StayCurrentMD · Pediatric Surgery Updates for the PCP - Full Show
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Video58 min·Published Nov 2020Older

Pediatric Surgery Updates for the PCP - Full Show

With Dr. Greg Tia & Dr. Dan Chuu & Dr. Georgie Bezarra & Dr. Becky Brown · hosted by Dr. Steve Warwick · StayCurrentMD
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What the experts said28 expert statements · 2 host summaries
The Cincinnati Children's Division of Pediatric Surgery has 19 partners, many of whom subspecialize within pediatric surgery.
ClinicalGreg Tiao
A pilot program in Northern Kentucky assigns a contact person (Dr. Koigal) who knows the schedule for all pediatric surgeons to facilitate timely care for urgent needs.
ClinicalGreg Tiao
Pectus excavatum occurs in approximately 1 in 300 to 400 people, more commonly in males (80%) than females (20%).
EpidemiologicalBecky Brown
Pectus excavatum is familial in about 40% of patients and associated with connective tissue diseases (Ehlers-Danlos, Marfan, Pott's disease, hypermobility syndrome) in 10-20% of patients.
EpidemiologicalBecky Brown
Pectus excavatum is associated with scoliosis in about 30% of patients.
ClinicalBecky Brown
Symptoms occur in about 75% of pectus patients and may include exercise intolerance, shortness of breath at rest or with position changes, fatigue, and psychosocial issues.
ClinicalBecky Brown
Vacuum bell therapy for pectus can completely correct the deformity in 25-40% of patients aged 6-10 years with milder defects and flexible chest walls.
ClinicalBecky Brown
Using erector spinae catheters for pain management after Nuss procedure, patients can be discharged within 2 days and opioid use has been minimized by a factor of 13.
ClinicalBecky Brown
A normal Haller index (ratio of chest width to depth at deepest point) is about 2.5 to 2.7; greater than 3.25 may warrant surgical correction.
ClinicalBecky Brown
In a study of 345 pectus patients undergoing cardiac MRI, 16-22% had abnormal cardiac function at rest with right ventricular ejection fractions less than 50% and left ventricular ejection fractions less than 55%.
ClinicalBecky Brown
33% of pectus patients had abnormal cardiopulmonary exercise tests.
ClinicalBecky Brown
Button battery ingestions are true emergencies that have caused fatalities within 2 hours of ingestion.
ClinicalVince Macada
Multiple magnets or a magnet with another metallic object can attract across bowel walls causing perforation and fistulas.
ClinicalVince Macada
Coins in the esophagus or causing symptoms need urgent removal; objects greater than 25mm may not pass the pylorus.
ClinicalVince Macada
Sharp objects that reach the intestine tend to pass without difficulty and can be observed.
ClinicalVince Macada
Pilonidal disease almost always presents in patients who have started puberty; presentation much younger than puberty age is exceedingly rare.
ClinicalNelson Rosen
For acute pilonidal abscesses, packing wounds with strips does not help drainage, increases pain, and creates home care challenges; tucking a corner of gauze into the opening is sufficient for hemostasis.
ClinicalNelson Rosen
Pilonidal patients with acute infections should be placed on broad-spectrum antibiotics (Augmentin, Clindamycin, or Cipro/Flagyl for recurrent/significant infections) for 5-7 days.
ClinicalNelson Rosen
The GIPS procedure for pilonidal disease uses skin biopsy punches to remove pits, curettes to scrape the cavity and remove hair, and leaves holes open to heal; about 75% of patients are cured.
ClinicalNelson Rosen
The cleft lift procedure for pilonidal disease has an over 95% success rate.
ClinicalNelson Rosen
Ovarian torsion may present with sharp onset of pain and a palpable or tender pelvic mass on exam; ultrasound does not always definitively diagnose torsion.
ClinicalMeera Kotagal
Symptomatic cholelithiasis patients often have had more than one episode of pain, while acute cholecystitis tends to be more abrupt in onset.
ClinicalMeera Kotagal
Appendicitis pain often starts periumbilical and migrates to the right lower quadrant as localized peritoneal inflammation develops.
ClinicalMeera Kotagal
Single-incision laparoscopic appendectomy is performed through an umbilical incision, mobilizing the cecum and appendix to remove the appendix through the belly button.
ClinicalMeera Kotagal
If a button battery has reached past the stomach in an asymptomatic patient, it can be observed as operative retrieval would be required and the danger point has usually passed.
ClinicalVince Macada
Honey (2 teaspoons every 10 minutes up to 6 doses) given en route to the emergency room may reduce damage from button batteries.
ClinicalVince Macada
Carafate used in the emergency room setting appears to reduce damage from button batteries based on available evidence.
ClinicalVince Macada
Mesenteric adenopathy is a secondary sign that can be associated with appendicitis but also occurs with gastroenteritis or mesenteric adenitis, requiring consideration of the whole clinical picture.
ClinicalMeera Kotagal
In the Midwest Pediatric Consortium study, about 67% of children treated non-operatively for appendicitis did not require appendectomy within the next year.
Host summaryMeera Kotagal · not cited in answers
In the CODA study (adult randomized trial), 40% of patients with an appendicolith failed non-operative management and required surgery within the first 90 days.
Host summaryMeera Kotagal · not cited in answers