7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
With Dr. Alex Gibbons & Dr. Mark Wolkin & Dr. Salim Islam & Dr. Fred Rescorla · hosted by Dr. Todd Ponsky · StayCurrentMD
Cued at 33:01 · stops at 33:46 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
More about sickle cell disease
same diagnosisOnly 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
Exception to restrictive transfusion is sickle cell disease where hematocrit needs to be around 30 or HbSS below 50%
At our institution, VTE prophylaxis policy is for patients 12 years and over
High risk for VTE includes femur fractures, cervical spine fracture, and intubated patients
Kids with IBD are probably the most at-risk group for deep venous thromboses
It is important to take lymph nodes in Wilms tumor regardless of whether the patient has lung metastases because you treat the local disease and it has an impact on treatment for abdominal disease
For Wilms tumor lymph node sampling, there are data to show that nine nodes or seven nodes are probably adequate, but plucking nodes from the mesentery or pelvis is not helpful just to get a number
For Wilms tumor, you should take nodes from both sides of the cava and the aorta, but you don't have to dive into the renal hilum on the other side or open Gerota's fascia
Babies don't need antibiotics just because they showed up in the NICU; they only need standard prophylactic antibiotics when going to the OR
Children with ruptured omphalocele or gastroschisis have an open abdomen and probably should receive antibiotics
Children with duodenal atresia probably don't need antibiotics if they're going to the operating room within the next 24 to 48 hours
For intact omphalocele managed with paint and wait, no antibiotics are needed as long as mom didn't have chorioamnionitis and baby doesn't have fever
Broad-spectrum antimicrobial therapy for sepsis means extended-spectrum penicillin like piperacillin-tazobactam or ampicillin-sulbactam to cover everything empirically
ECMO survival for patients with severe sepsis and recalcitrant hypotension is about 46% overall, which is better than zero
Restrictive transfusion protocols using a target hemoglobin of 7 instead of 8, 9, or 10 showed no difference in mortality
Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality
Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and is equally tolerated
In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still have recovery afterwards and it helps preserve fertility
Ultrasound is not a great tool for diagnosis of ovarian torsion; clinical judgment should not be based primarily on ultrasound findings
For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin
For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7
Burnout directly impacts patient care and outcomes
Support systems for physician wellness need to be established proactively during education and practice because burnt out surgeons are not likely to seek help
Physicians should talk to patients about whether there's a firearm in the home and if there is, whether it's safely stored
Isotonic fluids should be continued throughout hospitalization instead of switching to hypotonic fluids for maintenance, which decreases the risk of hyponatremia with similar morbidity and mortality
In Wilms tumor operations, failure to remove lymph nodes automatically upstages the patient
Pulmonary metastasis in Wilms tumor doesn't preclude doing a primary nephrectomy
Non-operative management of uncomplicated appendicitis has decreased days of hospitalization, decreased days of disability, and equal outcome measures
The important point in non-operative appendicitis management is not whether it's effective for six months or a year, but what happens 10, 20, or 40 years down the road regarding appendix scarring and future obstruction
In the APAC trial (adult study), at five years, 41% of the non-operative appendicitis group underwent an appendectomy
Parents surveyed for PCORI-funded study said if there was a 50% chance of non-operative appendicitis management being successful, they would enroll in the study
Recommendations for opioid crisis management include reducing total amount of opioids prescribed, using non-opioid analgesia and non-pharmacological approaches, and educating on disposal of unused opioids
Enhanced recovery after surgery protocols have been great at reducing opioids both in the inpatient setting and at time of discharge
For well-appearing neonates with intact omphalocele and no maternal fever or chorioamnionitis, preoperative antibiotic given one hour before incision and discontinued within 72 hours is most appropriate
Based on AAP and neonatology recommendations, as long as the baby is well and mother has no signs of sepsis or chorioamnionitis, you don't need to give antibiotics for children that don't have an open abdomen
According to Surviving Sepsis Campaign guidelines, give 20 cc per kilo boluses of isotonic fluid up to 60 ml per kilo total, with goal of perfusion improvement
Stop fluid boluses if you see over-perfusion such as rales on auscultation or enlarged liver
Must start broad-spectrum antibiotics in sepsis; data shows in adults that if you wait over three hours to start antibiotics in a septic patient, survival goes down
If hematocrit or hemoglobin is less than 10 in septic patient, transfusion may be indicated
For pediatric sepsis, epinephrine is the vasopressor of choice; two randomized trials showed mortality was better with epi in one study and epi had better improvement in systolic blood pressure in the other compared to dopamine
Hydrocortisone has a role in sepsis for patients who are vasopressor refractory, meaning vasopressors were started and systolic blood pressure remains low
Draw blood for lactate level and cultures just prior to starting antibiotics in sepsis, but don't delay starting antibiotics while waiting
Antibiotic stewardship in sepsis means following cultures and titrating antibiotics down or stopping them altogether if in three or four days patients have improved and it's no longer an infectious issue
The odds ratio for not starting antibiotics within three hours in children with sepsis was 3.92 for mortality - almost four times more likely to die
Updated APSA blunt liver-spleen injury guidelines recommend treating based on patients' hemodynamic status, not injury grade
Modified shock index for pediatrics (heart rate over systolic blood pressure) can determine if patient is still bleeding; if so, recommend ICU admission
If patient with solid organ injury has responded to normal saline bolus and remains hemodynamically stable, they just need to be observed on the ward
For ward admission with solid organ injury, patient needs only another hemoglobin check in six hours, can have regular diet, and no activity restrictions needed
After first 20 ml per kilo normal saline bolus in trauma, if patient still requires additional fluids, give blood (10 cc per kilo)
Angioembolization in stable patients with solid organ injury does not need to be done even with contrast blush, particularly in splenic injuries which have been shown not to continue bleeding
If there's evidence of ongoing bleeding in solid organ injury, then angioembolization should be performed
Based on ATOMIC protocol, 40 mLs per kilogram of packed red blood cells is the threshold; when you need more than 40 cc per kilo, you should go to the operating room
ATOMIC was started in 2010 as a group of level one pediatric trauma centers (Arkansas, Texas, Oklahoma, Memphis, Arizona) coming together to study vital trauma questions prospectively
Cervical spine injury is about 1 to 2% of all pediatric traumas
In older children, 70 to 80% of cervical spine injuries are bony injuries following adult patterns
In younger children less than or equal to 8 years, about 50% have isolated fractures and 50% have ligamentous injury, dislocations, or SCIWORA
60 to 80% of vertebral injuries in kids are in the cervical spine compared to 30 to 40% in adults
AAST study of over 12,000 children with blunt trauma found 0.6% had cervical spine injury; four independent predictors were GCS less than 14, involved in motor vehicle crash, age greater than or equal to 2 years
Patients with cervical spine injury score of 0-1 points had negative predictive value over 99% and did not need imaging
For cervical spine clearance imaging in children, use AP and lateral x-rays; if cross-sectional imaging needed, use MRI not CT because most injuries are ligamentous not bony
46% of institutions don't have a protocol for cervical spine clearance in children