# Trauma — GCMD Library living collection

Everything in the library about trauma — built automatically from dossiers that name it.

Updated: n/a · 6 episodes · 135 cited statements

## Episodes
### Fundamentals
- [Pediatric Gun Violence: Pediatric Trauma Series 2017](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392) — video · 22:56 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392.md)
- [Surgical Skill Acquisition in the Modern Era: Comparative Technology in...](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979) — video · 13:39 · [machine version](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979.md)
- [#APSA50: Social Determinants of Health](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435) — podcast · 47:40 · [machine version](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435.md)

### Acute Management
- [ATLS 2021 Pediatric Surgery Update](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355) — video · 16:06 · [machine version](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355.md)

### Evidence & Research
- [Differences Between Pediatric & Adult Trauma Centers](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334) — video · 3:39 · [machine version](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334.md)
- [Differences Between Pediatric & Adult Trauma Centers](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945) — video · 3:39 · [machine version](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=0) Introduction and Setting (Ep 1)
- [0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14) Study Review: Pediatric vs Adult Trauma Centers for Adolescents (Ep 1)
- [2:57](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=177) Discussion of Imaging Practices (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0) Epidemiology of Pediatric Firearm Injuries (Ep 2)
- [7:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420) Medical Organization Policy Responses to Sandy Hook (Ep 2)
- [12:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=720) Firearms as a Public Health Problem: The Haddon Matrix (Ep 2)
- [15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900) Firearms and Youth Suicide (Ep 2)
- [18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100) Research Funding and Physician-Patient Relationship (Ep 2)
- [20:10](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1210) Discussion: Advocacy and Working with the NRA (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=0) Introduction to the episode and guest (Ep 3)
- [0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14) Review of pediatric versus adult trauma center outcomes for adolescents (Ep 3)
- [2:57](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=177) Discussion of imaging differences and clinical implications (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=0) Historical context of surgical education and the apprenticeship model (Ep 4)
- [3:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=180) The five-step skill acquisition model (Ep 4)
- [5:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=300) Evolution of telementoring technology and early experiences (Ep 4)
- [9:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=540) Debates about telementoring applications and implementation barriers (Ep 4)
- [11:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=660) The Akron-Tromsø project: real-world validation of the skill acquisition model (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=0) Introduction to Social Determinants of Health at APSA 50 (Ep 5)
- [1:45](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=105) Parallels Between Criminal Justice and Public Health Disparities (Ep 5)
- [4:23](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=263) Cultural Competency Gaps in Professional Education (Ep 5)
- [7:19](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=439) Healthcare Disparities and Implicit Bias in Treatment (Ep 5)
- [11:01](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=661) Workforce Diversity and Building Pathways (Ep 5)
- [13:56](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=836) Personal Narrative: The Lottery of Privilege (Ep 5)
- [17:36](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1056) Mass Incarceration Statistics and Historical Context (Ep 5)
- [24:59](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1499) Health Disparities Data (Ep 5)
- [29:36](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1776) Stanley's Case: From Armed Robbery to College Baseball (Ep 5)
- [36:54](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2214) Structural Causes and the Call to Action (Ep 5)
- [0:00](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=0) Introduction and Case Presentation: Initial Assessment Priorities (Ep 6)
- [3:53](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=233) Airway Management in Pediatric Trauma (Ep 6)
- [7:05](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=425) Circulation and Shock Management (Ep 6)
- [11:58](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=718) Neurological Assessment and Imaging Decision Rules (Ep 6)
- [15:17](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=917) Conclusion (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- There is substantial data showing pediatric trauma centers are better for young children, but evidence for adolescents aged 15-19 is less clear. — Rich Falcone (clinical) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- A prior Ohio-only study showed no difference in outcomes for 15-19 year olds whether treated at adult or pediatric trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- The National Trauma Data Bank study included patients aged 15-19 with injury severity scores greater than 25 over a 5-year period, totaling almost 13,000 patients. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- 51% of severely injured adolescents in the study were treated at adult trauma centers and 49% at pediatric trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- The median injury severity score (ISS) in the study population was 33. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- 45% of patients in the study had Glasgow Coma Scale scores less than 8, indicating severe brain injuries. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- There was no significant difference in mortality between severely injured adolescents treated at adult versus pediatric trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Adolescents treated at adult trauma centers were approximately 81% more likely to have an imaging study performed compared to those at pediatric trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Severely injured adolescents had shorter length of stay at pediatric trauma centers compared to adult trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Severely injured adolescents had shorter ICU length of stay at pediatric trauma centers compared to adult trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- More adolescents were discharged to home (as opposed to rehab or skilled nursing facilities) when treated at pediatric trauma centers compared to adult trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Mortality is not the most important or reliable outcome for pediatric trauma because most children survive once they reach a hospital. — Rich Falcone (opinion) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Pediatric trauma centers add value for children even up into the adolescent age range (15-19 years). — Rich Falcone (opinion) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Adult trauma centers need to achieve equivalent imaging and length of stay practices to pediatric trauma centers for adolescents, since 51% of this population presents to adult facilities. — Rich Falcone (opinion) [Ep 1 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Pediatric trauma centers can achieve equivalent outcomes with less imaging by trusting clinical diagnosis and examination, avoiding unnecessary radiation exposure. — Rich Falcone (clinical) [Ep 1 · 3:15](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=195)
- A recent study showed that referring hospitals had higher imaging rates than children's hospitals for appendicitis. — Todd Ponsky (epidemiological) [Ep 1 · 2:57](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=177)
- Over the last 25 years, mortality from pediatric trauma has decreased by about 50%. (epidemiological) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- Trauma is still the single most common cause of death in the pediatric population and more common than all other causes combined. (epidemiological) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- Among pediatric injury deaths at trauma centers, motor vehicle crashes are the number one cause, followed by firearms and falls (National Trauma Data Bank 2016). (epidemiological) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- For children who reach a trauma center, firearms are the most lethal mechanism—the cause most likely to result in death. (clinical) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- The number of firearm deaths in the pediatric population now is about the same as at the beginning of this century, showing little progress. (epidemiological) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- Among pediatric firearm deaths by intent, homicides are most common, followed by suicide, then unintentional injuries. (epidemiological) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- In the 15-19 age group, firearms are responsible for 84% of homicides. (epidemiological) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- In the 15-19 age group, firearms are responsible for 46% of suicides. (epidemiological) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- In the 15-19 age group, 25% of all deaths involve a firearm. (epidemiological) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- Following Sandy Hook, the American Academy of Pediatrics, American College of Surgeons, and American Pediatric Surgical Association reviewed and updated their policy statements on firearm safety and injury prevention. (guideline) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420)
- Eight organizations, including the American Academy of Pediatrics, American Academy of Family Physicians, American College of Surgeons, American Psychiatric Association, American Public Health Association, and American Bar Association, published a white paper in the Annals of Internal Medicine advocating multidisciplinary collaboration to reduce firearm injuries. (guideline) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420)
- A survey of American College of Surgeons Committee on Trauma members showed that every advocacy topic related to firearms had over 50% support, and nearly half had over 90% support. (epidemiological) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420)
- The American Pediatric Surgical Association submitted its firearm policy statement to the entire membership for review and discussion at the annual meeting, resulting in overwhelming approval. (guideline) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420)
- Over the last 30-40 years, there has been a 17% reduction in motor vehicle-related deaths and a 77% increase in vehicle miles traveled, while firearm-related deaths increased by 15%. (epidemiological) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=720)
- Motor vehicle mortality has declined from about 5 deaths per billion vehicle miles traveled to 1.14 over the last five decades. (epidemiological) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=720)
- In the pediatric population, suicide is the third leading cause of death. (epidemiological) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- There are an estimated 25 suicide attempts for every completed suicide in youth. (epidemiological) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- In youth suicides, the use of a firearm is successful in 95% of cases. (epidemiological) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- Firearms are involved in almost 50% of completed youth suicides. (epidemiological) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- 90% of patients who survive a suicide attempt do not ultimately die from suicide. (epidemiological) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- Most adolescent suicides occur in the home with a firearm owned by the parent. (epidemiological) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- Many youth suicides are quite impulsive, happening in less than 5 minutes from impulse to action. (clinical) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- Suicide mortality is not reduced with trigger locks or gun safes in some cases because teenagers may have been shown where the firearm is or given the combination to protect themselves. (clinical) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- In 1992, the National Center for Injury Prevention and Control was established under the CDC. (epidemiological) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- Art Kellerman published a paper demonstrating that gun ownership is a risk factor for homicide in the home, which became a target of the NRA. (epidemiological) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- In 1996, Jay Dickey successfully added an amendment to an annual spending bill that cut CDC funding to the National Center for Injury Prevention and Control by the specific amount allocated for firearm research. (guideline) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- Cancer research is funded at a rate of about $4,200 per year of potential life lost, while firearm-related research is funded at $2.70 per year of potential life lost from US sources. (epidemiological) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- Many medical organizations recommend that physicians counsel parents regarding the risks and benefits of keeping firearms in the home. (guideline) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- The majority of gun-owning parents feel that physician counseling about firearm safety is appropriate. (epidemiological) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- Florida passed the Firearm Owners Privacy Act (Docs vs Glocks law), which restricts healthcare providers from making written inquiries or asking questions about firearm ownership, with penalties including loss of license and up to $10,000 fine. (guideline) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- The Florida Supreme Court overturned the Docs vs Glocks law, but the state appealed to the 11th Circuit Court of Appeals, where a three-judge panel ruled in favor of the state; the full en banc 11th Circuit then overturned the law again. (guideline) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- The NRA has a 40-50 year head start on advocacy efforts and has been profoundly successful, particularly at the state legislative level. (opinion) [Ep 2 · 20:10](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1210)
- Most firearm legislation and activity happens at the state level, not the federal level. (opinion) [Ep 2 · 20:10](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1210)
- Firearm legislation efforts tend to happen in fits and starts, with outrage following events like Sandy Hook gradually dying down along with advocacy efforts. (opinion) [Ep 2 · 20:10](https://qa.library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1210)
- The priorities for evaluating a small child with multi-system trauma are the same as for an adult patient - airway, breathing, and circulation. — Rich Falcone (clinical) [Ep 6 · 2:51](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=171)
- Pediatric patients have more pliable chests, so ribs don't necessarily break, but they can have significant pulmonary contusions and other injuries without obvious chest wall findings. — Rich Falcone (clinical) [Ep 6 · 3:58](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=238)
- Pediatric patients are more susceptible to tension pneumothorax because their mediastinum is more mobile and shifts more easily in response to tension. — Rich Falcone (clinical) [Ep 6 · 4:16](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=256)
- Pediatric patients have large tongues and large heads; when laid on a backboard, the large occiput flexes the head forward and can obstruct the airway. — Rich Falcone (clinical) [Ep 6 · 5:17](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=317)
- True pediatric backboards have a cutout for the head or a built-in bump to keep the torso higher and maintain ear-in-line-with-shoulder alignment. — Rich Falcone (clinical) [Ep 6 · 5:29](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=329)
- ATLS recommends needle cricothyroidotomy for children under 10 years old and surgical cricothyroidotomy for those over 10. — Rich Falcone (guideline) [Ep 6 · 6:13](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=373)
- The choice between needle and surgical cricothyroidotomy depends partly on what the provider is most comfortable with; saving the child's life with potential tracheal damage is better than death from inaction. — Rich Falcone (opinion) [Ep 6 · 6:25](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=385)
- Cricothyroidotomy (needle or surgical) is not a definitive airway; it buys time to get to the OR for formal tracheostomy. — Rich Falcone (clinical) [Ep 6 · 6:45](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=405)
- A 10 mL syringe with IV catheter can be used for needle cricothyroidotomy and connects directly to an Ambu bag. — Rich Falcone (clinical) [Ep 6 · 7:09](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=429)
- When performing needle cricothyroidotomy, you must allow for exhalation, not just continuous insufflation. — Rich Falcone (clinical) [Ep 6 · 7:18](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=438)
- The old ATLS protocol was to give two 20 mL/kg crystalloid boluses before considering blood products. — Rich Falcone (guideline) [Ep 6 · 8:54](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=534)
- Current ATLS teaching is to give one 20 mL/kg crystalloid bolus, and if there is transient or no response, move directly to blood products (10 mL/kg). — Rich Falcone (guideline) [Ep 6 · 9:05](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=545)
- Pediatric blood volume is calculated as weight in kilograms times 80 mL (infants differ slightly). — Rich Falcone (clinical) [Ep 6 · 10:21](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=621)
- A 12 kg child has a total blood volume of approximately 1 liter; a 25 kg child has approximately 2 liters. — Rich Falcone (clinical) [Ep 6 · 10:28](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=628)
- Massive transfusion protocols have been proven to help in adults and there is data supporting their use in pediatrics as well. — Rich Falcone (clinical) [Ep 6 · 10:55](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=655)
- Once a massive transfusion protocol is activated, blood products continue to arrive automatically until the protocol is deactivated; the key is remembering to call and stop it. — Rich Falcone (clinical) [Ep 6 · 11:04](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=664)
- Glasgow Coma Scale can be performed in nonverbal children; they do not automatically receive zero or low verbal scores if they cannot talk normally for their age. — Rich Falcone (clinical) [Ep 6 · 12:11](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=731)
- For nonverbal children on GCS verbal assessment: babbling/nonsense appropriate for age receives full score, irritable crying scores 4, moaning scores 2, and no response is most concerning. — Rich Falcone (clinical) [Ep 6 · 12:25](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=745)
- The most concerning neurological sign in a young trauma patient is a child who does not cry or respond to painful stimuli like IV or IO placement, or a child who stops crying suddenly. — Rich Falcone (clinical) [Ep 6 · 12:42](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=762)
- Children have more diffuse brain injuries in general than adults. — Rich Falcone (clinical) [Ep 6 · 13:05](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=785)
- Child abuse is the most common cause of severe head injury in children less than 2 years old. — Rich Falcone (epidemiological) [Ep 6 · 13:10](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=790)
- Children are more at risk for head injury because of large heads, soft skulls, and tendency to fall on their heads, leading to diffuse rather than focal injuries. — Rich Falcone (clinical) [Ep 6 · 13:11](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=791)
- A multi-institutional algorithm for blunt abdominal trauma identifies approximately 35% of patients at very low risk (0.6%) of intraabdominal injury if they have no abdominal pain, no abdominal wall trauma/tenderness/distension, normal chest X-ray, AST less than 200, and normal pancreatic enzymes. — Rich Falcone (clinical) [Ep 6 · 14:28](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=868)
- Having one positive criterion on the abdominal trauma algorithm does not mandate CT but stratifies risk; having multiple positive criteria increases risk further. — Rich Falcone (clinical) [Ep 6 · 15:16](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=916)
- Sir William Osler decided that medical training needed residency programs to bring doctors to patients, moving away from lecture-based education (clinical) [Ep 4 · 0:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=0)
- Dr. William Halstead, a surgeon, adapted Osler's residency concept to create surgical residency programs (clinical) [Ep 4 · 1:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=60)
- One-day surgical courses contradict Halstead's apprenticeship model, which requires intensive process of watching an expert and being watched by them (opinion) [Ep 4 · 3:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=180)
- The skill acquisition model consists of 5 steps: course attendance, trainee observes expert, trainee performs with expert watching, telementoring, and teleproctoring (guideline) [Ep 4 · 3:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=210)
- Telementoring should be introduced at step 4 of the skill acquisition model, not step 1, after a relationship has been established (guideline) [Ep 4 · 4:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=240)
- Virtual courses allow surgeons to learn without traveling, using the internet in ways that make sense (clinical) [Ep 4 · 4:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=270)
- In the first telementoring case using Skype for a lung resection, verbal pointing without telestration was really difficult for guiding the surgeon (clinical) [Ep 4 · 5:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=300)
- The Visitor One solution provides telestration capability allowing the mentor to draw on the surgical video in real-time (clinical) [Ep 4 · 6:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=360)
- Off-the-shelf technology including Androids and iPads can be used for telestration, based on solutions developed by the Norway team (clinical) [Ep 4 · 7:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=420)
- Telestration lines move when the camera moves during surgery, which is a technical limitation (clinical) [Ep 4 · 7:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=450)
- The surgeon performing the operation must be able to complete it independently if technology fails or internet connection is lost (guideline) [Ep 4 · 8:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=510)
- Two weeks prior to this presentation, a trauma patient at a non-pediatric trauma center was too unstable to transfer, requiring phone guidance until the speaker could drive to the hospital (clinical) [Ep 4 · 9:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=540)
- Some envision an emergency 'break the glass' telementoring system where a mentor helps through a case without prior relationship, called the co-pilot method or virtual first assistant (opinion) [Ep 4 · 9:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=570)
- The more accepted model incorporates telementoring at the end of a staged stepwise process following the skill acquisition model (guideline) [Ep 4 · 10:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=600)
- For telementoring to work on a global scale, experts need justification for not spending time in their own operating rooms, requiring compensation beyond goodwill (opinion) [Ep 4 · 10:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=630)
- The American College of Surgeons Education Committee under David Hoyt and Sadiva are pushing telementoring initiatives (clinical) [Ep 4 · 11:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=660)
- Demand for telementoring has come from rural surgeons working alone who want help without sending all patients to tertiary centers (epidemiological) [Ep 4 · 11:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=690)
- The Akron-Tromsø project tested whether laparoscopic non-mesh hernia repair could be taught using the skill acquisition model (clinical) [Ep 4 · 12:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=720)
- The Akron-Tromsø project began with a virtual course watched by Norwegian surgeons, followed by in-person training in Norway (clinical) [Ep 4 · 12:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=750)
- The first telementoring case in the Akron-Tromsø project had the mentor present in the same operating room 4 feet away to test the model before going fully remote (clinical) [Ep 4 · 13:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=780)
- The second telementoring test had the mentor on the 4th floor of the hospital while the surgeon operated, allowing the mentor to come down if needed (clinical) [Ep 4 · 13:30](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=810)
- Transatlantic telementoring was successfully performed at 3 AM for a full day of cases using iPad drawing system (clinical) [Ep 4 · 14:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=840)
- There is substantial data showing pediatric trauma centers are better for young children, but evidence for the 15-19 year old age group is less clear. — Richard Falcone (clinical) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- A previous study looking at Ohio alone showed no difference in outcomes for 15-19 year olds whether treated at adult or pediatric trauma centers. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- The Walther et al. study used the National Trauma Data Bank and included patients aged 15-19 with injury severity scores greater than 25 over a 5-year period. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- The study identified almost 13,000 patients meeting the inclusion criteria, with 51% treated at adult trauma centers and 49% at pediatric trauma centers. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- The patient groups at adult and pediatric trauma centers were demographically very similar without significant differences. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- The median injury severity score was 33 and 45% of patients had Glasgow Coma Scale scores less than 8, indicating severe brain injuries. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- There was no significant difference in mortality outcomes between adolescents treated at adult versus pediatric trauma centers. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Adolescents treated at adult trauma centers were approximately 81% more likely to have an imaging study performed compared to those at pediatric trauma centers. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Patients at pediatric trauma centers had shorter length of stay and shorter ICU length of stay compared to those at adult trauma centers. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- More patients were discharged to home rather than to rehab or skilled nursing facilities when cared for at pediatric trauma centers compared to adult trauma centers. — Richard Falcone (epidemiological) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Mortality is not the most important or reliable outcome for pediatric trauma because most children survive once they reach a hospital. — Richard Falcone (opinion) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- The study adds evidence that pediatric trauma centers add value for children even into the adolescent age range. — Richard Falcone (opinion) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Adult trauma centers need to achieve equivalent imaging rates and lengths of stay to pediatric trauma centers for adolescents, since 51% of these patients go to adult hospitals. — Richard Falcone (opinion) [Ep 3 · 0:14](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Pediatric trauma centers can achieve the same outcomes with less imaging by trusting clinical diagnosis and clinical examination. — Richard Falcone (clinical) [Ep 3 · 3:15](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=195)
- Less imaging with same outcomes and shorter length of stay proves that severely injured adolescents can be managed without unnecessary radiation exposure. — Richard Falcone (opinion) [Ep 3 · 3:15](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=195)
- Racial and socioeconomic disparities in criminal justice and public health have the same root causes. — Adam Foss (opinion) [Ep 5 · 1:45](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=105)
- Mass incarceration removes adults from communities, creating voids children cannot fill, leading to intergenerational cycles where children fall into the same traps as their families. — Adam Foss (opinion) [Ep 5 · 3:07](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=187)
- When prosecutors see domestic violence victims who don't want to press charges, they make judgments without understanding the constraints of poverty (lack of car, childcare, competing priorities) rather than recognizing these as barriers to appointment attendance. — Adam Foss (opinion) [Ep 5 · 8:05](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=485)
- Code for America reduced steps in California's criminal record clearance process and increased completion rates by 44% by removing barriers for people living in poverty. — Adam Foss (epidemiological) [Ep 5 · 9:18](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=558)
- Patients seeking help experience distrust when they enter a hospital or doctor's office and nobody looks like them, which can ruin the first interaction critical to long-term health outcomes. — Adam Foss (opinion) [Ep 5 · 11:23](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=683)
- There are 2.3 million people in jail and prison in the United States right now, with another 5 million on probation or parole. — Adam Foss (epidemiological) [Ep 5 · 17:36](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1056)
- One in three black men born today will spend some time in jail or prison. — Adam Foss (epidemiological) [Ep 5 · 18:10](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1090)
- 650,000 people are released from prison every year and face 50,000 collateral consequences of felony convictions that impede successful reentry into society. — Adam Foss (epidemiological) [Ep 5 · 18:25](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1105)
- 70 million Americans have a criminal record that will never go away and will impede their reentry into society. — Adam Foss (epidemiological) [Ep 5 · 19:00](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1140)
- The leading cause of death for young black men aged 18 to 35 in the United States is handgun homicide, which is not true of any other demographic in any other place on the planet. — Adam Foss (epidemiological) [Ep 5 · 19:30](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1170)
- Handgun homicide accounts for more deaths than the next nine leading causes of death combined for black men aged 18-35. — Adam Foss (epidemiological) [Ep 5 · 20:20](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1220)
- In Manhattan, black women are 12 times more likely to die during childbirth than white women. — Adam Foss (epidemiological) [Ep 5 · 20:50](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1250)
- Black women and white women experience breast cancer at almost the exact same rate, but black women are almost twice as likely to die from it. — Adam Foss (epidemiological) [Ep 5 · 21:20](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1280)
- Black women have a 71% higher chance of dying of cervical cancer. — Adam Foss (epidemiological) [Ep 5 · 21:50](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1310)
- In Boston, at one intersection on Massachusetts Avenue, life expectancy drops by 25 years depending on which direction you look. — Adam Foss (epidemiological) [Ep 5 · 22:10](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1330)
- There are more segregated schools in the United States today than there were at the time of Brown v. Board of Education. — Adam Foss (epidemiological) [Ep 5 · 22:50](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1370)
- There are more black people under correctional control today than there were slaves on the eve of the Civil War. — Adam Foss (epidemiological) [Ep 5 · 23:20](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1400)
- Over the 400 years of the transatlantic slave trade, researchers estimate 12 million Africans were captured, enslaved, and killed; last year 11 million people went through US jails, recreating slavery every single year. — Adam Foss (epidemiological) [Ep 5 · 23:50](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1430)
- Children conceived to mothers living in toxic stress inherit that toxic stress epigenetically, changing the way their bones and brains develop and eventually the way they behave, with these changes traceable into prison. — Adam Foss (clinical) [Ep 5 · 36:54](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2214)
- 75% of children who were incarcerated in 2015 had an average of 33 interactions with the child welfare system before age 3 for abuse, neglect, and malnutrition. — Adam Foss (epidemiological) [Ep 5 · 38:00](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2280)
- Children in underperforming schools never learn to read not because they are black, brown, or poor, but because educators don't understand the stress they bring to school and instead blame, shame, and expel them. — Adam Foss (opinion) [Ep 5 · 39:00](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2340)
- In Massachusetts, if an 18-year-old kills another 18-year-old, he receives a life without parole sentence at a cost of $11 million. — Adam Foss (epidemiological) [Ep 5 · 40:00](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2400)
- Being convicted of a drug crime in the 1990s deprived people of access to housing, employment, education, healthcare, and pro-social activity, increasing rather than decreasing the likelihood of committing another crime. — Adam Foss (opinion) [Ep 5 · 17:36](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1056)
- Handguns are more accessible than jobs in impoverished communities. — Adam Foss (opinion) [Ep 5 · 40:50](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2450)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Trauma and trauma-related injuries are the number one killer of pediatric patients. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 6 · 0:30](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=30)
- Intraosseous (IO) access can be placed in the tibia, humeral head, or distal femur; sternal IO is avoided in children though used in adults. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 6 · 8:28](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=508)
- For a child to show signs of hemorrhagic shock (both tachycardia and hypotension), they must lose about half their total blood volume. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 6 · 9:56](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=596)
- Over 75% of pediatric trauma deaths are due to head injuries. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 6 · 11:58](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=718)
- There are validated clinical decision rules for determining when head CT is not necessary in pediatric trauma, with different criteria for children under 2 versus over 2 years old. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 6 · 13:41](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=821)
- In the low-risk abdominal trauma group identified by the algorithm, 0.0% required intervention for intraabdominal injury. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 6 · 15:00](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=900)
- Medical knowledge doubles every 18 months, making techniques learned in training rapidly obsolete — The host summarizing the discussion [Ep 4 · 2:00](https://qa.library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=120)
- A recent study showed that referring hospitals had higher imaging rates than children's hospitals for appendicitis cases. — Todd Ponsky summarizes what Dr. Richard Falcone said [Ep 3 · 2:57](https://qa.library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=177)
- Social determinants of health include economic stability, housing, transportation, physical and psychological safety, zip code, geography, literacy, education, hunger, poverty, community support, discrimination, stress, and provider linguistic and cultural competencies, affecting outcomes like quality of care, mortality, morbidity, life expectancy, and healthcare costs. — Alex Cassar summarizes what Dr. Adam Foss said [Ep 5 · 0:25](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=25)
- Black mothers are dying in childbirth at disproportionate rates compared to other groups in the United States. — Alex Cassar summarizes what Dr. Adam Foss said [Ep 5 · 6:24](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=384)
- In pediatric surgery, black and other diverse children receive fewer pain medications and have their pain taken less seriously, causing them to struggle more during illness and creating distrust in the healthcare system. — Alex Cassar summarizes what Dr. Adam Foss said [Ep 5 · 6:24](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=384)
- Cardiologists give inferior stents to patients they assume will not follow up based on cultural or socioeconomic status, compromising standards of care. — Alex Cassar summarizes what Dr. Adam Foss said [Ep 5 · 7:19](https://qa.library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=439)

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