Since institution of our clinical care pathway about 2 to 3 years ago, we have reduced our length of stay from 4.5 days to 3 days and have also increased our patient satisfaction.
Since institution of our clinical care pathway about 2 to 3 years ago, we have reduced our length of stay from 4.5 days to 3 days and have also increased our patient satisfaction.
The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age.
The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age.
The 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age.
quoteAnd it's a bacterial colonization of that umbilical stump.↗
▶Ep 39 · 1:12
clinicalOmphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora.↗
▶Ep 39 · 1:30
clinicalIn advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation.↗
▶Ep 39 · 2:17
epidemiologicalUmbilical hernias are more common in African Americans, low birth weight infants, and premature infants.↗
▶Ep 39 · 3:21
quoteIncarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect.↗
▶Ep 39 · 3:21
epidemiologicalIncarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects.↗
▶Ep 39 · 3:42
epidemiologicalIn Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age.↗
▶Ep 39 · 4:06
guidelineA literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size.↗
▶Ep 39 · 4:26
quoteEarly surgical repair before age 4 was not indicated regardless of the size of the defect.↗
▶Ep 39 · 4:40
epidemiologicalIn a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age.↗
▶Ep 39 · 4:45
quoteThe 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age.↗
▶Ep 39 · 6:03
quoteIf that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years.↗
▶Ep 39 · 6:03
epidemiologicalIf an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5.↗
▶Ep 39 · 6:34
opinionDr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously.↗
▶Ep 39 · 6:34
quoteIf it has a huge defect and it's proboscoid, it's probably not gonna close.↗
▶Ep 39 · 6:43
guidelineIndications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school.↗
▶Ep 39 · 7:11
quoteI think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms.↗
▶Ep 39 · 7:11
opinionDr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms.↗
▶Ep 39 · 7:22
clinicalUmbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus.↗
▶Ep 39 · 8:52
epidemiologicalUmbilical granulomas are the most common umbilical masses in newborns.↗
▶Ep 39 · 9:17
clinicalDr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading.↗
▶Ep 39 · 9:40
clinicalBright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas.↗
clinicalOmphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora.↗
▶Ep 59 · 1:12
quoteAnd it's a bacterial colonization of that umbilical stump.↗
▶Ep 59 · 1:30
clinicalIn advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation.↗
▶Ep 59 · 2:17
epidemiologicalUmbilical hernias are more common in African Americans, low birth weight infants, and premature infants.↗
▶Ep 59 · 3:21
quoteIncarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect.↗
▶Ep 59 · 3:21
epidemiologicalIncarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects.↗
▶Ep 59 · 3:42
epidemiologicalIn Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age.↗
▶Ep 59 · 4:06
guidelineA literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size.↗
▶Ep 59 · 4:26
quoteEarly surgical repair before age 4 was not indicated regardless of the size of the defect.↗
▶Ep 59 · 4:40
epidemiologicalIn a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age.↗
▶Ep 59 · 4:45
quoteThe 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age.↗
▶Ep 59 · 6:03
epidemiologicalIf an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5.↗
▶Ep 59 · 6:03
quoteIf that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years.↗
▶Ep 59 · 6:34
quoteIf it has a huge defect and it's proboscoid, it's probably not gonna close.↗
▶Ep 59 · 6:34
opinionDr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously.↗
▶Ep 59 · 6:43
guidelineIndications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school.↗
▶Ep 59 · 7:11
opinionDr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms.↗
▶Ep 59 · 7:11
quoteI think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms.↗
▶Ep 59 · 7:22
clinicalUmbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus.↗
▶Ep 59 · 8:52
epidemiologicalUmbilical granulomas are the most common umbilical masses in newborns.↗
▶Ep 59 · 9:17
clinicalDr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading.↗
▶Ep 59 · 9:40
clinicalBright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas.↗
clinicalOmphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora.↗
▶Ep 89 · 1:12
quoteAnd it's a bacterial colonization of that umbilical stump.↗
▶Ep 89 · 1:30
clinicalIn advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation.↗
▶Ep 89 · 2:17
epidemiologicalUmbilical hernias are more common in African Americans, low birth weight infants, and premature infants.↗
▶Ep 89 · 3:21
epidemiologicalIncarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects.↗
▶Ep 89 · 3:21
quoteIncarceration with umbilical hernias, it's actually pretty rare, less than 0.2%, and it's more common if you have a smaller defect.↗
▶Ep 89 · 3:42
epidemiologicalIn Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age.↗
▶Ep 89 · 4:06
guidelineA literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size.↗
▶Ep 89 · 4:26
quoteEarly surgical repair before age 4 was not indicated regardless of the size of the defect.↗
▶Ep 89 · 4:40
epidemiologicalIn a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age.↗
▶Ep 89 · 4:45
quoteThe 3 year recurrence rate when you fix umbilical hernia was twice as high in children less than 4 years of age versus if they were greater than 4 years of age.↗
▶Ep 89 · 6:03
epidemiologicalIf an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5.↗
▶Ep 89 · 6:03
quoteIf that umbilical hernia was persistent at age 3, spontaneous closure was 20% by 4 years and 35% by 5 years.↗
▶Ep 89 · 6:34
opinionDr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously.↗
▶Ep 89 · 6:34
quoteIf it has a huge defect and it's proboscoid, it's probably not gonna close.↗
▶Ep 89 · 6:43
guidelineIndications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school.↗
▶Ep 89 · 7:11
opinionDr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms.↗
▶Ep 89 · 7:11
quoteI think in general, 5 years, regardless of size, if it hasn't closed, fix it. If until then, leave it alone unless they're having symptoms.↗
▶Ep 89 · 7:22
clinicalUmbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus.↗
▶Ep 89 · 8:52
epidemiologicalUmbilical granulomas are the most common umbilical masses in newborns.↗
▶Ep 89 · 9:17
clinicalDr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading.↗
▶Ep 89 · 9:40
clinicalBright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas.↗
quoteI am Rebecca L. Brown, and I'm a pediatric surgeon at Cincinnati Children's and the co-director of the Chestwall Center.↗
▶Ep 19 · 0:05
quoteI am Rebecca L. Brown, and I'm a pediatric surgeon at Cincinnati Children's and the co-director of the Chestwall Center.↗
▶Ep 19 · 0:19
clinicalThe pectus excavatum clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output.↗
▶Ep 19 · 0:19
quoteThere are 5 major components to the clinical care pathway pain management, mobility, lung recruitment, daily intake, and daily output.↗
▶Ep 19 · 0:19
clinicalThe pectus excavatum clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output.↗
▶Ep 19 · 0:19
quoteThere are 5 major components to the clinical care pathway pain management, mobility, lung recruitment, daily intake, and daily output.↗
▶Ep 19 · 0:27
clinicalPreoperatively, compression boots are applied for pectus excavatum repair.↗
▶Ep 19 · 0:27
clinicalPreoperatively, compression boots are applied for pectus excavatum repair.↗
▶Ep 19 · 0:31
clinicalA type and screen is performed preoperatively for pectus excavatum repair.↗
▶Ep 19 · 0:31
clinicalA type and screen is performed preoperatively for pectus excavatum repair.↗
▶Ep 19 · 0:33
clinicalAncef is given prior to incision, or vancomycin if the patient is MRSA positive.↗
▶Ep 19 · 0:33
clinicalPreoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after pectus excavatum surgery.↗
▶Ep 19 · 0:33
clinicalAncef is given prior to incision, or vancomycin if the patient is MRSA positive.↗
▶Ep 19 · 0:33
clinicalPreoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after pectus excavatum surgery.↗
▶Ep 19 · 0:46
clinicalPatients are placed on continuous pulse oximetry postoperatively.↗
▶Ep 19 · 0:46
clinicalPatients are placed on continuous pulse oximetry postoperatively.↗
▶Ep 19 · 0:49
clinicalPatients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0.↗
▶Ep 19 · 0:49
clinicalPatients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0.↗
▶Ep 19 · 0:55
clinicalPatients are encouraged to be out of bed to the chair and then to ambulate on postoperative day 0, especially if they are the first case of the day.↗
▶Ep 19 · 0:55
clinicalPatients are encouraged to be out of bed to the chair and then to ambulate on postoperative day 0, especially if they are the first case of the day.↗
▶Ep 19 · 1:01
clinicalIncentive spirometry is performed 10 times per hour postoperatively.↗
▶Ep 19 · 1:01
clinicalIncentive spirometry is performed 10 times per hour postoperatively.↗
▶Ep 19 · 1:11
clinicalPatients receive Ancef times 3 doses postoperatively, or clindamycin if they are MRSA positive.↗
▶Ep 19 · 1:11
clinicalPatients receive Ancef times 3 doses postoperatively, or clindamycin if they are MRSA positive.↗
▶Ep 19 · 1:19
clinicalAn epidural is routinely used for pain management after pectus excavatum repair, supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran for nausea.↗
▶Ep 19 · 1:19
clinicalAn epidural is routinely used for pain management after pectus excavatum repair, supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran for nausea.↗
▶Ep 19 · 1:31
clinicalPatients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively.↗
▶Ep 19 · 1:31
clinicalPatients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively.↗
▶Ep 19 · 1:33
clinicalFor bowel management, patients are given Senna and MiraLax twice a day as well as Movantik.↗
▶Ep 19 · 1:33
clinicalFor bowel management, patients are given Senna and MiraLax twice a day as well as Movantik.↗
▶Ep 19 · 1:43
clinicalThe Foley catheter inserted during surgery is continued on postoperative day 1.↗
▶Ep 19 · 1:43
clinicalThe Foley catheter inserted during surgery is continued on postoperative day 1.↗
▶Ep 19 · 1:49
clinicalOn postoperative day 1, patients are encouraged to be out of bed, up to a chair, and ambulating about the room 3 times a day.↗
▶Ep 19 · 1:49
clinicalOn postoperative day 1, patients are encouraged to be out of bed, up to a chair, and ambulating about the room 3 times a day.↗
▶Ep 19 · 1:56
clinicalThe Foley catheter is removed on postoperative day 1 to encourage ambulation.↗
▶Ep 19 · 1:56
clinicalThe Foley catheter is removed on postoperative day 1 to encourage ambulation.↗
▶Ep 19 · 2:03
clinicalOn postoperative day 1, the epidural remains in place and medications are supplemented with Valium, Robaxin, Toradol, IV Tylenol, and oxycodone is started orally once patients are tolerating a diet.↗
▶Ep 19 · 2:03
clinicalOn postoperative day 1, the epidural remains in place and medications are supplemented with Valium, Robaxin, Toradol, IV Tylenol, and oxycodone is started orally once patients are tolerating a diet.↗
▶Ep 19 · 2:21
clinicalMaintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal.↗
▶Ep 19 · 2:21
clinicalMaintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal.↗
▶Ep 19 · 2:34
clinicalZofran, initially given routinely every 8 hours, is changed to as needed on postoperative day 1.↗
▶Ep 19 · 2:34
clinicalZofran, initially given routinely every 8 hours, is changed to as needed on postoperative day 1.↗
▶Ep 19 · 2:49
clinicalOn postoperative day 2, IV fluids are discontinued if still running.↗
▶Ep 19 · 2:49
clinicalOn postoperative day 2, IV fluids are discontinued if still running.↗
▶Ep 19 · 2:53
clinicalThe epidural catheter is stopped at 6 in the morning on postoperative day 2.↗
▶Ep 19 · 2:53
clinicalThe epidural catheter is stopped at 6 in the morning on postoperative day 2.↗
▶Ep 19 · 2:57
clinicalThe epidural is removed when the pain team rounds later in the morning on postoperative day 2.↗
▶Ep 19 · 2:57
clinicalThe epidural is removed when the pain team rounds later in the morning on postoperative day 2.↗
▶Ep 19 · 3:01
clinicalOn postoperative day 2, the patient is transitioned to all oral pain medications including oxycodone, Valium, Robaxin, Motrin, and Tylenol.↗
▶Ep 19 · 3:01
clinicalOn postoperative day 2, the patient is transitioned to all oral pain medications including oxycodone, Valium, Robaxin, Motrin, and Tylenol.↗
▶Ep 19 · 3:10
clinicalA two-view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out any pleural effusion or pneumothorax.↗
▶Ep 19 · 3:10
clinicalA two-view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out any pleural effusion or pneumothorax.↗
▶Ep 19 · 3:19
clinicalDressings are removed and the chest is washed daily starting on postoperative day 2.↗
▶Ep 19 · 3:19
clinicalDressings are removed and the chest is washed daily starting on postoperative day 2.↗
▶Ep 19 · 3:26
clinicalOn postoperative day 2, patients are encouraged to ambulate at least 3 times in the halls.↗
▶Ep 19 · 3:26
clinicalOn postoperative day 2, patients are encouraged to ambulate at least 3 times in the halls.↗
▶Ep 19 · 3:51
clinicalOn postoperative day 3, physical therapy and occupational therapy work with the patient to help them walk up and down the stairs, and PT/OT will sign off once they are able to do this.↗
▶Ep 19 · 3:51
clinicalOn postoperative day 3, physical therapy and occupational therapy work with the patient to help them walk up and down the stairs, and PT/OT will sign off once they are able to do this.↗
▶Ep 19 · 4:02
clinicalPrescriptions are filled and the medication schedule is given to the parent and patients on postoperative day 3.↗
▶Ep 19 · 4:02
clinicalPrescriptions are filled and the medication schedule is given to the parent and patients on postoperative day 3.↗
▶Ep 19 · 4:27
clinicalThe patient should be on oral pain medication only by postoperative day 3.↗
▶Ep 19 · 4:27
clinicalThe patient should be on oral pain medication only by postoperative day 3.↗
▶Ep 19 · 4:31
clinicalThe patient is discharged home on postoperative day 3 if pain is well controlled and the patient is tolerating oral intake.↗
▶Ep 19 · 4:31
clinicalThe patient is discharged home on postoperative day 3 if pain is well controlled and the patient is tolerating oral intake.↗
▶Ep 19 · 4:46
quoteSince institution of our clinical care pathway about 2 to 3 years ago, we have reduced our length of stay from 4.5 days to 3 days and have also increased our patient satisfaction.↗
▶Ep 19 · 4:46
clinicalSince institution of the clinical care pathway about 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days.↗
▶Ep 19 · 4:46
clinicalSince institution of the clinical care pathway about 2 to 3 years ago, patient satisfaction has increased.↗
▶Ep 19 · 4:46
clinicalSince institution of the clinical care pathway about 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days.↗
▶Ep 19 · 4:46
quoteSince institution of our clinical care pathway about 2 to 3 years ago, we have reduced our length of stay from 4.5 days to 3 days and have also increased our patient satisfaction.↗
▶Ep 19 · 4:46
clinicalSince institution of the clinical care pathway about 2 to 3 years ago, patient satisfaction has increased.↗
