# CPVT (catecholaminergic Polymorphic Ventricular Tachycardia) — GCMD Library living collection Everything in the library about CPVT (catecholaminergic polymorphic ventricular tachycardia) — built automatically from dossiers that name it. Updated: n/a · 4 episodes · 20 cited statements ## Episodes ### Surgical Management - [Cardiac Sympathectomy: Update Course 2017](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413) — video · 28:38 · [machine version](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413.md) ### In-Depth Reviews - [Top Ten Things to Remember from the 2017 Stay Current Annual Update Course...](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400) — podcast · 25:04 · [machine version](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400.md) - [Top Ten Things to Remember: Update Course 2017](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401) — video · 25:04 · [machine version](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401.md) - [Top Ten Things to Remember: Update Course 2017](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486) — podcast · 25:04 · [machine version](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486.md) ## Chapters - [0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) Introduction and Updates 10-9: Gastric Stimulation and Cardiac Sympathectomy (Ep 1) - [3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) Updates 8-6: Diaphragm Pacing, Abdominal Wall Reconstruction, and Gastroesophageal Disconnection (Ep 1) - [7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) Updates 5-4: Blunt Abdominal Trauma CT Criteria and ATOMAC Solid Organ Protocol (Ep 1) - [13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) Update 3: Radiology Advances - Volumetric CT and Contrast Use (Ep 1) - [18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080) Update 2: Top Three Journal of Pediatric Surgery Papers (Ep 1) - [21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260) Update 1: Minimally Invasive Pilonidal Disease Treatment (Ep 1) - [22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) Thoracoscopic Lobectomy Technique with Steven Rothenberg (Ep 1) - [0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0) Introduction and Gastric Stimulation for Gastroparesis (Ep 2) - [3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180) Cardiac Sympathectomy for Arrhythmia and Diaphragm Pacing (Ep 2) - [7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) Abdominal Wall Reconstruction and Gastroesophageal Disconnection (Ep 2) - [12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) Blunt Abdominal Trauma CT Criteria and ATOMAC Solid Organ Protocol (Ep 2) - [17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) Radiology Updates: CT for Foreign Body and Contrast Use (Ep 2) - [21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260) Top Journal Papers: Pyloric Stenosis, Pneumomediastinum, and TEF Leaks (Ep 2) - [23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1380) Pilonidal Disease: Minimally Invasive Punch-Biopsy Technique (Ep 2) - [24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) Thoracoscopic Lobectomy Technique Pearls (Ep 2) - [0:00](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=0) Introduction and Surgical Technique Video (Ep 3) - [6:15](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=375) Historical Context and First Case: CPVT (Ep 3) - [10:19](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=619) Technical Discussion and Stellate Ganglion Resection (Ep 3) - [15:18](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=918) Second Case: Hypertrophic Cardiomyopathy (Ep 3) - [24:50](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=1490) Durability, Indications, and Future Directions (Ep 3) - [0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=0) Introduction and Gastric Stimulation for Gastroparesis (Ep 4) - [3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=180) Cardiac Sympathectomy for Arrhythmia Management (Ep 4) - [6:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=360) Diaphragm Pacing for Ventilator Dependence (Ep 4) - [8:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=480) Modern Abdominal Wall Reconstruction Techniques (Ep 4) - [11:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=660) Gastroesophageal Disconnection for Failed Fundoplication (Ep 4) - [14:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=840) CT Scan Decision Rule for Blunt Abdominal Trauma (Ep 4) - [17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1020) Revised Solid Organ Injury Management Protocol (Ep 4) - [20:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1200) Radiology Updates: CT for Foreign Body and Contrast Use (Ep 4) - [22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320) Top Journal Articles: Pyloric Stenosis, Pneumomediastinum, and TEF Leaks (Ep 4) - [23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1380) Minimally Invasive Pilonidal Disease Treatment and Thoracoscopic Lobectomy Technique (Ep 4) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - Cardiac sympathectomy was first introduced in the 1940s as a treatment for angina, allowing patients to continue having MIs without pain — John (clinical) [Ep 3 · 6:58](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=418) - When cardiac surgery came in the 1950s, there was no need anymore for cardiac sympathectomy — John (clinical) [Ep 3 · 7:18](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=438) - In the 1970s there was a mild resurgence when Long QT syndrome was defined, but ICDs became the primary treatment — John (clinical) [Ep 3 · 7:28](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=448) - In the last 10 years, newer techniques of cardiac sympathectomy have come back because some Long QT patients continue to have life-threatening events despite appropriate medical treatment and ICDs — John (clinical) [Ep 3 · 7:50](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=470) - Catecholaminergic polymorphic VT is quite rare, with kids usually presenting in the 5-10 year age range with syncope or seizure during exercise or emotional states — John (epidemiological) [Ep 3 · 8:50](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=530) - CPVT has 50% mortality by 40 years of age, always related to sudden death — John (epidemiological) [Ep 3 · 9:30](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=570) - Primary treatment for CPVT is beta blockers, secondarily flecainide, and in addition ICDs — John (guideline) [Ep 3 · 9:40](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=580) - With combination therapy of beta blockers, flecainide, and ICD, most CPVT patients can live a normal lifespan — John (clinical) [Ep 3 · 9:55](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=595) - In catecholamine-driven disease, if patients get an inappropriate ICD shock when perfectly healthy, it is hard to suppress the adrenaline surge, creating risk of sudden death — John (clinical) [Ep 3 · 10:50](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=650) - Sympathectomy provides 100% compliance once performed, unlike daily medications — John (clinical) [Ep 3 · 11:25](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=685) - Sympathectomy can potentially attenuate the effects of adrenaline if there is an inappropriate shock or any other adrenaline surge — John (clinical) [Ep 3 · 11:35](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=695) - The ganglion must be anesthetized before doing anything to it because you can create a ventricular storm if you just clamp it without numbing it first (clinical) [Ep 3 · 13:05](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=785) - The first CPVT patient is 2.5 years post-sympathectomy with no ICD shocks since surgery — John (clinical) [Ep 3 · 16:20](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=980) - Hypertrophic cardiomyopathy is the number one cause of sudden death in young athletes, accounting for 50% of sudden deaths in the United States — John (epidemiological) [Ep 3 · 17:10](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=1030) - Current 2015 guidelines say if you've had an arrest and have an ICD you should not play competitive sports, but they added 'but if you do' which changed practice — John (guideline) [Ep 3 · 18:20](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=1100) - Guidelines require no events for six months, a functional device, and medication compliance before allowing return to sports — John (guideline) [Ep 3 · 18:50](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=1130) - The HCM patient is 10 months post-sympathectomy and has not had an episode of VT or required a shock — John (clinical) [Ep 3 · 24:20](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=1460) - Only the left side needs to be operated on because the sympathetic chain comes from the left side to the heart (clinical) [Ep 3 · 25:15](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=1515) - Anyone giving anesthetics to ICD patients needs to be capable of full resuscitation, and if not, should rethink the location of the procedure — John (clinical) [Ep 3 · 26:00](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=1560) - Almost everybody who has an ICD gets even minor procedures done in the hospital because if it requires inhaled or IV anesthetic, their risks are greater — John (clinical) [Ep 3 · 26:17](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=1577) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - Gastric stimulation for pediatric gastroparesis can be tested temporarily via endoscopic placement before permanent laparoscopic or open implantation — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) - Reynaldo Garcia from Akron Children's Hospital presented gastric stimulation results showing significant symptom improvement in patients with persistent nausea and vomiting unresponsive to medical therapy — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) - Cardiac sympathectomy for CPVT (catecholaminergic polymorphic ventricular tachycardia) and hypertrophic cardiomyopathy involves high thoracoscopic approach to the lower stellate ganglion to prevent fatal arrhythmias — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) - Sophia Abdulhai and John Clark presented cardiac sympathectomy technique using clips and scissors for partial stellate ganglion resection, avoiding electrocautery to prevent Horner's syndrome — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) - Sympathectomy provides 100% compliance for arrhythmia management as patients cannot skip the intervention once performed — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) - Ray Anders from University Hospitals of Cleveland demonstrated diaphragm pacing for spinal cord injury, transverse myelitis, acute flaccid myelitis, and brain stem tumors, with youngest implant at one year of age — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - Diaphragm pacing requires intact phrenic nerve and motor neurons; diaphragm contraction with neurostimulation must be confirmed before implantation — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - Dave Carpata from Cleveland Clinic stated biologic mesh is not appropriate for bridging gaps in ventral hernia repair, only for temporary solution or reinforcement — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - The best mesh for ventral hernia repair is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in retromuscular space — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - Retrorectus repair with mesh is superior to laparoscopic underlay for ventral hernia repair — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - David Lanning from Virginia Commonwealth presented gastroesophageal disconnection (esophageal division with Roux-en-Y jejunal interposition) for severe reflux after failed Nissen fundoplication — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - Gastroesophageal disconnection may be appropriate as primary repair for high-risk patients predicted to fail fundoplication — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - Laparoscopic gastroesophageal disconnection can take 6 to 8 hours — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - Patients who took full feeds by mouth preoperatively can continue oral feeding after gastroesophageal disconnection — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) - Chris Druck published a five-variable prediction rule identifying low-risk population for intra-abdominal injury after blunt trauma to guide CT scan decisions — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - Patients with only abdominal pain after trauma have approximately 5% risk of abdominal injury and nearly 0% chance of requiring intervention — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - Patients with abnormal physical exam findings such as handlebar injury have approximately 15% chance of abdominal injury — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - The low-risk group (55% of trauma population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - Patients without abdominal wall trauma, tenderness or distention, with normal chest X-ray, no abdominal pain complaints, normal AST, and normal pancreatic enzymes probably do not need CT scan and can be sent home — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - The ATOMAC prospective multi-institutional solid organ injury protocol de-emphasizes injury grade in favor of clinical predictive factors — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - Patients with solid organ injury who do not respond to 20 cc/kg crystalloid bolus should receive 10-20 cc/kg blood bolus rather than second crystalloid bolus — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - Patients requiring 40 cc/kg blood (4 units) or with hemoglobin less than 7 after blood transfusion should go to the operating room as this indicates non-operative management failure — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - Stable solid organ injury patients can be admitted to the floor with vitals every 2-4 hours and hemoglobin at 6 hours, and discharged the next day if they never required blood transfusion — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - Sean Saint Peter's group demonstrated stable solid organ injury patients can be discharged much more quickly than traditional prolonged admissions based on injury grade — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) - Mike Rubin from Akron Children's Hospital recommends chest CT for suspected airway foreign bodies in unclear cases, with nearly 100% sensitivity for detecting radiolucent and radiopaque foreign bodies — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) - CT scan for suspected airway foreign body eliminates unnecessary bronchoscopies in children with respiratory virus symptoms — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) - Oral contrast is unnecessary for suspected bowel obstruction CT scans as intraluminal fluid serves as adequate contrast — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) - Eliminating oral contrast speeds up CT acquisition time and prevents nausea and vomiting in bowel obstruction patients — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) - Unsuccessful intussusception reduction should be reattempted if there is movement to the ileocecal valve, with second attempts mostly successful — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) - Modern pediatric hospital CT scans deliver 1-10 millisieverts of radiation, equivalent to one year of natural background radiation on Earth — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) - Dalton's pyloric stenosis resuscitation protocol: chloride less than 85 requires 3 fluid boluses, chloride less than 97 requires 2 boluses, chloride greater than 97 with bicarbonate less than 33 requires 1 bolus — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080) - Richer's paper showed traumatic or non-traumatic pneumomediastinum requires only chest X-ray without further imaging — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080) - Vella's randomized trial of 42 patients with post-TEF repair leaks showed glycopyrrolate group had 124 mL chest tube output versus 370 mL in placebo group — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080) - Glycopyrrolate achieved leak resolution in 76% of treatment group versus 29% of placebo group after TEF repair — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080) - The Gips procedure for pilonidal disease involves trephine excision of pits, mosquito extraction of granulation tissue and hair, curettage with smaller trephine, and irrigation with saline then peroxide — Todd Ponsky summarizing a resource [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260) - Pilonidal disease Gips procedure takes 3-5 minutes with no packing, no sutures, no drains, and no activity restrictions except avoiding swimming for 2 weeks — Todd Ponsky summarizing a resource [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260) - Steven Rothenberg recommends thoracoscopic lobectomy scope placement anterior to scapula tip at mid-axillary line, not posterior, to avoid working in paradox during anterior fissure dissection — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) - For thoracoscopic lobectomy vessel division, seal proximally and distally separately, make test incision between seals to confirm hemostasis, then complete division rather than using seal-and-divide device — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) - Understanding segmental pulmonary anatomy allows prediction of vessel relationships to bronchus, such as superior segmental artery location above lower lobe bronchus — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) - Incomplete fissure during thoracoscopic lobectomy should be managed by layer-by-layer sealing like finger fracture technique until structures are identified — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) - Contralateral main stem intubation is the best and easiest technique for single lung ventilation during thoracoscopic lobectomy, superior to double lumen tube, bronchial blocker, or CO2 collapse — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) - Previous reports showed that if the lower half of the stellate ganglion is taken, patients stopped getting ICD firings — John summarizing the discussion [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/cardiac-sympathectomy-update-course-2017-413?t=900) - Gastric stimulation reduces symptoms of gastroparesis in pediatric patients with persistent nausea and vomiting that does not respond to medical therapy — Todd Ponsky summarizing a resource [Ep 4 · 1:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=60) - Temporary gastric stimulating test can be performed endoscopically before permanent implantation — Todd Ponsky summarizing a resource [Ep 4 · 2:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=120) - High thoracoscopic sympathectomy extending to the lower stellate ganglion can shut off arrhythmias in patients with CPVT and hypertrophic cardiomyopathy who have ICDs — Todd Ponsky summarizing a resource [Ep 4 · 4:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=240) - Partial resection of the stellate ganglion should be performed using clips and scissors, avoiding electric cautery to prevent Horner's syndrome — Todd Ponsky summarizing a resource [Ep 4 · 4:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=290) - Sympathectomy provides 100% compliance as patients cannot skip the treatment once performed — Todd Ponsky summarizing a resource [Ep 4 · 5:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=330) - Diaphragm pacing can only be used if the phrenic nerve and phrenic motor neurons are intact — Todd Ponsky summarizing a resource [Ep 4 · 7:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=440) - The youngest patient to receive diaphragm pacing implantation was one year of age — Todd Ponsky summarizing a resource [Ep 4 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=420) - Biologic mesh is not good for bridging a gap in abdominal wall reconstruction and is only a temporary solution or reinforcement — Todd Ponsky summarizing a resource [Ep 4 · 9:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=540) - The best mesh for abdominal wall reconstruction is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in a retromuscular space — Todd Ponsky summarizing a resource [Ep 4 · 9:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=560) - Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation — Todd Ponsky summarizing a resource [Ep 4 · 10:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=620) - Gastroesophageal disconnection may be appropriate as a primary upfront repair for patients at high risk for fundoplication failure — Todd Ponsky summarizing a resource [Ep 4 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=720) - Laparoscopic gastroesophageal disconnection can take 6 to 8 hours to complete — Todd Ponsky summarizing a resource [Ep 4 · 12:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=750) - Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection — Todd Ponsky summarizing a resource [Ep 4 · 12:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=770) - A patient with only abdominal pain after blunt trauma has approximately 5% risk of abdominal injury and almost 0% chance of needing intervention — Todd Ponsky summarizing a resource [Ep 4 · 15:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=900) - A child with abnormal physical exam findings such as handlebar injury has about 15% chance of abdominal injury — Todd Ponsky summarizing a resource [Ep 4 · 15:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=930) - The low-risk group for abdominal trauma (55% of population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention — Todd Ponsky summarizing a resource [Ep 4 · 16:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=980) - Patients without abdominal wall trauma, tenderness or distention, normal chest X-ray, no abdominal pain complaints, normal AST, and no abnormal pancreatic enzymes probably do not need CT scan and can be sent home — Todd Ponsky summarizing a resource [Ep 4 · 16:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1010) - The grade of solid organ injury is falling by the wayside in favor of clinical predictive factors — Todd Ponsky summarizing a resource [Ep 4 · 17:40](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1060) - Patients who receive 20 cc/kg crystalloid and do not respond should receive 10-20 cc/kg bolus of blood — Todd Ponsky summarizing a resource [Ep 4 · 18:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1100) - If a patient's hemoglobin drops below 7 and they need further blood totaling 40 cc/kg, they probably need to go to the operating room — Todd Ponsky summarizing a resource [Ep 4 · 18:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1130) - Transfusion with 40 cc/kg of blood or 4 units is an indication of failure of non-operative management and the patient should go to the operating room — Todd Ponsky summarizing a resource [Ep 4 · 19:10](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1150) - Stable solid organ injury patients can be admitted to the floor with vitals every 2-4 hours and hemoglobin check at 6 hours, and can go home the next day if they never needed blood — Todd Ponsky summarizing a resource [Ep 4 · 19:40](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1180) - Chest CT for suspected airway foreign body has nearly 100% sensitivity and can detect both radiolucent and radiopaque foreign bodies — Todd Ponsky summarizing a resource [Ep 4 · 20:40](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1240) - Using chest CT for suspected airway foreign bodies will eliminate many unnecessary bronchoscopies — Todd Ponsky summarizing a resource [Ep 4 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1260) - Oral contrast is not needed for suspected bowel obstruction as fluid serves as the contrast agent — Todd Ponsky summarizing a resource [Ep 4 · 21:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1290) - Patients with unsuccessful intussusception reduction should get a repeat attempt as long as there is some movement — Todd Ponsky summarizing a resource [Ep 4 · 21:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1310) - The average range of radiation from a pediatric CT scan is 1-10 millisieverts, equivalent to living on Earth for one year — Todd Ponsky summarizing a resource [Ep 4 · 22:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1340) - For pyloric stenosis resuscitation: if chloride is less than 85, give 3 boluses of fluid; if less than 97, give 2 boluses; if greater than 97 but bicarbonate less than 33, give 1 bolus — Todd Ponsky summarizing a resource [Ep 4 · 23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1380) - Patients with traumatic or non-traumatic pneumomediastinum probably do not need any imaging beyond chest X-ray — Todd Ponsky summarizing a resource [Ep 4 · 23:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1410) - In a study of 42 TEF leak patients randomized to glycopyrrolate vs placebo, the treatment group had 124 mL chest tube output vs 370 mL in placebo, and 76% leak resolution vs 29% in placebo — Todd Ponsky summarizing a resource [Ep 4 · 24:10](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1450) - The minimally invasive pilonidal procedure involves coring out pits with a trephine, removing granulation tissue and hair with a mosquito, curettage with a smaller trephine, and flushing with saline then hydrogen peroxide, leaving wounds unpacked and unsutured — Todd Ponsky summarizing a resource [Ep 4 · 24:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1490) - For thoracoscopic lobectomy, the scope should be placed anterior to the tip of the scapula at the mid-axillary line, not posterior, to avoid working in paradox — Todd Ponsky summarizing a resource [Ep 4 · 25:40](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1540) - When sealing blood vessels during thoracoscopic lobectomy, use a sealer (not seal-divider) to seal proximally and distally, make a small nick between seals to verify complete sealing, then complete the cut — Todd Ponsky summarizing a resource [Ep 4 · 26:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1580) - For incomplete fissure during lobectomy, use a sealing device to go layer by layer until structures are identified — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504) - Contralateral main stem intubation is the best and easiest technique for single lung ventilation during thoracoscopic lobectomy — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504) - Gastric stimulation reduces symptoms of gastroparesis in children with persistent nausea and vomiting unresponsive to medical therapy. — Todd Ponsky summarizing a resource [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0) - Temporary endoscopic gastric stimulation testing can predict response before permanent laparoscopic or open placement. — Todd Ponsky summarizing a resource [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0) - Thoracoscopic sympathectomy extending to the lower stellate ganglion can reduce ICD shocks in patients with CPVT and hypertrophic cardiomyopathy. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180) - Partial resection of the stellate ganglion should use clips and scissors; electric cautery may damage the remaining ganglion and cause Horner's syndrome. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180) - Sympathectomy provides 100% compliance because patients cannot skip the intervention once performed. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180) - Diaphragm pacing is a reasonable option for children with spinal cord injury, transverse myelitis, acute flaccid myelitis, or brainstem tumors, allowing ventilator independence. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180) - Diaphragm pacing requires an intact phrenic nerve and phrenic motor neurons; diaphragm contraction with neurostimulation must be confirmed before implantation. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180) - The youngest patient to receive diaphragm pacing was one year of age. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180) - Biologic mesh is not suitable for bridging gaps in ventral hernia repair; it is only a temporary solution or reinforcement. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) - The best mesh for ventral hernia repair is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in the retromuscular space. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) - Retrorectus repair is superior to laparoscopic underlay for ventral hernias. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) - Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) - Gastroesophageal disconnection (esophageal division with Roux-en-Y jejunal interposition) is effective for children with severe reflux who have failed Nissen fundoplication. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) - Gastroesophageal disconnection may be appropriate as a primary repair in patients at high risk for fundoplication failure. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) - Laparoscopic gastroesophageal disconnection can take 6 to 8 hours. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) - Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) - A five-variable prediction rule identifies children at low risk for intraabdominal injury after blunt trauma: no abdominal pain, normal abdominal exam, normal chest X-ray, normal AST, and normal pancreatic enzymes. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - Children with only abdominal pain after blunt trauma have approximately 5% risk of abdominal injury and less than 0.3% risk of requiring intervention. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - Children with abdominal wall trauma (e.g., handlebar injury) have approximately 15% risk of abdominal injury. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - The low-risk group (55% of the trauma population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention; these patients may not need CT and can be observed or sent home with close follow-up. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - The ATOMAC protocol recommends earlier blood transfusion: after 20 cc/kg crystalloid bolus, non-responders should receive 10–20 cc/kg blood rather than additional crystalloid. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - Transfusion of 40 cc/kg blood (or 4 units) is an indication of non-operative management failure in solid organ injury; these patients should go to the operating room. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - Patients with solid organ injury who respond to initial resuscitation and never require blood transfusion can be discharged the next day. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - Stable solid organ injury patients should be admitted to the floor (not ICU) with vitals every 2–4 hours and hemoglobin at 6 hours; if hemoglobin remains above 7 and the patient is asymptomatic, they can be discharged. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - The grade of solid organ injury is no longer the primary guide for management; clinical predictive factors are now used instead. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) - Volumetric chest CT has nearly 100% sensitivity for airway foreign body, including radiolucent objects. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) - Chest CT for suspected airway foreign body can eliminate unnecessary bronchoscopies in children with unclear history or respiratory virus symptoms. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) - Oral contrast is unnecessary for suspected bowel obstruction; fluid in the bowel serves as the contrast agent. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) - Omitting oral contrast speeds up CT acquisition and prevents nausea and vomiting in patients with bowel obstruction. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) - Repeat enema reduction attempts for intussusception are appropriate if there is movement of the intussusception toward the ileocecal valve. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) - Modern pediatric CT scans deliver 1–10 millisieverts of radiation, equivalent to one year of background radiation on Earth. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) - For pyloric stenosis resuscitation, if chloride is less than 85, give 3 boluses of fluid; if chloride is less than 97, give 2 boluses; if chloride is greater than 97 but bicarbonate is less than 33, give 1 bolus. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260) - Traumatic or non-traumatic pneumomediastinum requires only chest X-ray; no further imaging is needed. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260) - Intravenous glycopyrrolate (Robinol) improves closure rates of post-TEF repair leaks: 76% in the treatment group vs 29% in the placebo group. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260) - Glycopyrrolate treatment reduced chest tube output in post-TEF leak patients: 124 mL in the treatment group vs 370 mL in the placebo group. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260) - The Gips technique for pilonidal disease involves coring out pits with a trephine, evacuating granulation tissue and hair with a mosquito, curettage with a smaller trephine, flushing with saline then hydrogen peroxide, and leaving the wounds open and unpacked. — Todd Ponsky summarizing a resource [Ep 2 · 23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1380) - The Gips pilonidal procedure takes 3–5 minutes with minimal bleeding, no drains, no sutures, and no activity restrictions except avoiding swimming for two weeks. — Todd Ponsky summarizing a resource [Ep 2 · 23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1380) - For thoracoscopic lobectomy, the scope should be placed anterior to the scapula tip at the mid-axillary line, directly over the major fissure, not posterior to the scapula. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) - Placing the thoracoscope posterior to the scapula tip causes the surgeon to look back on themselves when working in the anterior fissure, creating a paradoxical view. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) - When sealing vessels during thoracoscopic lobectomy, seal proximally and distally, then make a small nick between the seals to confirm hemostasis before completing the division; do not use seal-and-divide devices. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) - Understanding segmental pulmonary anatomy helps predict vessel location and relationships during thoracoscopic lobectomy; for example, the superior segmental artery comes off the lower lobe with the bronchus directly below it. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) - Incomplete fissures should be approached layer-by-layer with a sealing device, similar to finger fracture technique in the liver, until structures are identified. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) - Contralateral main-stem intubation is the best and easiest method for single-lung ventilation during thoracoscopic lobectomy, superior to double-lumen tubes, bronchial blockers, or CO2 collapse. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) --- Educational content from recorded physician discussions — not medical advice. 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