#APSA50: Top Educational Content
With Dr. Aaron Jensen & Dr. Samir Gattapoli · hosted by Dr. Alex Cassar · StayCurrentMD
Part of
Cervical Spine Injury 3 items
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
285 min · Published Jul 2020
Podcast
Trauma
56 min · Published May 2017
Video
Cervical Spine Injury: Update Course 2016
21 min · Published Jul 2017
Video
Indications for CT Scan for Blunt Abdominal Trauma: Update Course 2017
34 min · Published Aug 2017
Only a few other public items share this expert — go deeper there →
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
Children can be clinically cleared without C-spine imaging if they have GCS 14-15, are not intoxicated, have no painful distracting injury, no neurologic deficits, no midline cervical tenderness, and can move head in all directions without limitation
Children age 3 and under can be clinically cleared unless they have high-risk mechanism of injury, particularly child abuse where C-spine injury rates are very high
Boston study of 300 children with normal initial C-spine imaging showed only 2% had ligamentous injury on MRI, none required surgery, and 84% were clinically cleared at first clinic visit 1-2 weeks later
Cervical collar pressure ulcers occur in 6-38% of patients, typically on clavicles, back of head, and base of neck; occur in ICU patients who receive significant fluid and have ICP monitors or are ventilated
Meta-analysis of 5 adult studies with 1,000 patients showed that with completely normal CT scans (no osteophytes, no degenerative disease), 9% had stable injuries on MRI requiring no treatment, and no patient required surgery
Adult recommendation is to remove collar with normal CT scan without MRI, but this has not been validated in children who have greater frequency of unstable ligamentous injury
70,000 children are hospitalized annually in the United States for sepsis, with 7,000 deaths - three times more than pediatric cancers, approximately 20 deaths per day
Sepsis has a 10% mortality rate (1 in 10), while septic shock has a 40% mortality rate (more than 1 in 3)
Three randomized trials (PROCESS, PROMISE, ARISE) showed no difference with goal-directed or protocol-based resuscitation in sepsis, but key principles remain important
For each hour delay in antibiotic administration in sepsis, there is an increase in mortality (Kumaral, Critical Care Medicine, 2006)
Procalcitonin is a biomarker specific for bacterial infections; trend is more important than absolute value; when it reaches normal levels, antibiotics can be stopped
In abdominal sepsis with adequate source control, antibiotics can be stopped at 4 days based on the STOP-IT trial (randomized multi-center trial)
The sepsis clock starts from time blood pressure is checked and found low to when antibiotics are actually hung, requiring IV access within first hour
The Andromeda shock study (2019, Hernandez et al., JAMA) found capillary refill was just as good as or better than lactate levels for guiding resuscitation, with cap refill group showing 35% mortality versus 43% in lactate group (p=0.06)
30 mL/kg of isotonic fluid is the appropriate initial volume resuscitation for sepsis
The FEAST trial in African children with severe infections showed that over-resuscitation increased mortality in pediatric sepsis
The ALBIOS trial showed albumin use in sepsis decreased the amount of fluid needed to achieve resuscitation goals
The TRISS trial identified hemoglobin of 7 g/dL as an adequate transfusion threshold in septic shock
For pediatric septic shock, start with dopamine in babies and norepinephrine in older children; use vasopressin as adjunct in renal failure (VANISH trial)
Milrinone is appropriate for warm shock (adequate blood pressure but inadequate perfusion) to provide inotropic support
Steroids (hydrocortisone 1.5-2 mg/kg every 6 hours) should be started when initiating a second pressor; no data supports doing a stim test in this setting
On VA ECMO for septic shock, if SVO2 is 70%, there is adequate flow; further increases in flow are not needed and focus should return to source control and appropriate antibiotics
CVP monitoring in pediatric sepsis is often intermittent rather than continuous due to limited central line lumens being occupied by sedation drips and other infusions
Bedside ultrasound for sepsis assessment includes checking IVC for respiratory variation and collapse, right atrium for dilation and pulmonary hypertension, and heart function for dynamic contractility
In sepsis, diastolic blood pressure typically drops significantly (e.g., 70/30 or 80/20) due to loss of systemic vascular resistance
For septic shock with renal failure, if SVO2 is 70% on ECMO, adequate flow is present; focus should shift to source control and appropriate antibiotics rather than increasing ECMO flow
If patient is improving with normal procalcitonin, antibiotics should be stopped rather than continuing for 'a couple more days'; stopping early allows for reculturing if patient worsens and bacteria may have developed resistance
Over 2 million patients annually suffer from infections with resistant organisms in hospitals at annual cost of $20 billion, with 23,000 American deaths per year; largest impact is in elderly and children under 1 year
Over 40% of patients undergoing clean surgical procedures without foreign body implantation at freestanding children's hospitals receive unindicated antibiotic prophylaxis
Over 50% of patients who appropriately receive antibiotic prophylaxis have it extended past incision closure; for colorectal procedures, average duration is 2.5 days
Almost 30% of patients receive antibiotics with broader spectrum than recommended guidelines, with double coverage (Flagyl and Zosyn) being common
Three areas account for 85% of inappropriate antibiotic use in pediatric surgery: prophylaxis for clean cases without foreign bodies (50%), prophylaxis after incision closure (30%), and anaerobic coverage for proximal GI procedures (remaining percentage)
About 40% of central venous lines (tunneled CVLs and ports) at freestanding children's hospitals receive prophylaxis, with practice split approximately 50/50
Cochrane reviews on central line infections show disparate data with no strong conclusion, but trend toward reduced infection rates in oncology population
For oncology patients receiving central lines who will undergo induction chemotherapy with expected count decrease, prophylactic antibiotics are recommended based on higher infection risk
Adult literature for colorectal cases shows no benefit to antibiotics past incision closure; pediatric SSI rates are much lower than adults when adjusting for procedure type and RVUs
Bratzler consensus guidelines (from Infectious Disease Society of America, Surgical Infection Society, American Society of Hospital Pharmacists) do not recommend routine fungal coverage for proximal GI procedures as SSI data does not support it
NSQIP collaborative of 84 hospitals will collect data on 85,000 children over one year, relating prophylaxis to surgical site infections and C. difficile using CDC criteria, providing first rigorous pediatric-specific antibiotic stewardship data
For children without perforated appendicitis, avoid anti-pseudomonal agents; start with cefoxitin or ceftriaxone and Flagyl instead of Zosyn