Beth Rymeski

Beth's statements about Abdominal Wall Defects 10 statements

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Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee

Statement Cincinnati Children's protocol includes standardized feed advancement and sham feeding to address poor oral feeding skills in gastroschisis patients. Open

Quotation we introduced sham feeding because what we realized is a lot of our gastroschesis babies have very poor oral feeding skills from you know delayed access to feeding Open

Statement Cincinnati Children's attempted ad-lib feeding for gastroschisis but abandoned it after one year due to poor results, including delayed NG tube removal and starting feeds too late. Open

Quotation we had trialed a system of just ad-lib feeding um it was not successful i think there were a number of reasons for that part of it was that there was no standardized plan for when to get the ng tube out so there was i think we started feeding these babies too late Open

Statement Cincinnati Children's current gastroschisis feeding protocol has been in place for approximately four years. Open

Statement Approximately two-thirds of Cincinnati Children's gastroschisis patients are discharged home with an NG tube or G-tube for continued feeding support. Open

Statement Cincinnati Children's protocol includes both intermittent feeds and sham feeds, with sham feeds implemented for approximately one year. Open

Quotation our rate of sending gastroschisis babies home with an ng or a g tube it's like two thirds of them go home with some sort of tube to help them continue feeding which is crazy Open

Quotation we did put in our protocol for our nursing college as well as our families that emesis is expected we put that within our written protocol to make that expectation known that it's okay it's okay they're going to throw up we'll just keep working through it Open

Statement Cincinnati Children's written protocol explicitly states that emesis is expected during gastroschisis feeding to set appropriate expectations for nursing staff and families. Open

Beth's statements about Colorectal / ARM & Hirschsprung 13 statements

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Update Course Rewind: 2020 Colorectal Part 2

Quotation I think this is like a nightmare in clinic, honestly, this is the patient that no one wants to see, right? I mean, rectal prolapses. I it's very distressing to the patient and the family, and we don't really have a lot of, of great options. Open

Quotation If it's a patient that I've never met before, I typically will address, you know, concerns about the constipation first and sort of prove or disprove whether or not this patient is significantly constipated. Open

Quotation I think if they are constipated, that's like the easier patient to deal with, but every once in a while, you get a kid who is well managed on whatever their regimen is, and they're still prolapsing, and then I think the question is, what do you do? Open

Journal of Pediatric Surgery Article Review: February 2023, BAPS issue

Statement The Sheffield Hirschsprung management sequence does not reflect typical practice in the United States Open

Quotation That it does not seem reflective at all of the type of things that that we see in our practice here, and I think that would be seen in a lot of practices in the United States. Open

Statement In US practice, most Hirschsprung patients undergo either neonatal pull-through or are sent home on irrigations for pull-through in the first couple of months of life Open

Statement In US practice, pre-pull-through diversion is only done for delayed presentation with perforation or complicated cardiac babies Open

Statement Before implementing preoperative bathing in Tanzania, almost every pediatric surgery patient developed a wound infection Open

Quotation Yeah, I mean, the first year that we operated there, almost every kid got a wound infection, and then we started the next year we had the nurses do pre-op baths up on the floor the day before, and that year we had like 0 wound infections. Open

Statement After implementing preoperative baths in Tanzania, wound infection rates dropped to nearly zero Open

Beth's statements about Congenital Diaphragmatic Hernia 21 statements

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Neonatal Gastric Volvulus with Dr. Jason Frischer

Quotation Yeah, we've had a couple unrepaired CDH's valvulize their stomach and need to get fixed more urgently. It's not common, but it's happened. Open

Quotation Had a weird looking sort of fixed bubble in the chest that was not able to be decompressed, couldn't advance the repogal. Open

Statement Key presentation findings in gastric volvulus include a weird looking fixed bubble in the chest that cannot be decompressed and inability to advance the NG tube. Open

Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski

Quotation So this is just a little schematic of what this looks like. Open

Quotation For it's a percutaneous intervention on mom. Open

Statement FETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus. Open

Statement A standard fetoscope with a side channel is used, and the balloon is worked through the side channel. Open

Statement The tongue is an easy landmark to identify during FETO because it is bumpy in appearance. Open

Quotation So the tongue is a very easy landmark when you're doing a feto. Open

Statement Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement. Open

Statement If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth. Open

Quotation In this particular case, the first thing we saw was the esophagus, and we're like, OK, that's the wrong hole, right? Open

Statement The epiglottis is a key landmark to locate when navigating to the trachea. Open

Statement Excessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage. Open

Quotation You also don't want to be torquing the membranes too much, right? Open

Statement The scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus. Open

Quotation You always advance the scope till you see the carina, right? Open

Quotation That tells you both where you are in the trachea. Open

Statement The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea. Open

Statement The scope is backed up as the balloon is inflated so that balloon inflation can be watched. Open

Statement The balloon contains a little metal ball that can be visualized. Open

Beth's statements about Esophageal Atresia 7 statements

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