Update Course Rewind: 2023 Top Ten Key Takeaways
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Sarcoma (Ewing/Rhabdo) 36 items
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More about achalasia
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What the experts said
POEM (peroral endoscopic myotomy) provides 360 degrees of options to perform myotomy, whereas with Heller myotomy you have maybe 180 degrees and must worry about the vagus nerve.
POEM can be performed after a failed Heller or previous POEM by choosing a different side for dissection, avoiding burned bridges.
POEM does not require dissection of the hiatus, reducing concern for reflux.
A patient with delayed diagnosis stroke from a missed BCVI prompted the institution to create a routine BCVI screening protocol requiring CTA head and neck for at-risk patients.
If you are giving blood in the trauma bay, you need to activate MTP—giving blood equals MTP activation.
For bad trauma with unstable or abnormal patients, whole blood would be the best option.
The blood bank has not been able to provide whole blood for pediatric patients because it needs to be irradiated.
The goal is 1:1:1 ratio of blood products (packed red blood cells:FFP:platelets), with FFP given after blood.
Most hospital trauma coolers do not initially contain platelets, requiring separate call for platelets through MTP or direct request.
In the acute postoperative period after TPIAT, glucose must be managed externally; all patients are on insulin in the ICU to avoid stressing the islet cells, allowing them to implant and find new vessels from the liver without doing work.
In one institution's practice, 80% of pediatric trauma patients are transfers who have already had CBC at the referring hospital; hemodynamically normal children go to the floor without repeat hemoglobin.
The gold standard for achalasia treatment is laparoscopic Heller myotomy.
Blunt cerebrovascular injury (BCVI) occurs in 1.3% of all head trauma in the pediatric population.
Nearly one-third of pediatric patients with BCVI will have a stroke, increasing mortality up to 20%.
The Memphis score is the most sensitive scoring system for BCVI screening in pediatric head trauma patients.
Patients under 37 weeks gestational age require overnight monitoring following anesthesia after pyloromyotomy, even if tolerating feeds shortly after surgery.
Full-term babies over 4 weeks old may be eligible for discharge from PACU after pyloromyotomy.
NSQIP data shows only 1.5% of pyloromyotomy patients were discharged on day of surgery, with no difference in odds of readmission or complications compared to overnight stay.
ICG (indocyanine green) has become increasingly integrated into biliary-related surgeries such as cholecystectomies due to its hepatic excretion.
Technetium-99 requires a special machine to detect and is difficult to control the injection timing.
ICG technique is real-time in the operating room with equipment that is standard or soon to be standard in all laparoscopic towers.
With ICG injection into the tumor, you can watch over 45-75 seconds as the ICG travels to the sentinel node with lights off under fluorescence.
Recent studies have revealed a lack of firm correlation between anal dilations and stricture development following PSARP.
Many PSARP patients have a colostomy and will undergo another procedure for colostomy closure, which is a perfect moment to perform strictureplasty if needed.
The surgeon sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses whether dilations are needed based on the examination, informing families that strictureplasty may be needed later.
Every society emphasizes fertility preservation counseling even when surgery is not planned for children facing gonadotoxic therapy.
When a patient has a new cancer diagnosis or is approaching stem cell transplant, the fertility preservation counseling service is activated through an Epic order set, triggering consultation by advanced practice nurse, physician, or oncology team for risk assessment.
In a prepubertal child, the ovary is about 2 centimeters in size, approximately the size of a grape, and laparoscopic oophorectomy is the best recommendation for ovarian tissue preservation.
Laparoscopic oophorectomy is recommended to reduce the risk of hemorrhage and ensure remaining ovarian tissue is preserved for future fertility.
Massive transfusion protocol (MTP) is a multidisciplinary process for rapidly obtaining blood and blood products for severely bleeding patients.
Massive transfusion protocol should be activated after administering 20 mL/kg of blood in the trauma bay.
Ovarian torsion often presents with a cystic area visible on ultrasound that may be less visible in the operating room due to edema.
If the fallopian tube is black and edematous after detorsion and adequate time, consideration should be given to management of that tube.
It is best to avoid removing the ovary in torsion because it may regain functionality even if it appears black.
Doctor Breech advises against oophoropexy (ovarian fixation) and instead recommends detorsion with subsequent monitoring.
Chronic pancreatitis causes pancreatic insufficiency and damage to islet cells.
TPIAT involves complete removal of pancreas and spleen, extraction of islet cells in a specialized lab, then injection of those cells into the portal vein.
Many chronic pancreatitis patients have gene mutations triggering recurrent attacks, causing the gland to replace normal cells with fibrosis.
Performing surgical resection for chronic pancreatitis without islet cell extraction may result in continued pancreatitis attacks and increased diabetes risk due to reduced pancreatic parenchyma.
The American Pediatric Surgical Association (APSA) released revised guidelines for blunt hepatosplenic trauma management including four categories: admission location, procedures, discharge timing, and post-discharge management.
For grades 1 and 2 blunt liver and spleen trauma, hemodynamically stable patients can be monitored and considered for discharge from the emergency department.
Data shows hemodilution occurs in trauma, and patients more likely to fail non-operative management have initial hemoglobin less than 9.25 g/dL.
For blunt liver and spleen trauma, increasing evidence supports treating the patient based on signs and symptoms rather than solely on injury grade.