every kid got a wound infection, and then we started the next year we had the nurses do pre-op baths up on the floor the day before, and that year we had like 0 wound infections.↗
▶Ep 55 · 10:41
clinicalBefore implementing preoperative bathing in Tanzania, almost every pediatric surgery patient developed a wound infection↗
▶Ep 55 · 10:41
quoteYeah, I mean, the first year that we operated there, almost every kid got a wound infection, and then we started the next year we had the nurses do pre-op baths up on the floor the day before, and that year we had like 0 wound infections.↗
▶Ep 55 · 10:41
clinicalBefore implementing preoperative bathing in Tanzania, almost every pediatric surgery patient developed a wound infection↗
▶Ep 55 · 10:56
clinicalAfter implementing preoperative baths in Tanzania, wound infection rates dropped to nearly zero↗
▶Ep 55 · 10:56
clinicalAfter implementing preoperative baths in Tanzania, wound infection rates dropped to nearly zero↗
quoteYeah, we've had a couple unrepaired CDH's valvulize their stomach and need to get fixed more urgently. It's not common, but it's happened.↗
▶Ep 59 · 2:38
quoteHad a weird looking sort of fixed bubble in the chest that was not able to be decompressed, couldn't advance the repogal.↗
▶Ep 59 · 2:38
clinicalKey presentation findings in gastric volvulus include a weird looking fixed bubble in the chest that cannot be decompressed and inability to advance the NG tube.↗
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 62 · 6:52
clinicalCincinnati Children's protocol includes standardized feed advancement and sham feeding to address poor oral feeding skills in gastroschisis patients.↗
▶Ep 62 · 7:40
quotewe introduced sham feeding because what we realized is a lot of our gastroschesis babies have very poor oral feeding skills from you know delayed access to feeding↗
▶Ep 62 · 8:10
quotewe had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late↗
▶Ep 62 · 8:10
clinicalCincinnati Children's attempted ad-lib feeding for gastroschisis but abandoned it after one year due to poor results, including delayed NG tube removal and starting feeds too late.↗
▶Ep 62 · 8:40
clinicalCincinnati Children's current gastroschisis feeding protocol has been in place for approximately four years.↗
▶Ep 62 · 10:01
host_summaryIn a multi-institutional study, protocol-fed gastroschisis infants had fewer surgical site infections compared to non-protocol-fed infants.↗
▶Ep 62 · 10:01
quotethe protocol fed infants had fewer surgical site infections↗
▶Ep 62 · 13:51
epidemiologicalApproximately two-thirds of Cincinnati Children's gastroschisis patients are discharged home with an NG tube or G-tube for continued feeding support.↗
▶Ep 62 · 13:51
quoteour rate of sending gastroschisis babies home with an ng or a g tube it's like two thirds of them go home with some sort of tube to help them continue feeding which is crazy↗
▶Ep 62 · 13:51
clinicalCincinnati Children's protocol includes both intermittent feeds and sham feeds, with sham feeds implemented for approximately one year.↗
▶Ep 62 · 16:58
quotewe did put in our protocol for our nursing college as well as our families that emesis is expected we put that within our written protocol to make that expectation known that it's okay it's okay they're going to throw up we'll just keep working through it↗
▶Ep 62 · 16:58
clinicalCincinnati Children's written protocol explicitly states that emesis is expected during gastroschisis feeding to set appropriate expectations for nursing staff and families.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 3 · 7:09
quoteThat it does not seem reflective at all of the type of things that that we see in our practice here, and I think that would be seen in a lot of practices in the United States.↗
▶Ep 3 · 7:09
opinionThe Sheffield Hirschsprung management sequence does not reflect typical practice in the United States↗
▶Ep 3 · 7:20
clinicalIn US practice, most Hirschsprung patients undergo either neonatal pull-through or are sent home on irrigations for pull-through in the first couple of months of life↗
▶Ep 3 · 7:39
clinicalIn US practice, pre-pull-through diversion is only done for delayed presentation with perforation or complicated cardiac babies↗
▶Ep 3 · 10:41
quoteYeah, I mean, the first year that we operated there, almost every kid got a wound infection, and then we started the next year we had the nurses do pre-op baths up on the floor the day before, and that year we had like 0 wound infections.↗
▶Ep 3 · 10:41
clinicalBefore implementing preoperative bathing in Tanzania, almost every pediatric surgery patient developed a wound infection↗
▶Ep 3 · 10:56
clinicalAfter implementing preoperative baths in Tanzania, wound infection rates dropped to nearly zero↗
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
▶Ep 6 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 6 · 0:27
quoteSo this is just a little schematic of what this looks like.↗
▶Ep 6 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 6 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus.↗
▶Ep 6 · 0:33
clinicalFETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus.↗
▶Ep 6 · 0:33
quoteFor it's a percutaneous intervention on mom.↗
▶Ep 6 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 6 · 0:36
clinicalA standard fetoscope with a side channel is used, and the balloon is worked through the side channel.↗
▶Ep 6 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 6 · 1:21
clinicalThe tongue is an easy landmark to identify during FETO because it is bumpy in appearance.↗
▶Ep 6 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 6 · 1:24
quoteSo the tongue is a very easy landmark when you're doing a feto.↗
▶Ep 6 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 6 · 1:29
clinicalFluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.↗
▶Ep 6 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 6 · 1:38
clinicalIf the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth.↗
▶Ep 6 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 6 · 1:48
quoteIn this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right?↗
▶Ep 6 · 1:58
clinicalThe epiglottis is a key landmark to identify when navigating toward the trachea.↗
▶Ep 6 · 1:58
clinicalThe epiglottis is a key landmark to identify when navigating toward the trachea.↗
▶Ep 6 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 6 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the trocar goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 6 · 2:23
quoteYou also don't want to be torquing the membranes too much, right?↗
▶Ep 6 · 2:23
clinicalExcessive torquing of the membranes should be avoided because the trocar goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.↗
▶Ep 6 · 2:36
clinicalThe scope should always be advanced until the carina is visualized to confirm position in the trachea and determine location within the trachea.↗
▶Ep 6 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 6 · 2:36
quoteYou always advance the scope till you see the carina, right?↗
▶Ep 6 · 2:36
clinicalThe scope should always be advanced until the carina is visualized to confirm position in the trachea and determine location within the trachea.↗
▶Ep 6 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 6 · 2:56
clinicalThe balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea.↗
▶Ep 6 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
▶Ep 6 · 3:03
clinicalThe scope is backed up as the balloon is inflated so that balloon inflation can be watched.↗
quoteI think this is like a nightmare in clinic, honestly, this is the patient that no one wants to see, right? I mean, rectal prolapses. I it's very distressing to the patient and the family, and we don't really have a lot of, of great options.↗
▶Ep 2 · 1:54
quoteIf it's a patient that I've never met before, I typically will address, you know, concerns about the constipation first and sort of prove or disprove whether or not this patient is significantly constipated.↗
▶Ep 2 · 2:07
quoteI think if they are constipated, that's like the easier patient to deal with, but every once in a while, you get a kid who is well managed on whatever their regimen is, and they're still prolapsing, and then I think the question is, what do you do?↗
