we, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.
we, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.
we, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.
we, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.
we, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.
there was a lot of education that needs to be done on the floor while they are inpatients, and there's, because this is not an everyday common occurrence, the nursing staff very commonly will have a different level of, of education based on. Rectal irrigations, rectal enemas
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
▶Ep 81 · 2:07
quoteThis baby was prenatally diagnosed with tetralogy of fallot↗
▶Ep 81 · 5:23
quoteyou know the lesion that you're dealing with, the interrectal malformation lesion you're dealing with, is one of the less complicated lesions↗
▶Ep 81 · 5:23
clinicalWhite beads along the scrotal raphe with meconium smear indicate the anorectal malformation is one of the less complicated lesions with an opening somewhere along the perineal body.↗
▶Ep 81 · 5:23
opinionFor ARM with external opening and no cardiac defect, primary repair in the neonatal period would be the optimal choice.↗
clinicalA baby is too young to calculate a sacral ratio in the neonatal period.↗
▶Ep 81 · 9:04
clinicalVCUG is obtained if there are renal anomalies in ARM patients.↗
▶Ep 81 · 9:14
quoteevery time that they would try to dilate, the baby would cry and then desat down to like the 60s↗
▶Ep 81 · 10:23
quotewe initially always start out with cardiac babies around a pressure of eight, if we can get away with it↗
▶Ep 81 · 10:23
clinicalIrrigating the distal rectum and evacuating stool helps keep laparoscopic pressures low in ARM patients.↗
▶Ep 81 · 10:23
clinicalFor laparoscopy in cardiac babies, initial insufflation pressure should start around 8 mmHg if possible.↗
▶Ep 81 · 13:36
clinicalWhen half of the perineal fistula opening is anterior to the muscular complex, the entire opening should be formally moved back into the center around the anal muscular complex.↗
▶Ep 81 · 13:36
quoteHalf of the perineal opening was anterior to the muscular complex. So, we did actually formally move the entire opening back into the center around the anal muscular complex↗
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
▶Ep 82 · 2:07
quoteThis baby was prenatally diagnosed with tetralogy of fallot.↗
▶Ep 82 · 3:53
quoteActually, the topic of missed ARM, that's a totally other podcast altogether.↗
▶Ep 82 · 4:41
quoteI don't stand in the way when the NICU gets an echo. I routinely get them all.↗
▶Ep 82 · 5:24
quoteyou could ideally do a primary repair on this patient in the neonatal period. There also would be an option to potentially send the baby home and dilate.↗
▶Ep 82 · 5:24
clinicalWhite beads in the scrotal raphe with meconium smear indicate the ARM lesion is one of the less complicated lesions with an opening somewhere along the perineal body.↗
▶Ep 82 · 5:24
clinicalFor a perineal fistula with no cardiac defect, primary repair would be the optimal choice, though dilation and delayed repair is also an option.↗
clinicalDr. Durham gets a VCUG if there are renal anomalies.↗
▶Ep 82 · 9:14
clinicalEvery time they tried to dilate this baby, he would cry and desat down to the 60s due to TET spells, leading to the decision to perform colostomy.↗
▶Ep 82 · 9:14
quoteevery time that they would try to dilate, the baby would cry and then desat down to like the 60s.↗
▶Ep 82 · 10:23
clinicalFor laparoscopy in cardiac babies, Dr. Durham starts with a pressure of eight if possible and a flow rate of one.↗
▶Ep 82 · 10:23
quoteI always start on the babies at a flow rate of one. I'm probably a little more slow than others, and sometimes I'll increase it.↗
▶Ep 82 · 10:23
quotewe initially always start out with cardiac babies around a pressure of eight, if we can get away with it.↗
▶Ep 82 · 12:33
clinicalImportant factors for continence are sensation in the anal canal, absence of the dentate line, quality of the spine, quality of the anorectal malformation, and quality of the sacrum.↗
▶Ep 82 · 12:33
clinicalThis baby has a low lesion with closely approximated perineal fistula to the anal muscular complex and should do really well for continence.↗
▶Ep 82 · 12:33
quoteThis baby has a low lesion. So, basically, just had a closely approximated perineal fistula to the anal muscular complex. So, should do really well.↗
▶Ep 82 · 13:41
quoteHalf of the perineal opening was anterior to the muscular complex. So, we did actually formally move the entire opening back into the center around the anal muscular complex.↗
▶Ep 82 · 13:41
clinicalWhen half of the perineal fistula opening is anterior to the muscular complex, the entire opening should be formally moved back into the center around the anal muscular complex.↗
clinicalAfter Hirschsprung pull-through, Dr. Durham brings patients back about 2 weeks after surgery to calibrate the anus and assess for cicatrix or narrowing at the anastomosis.↗
▶Ep 90 · 1:58
clinicalAfter Hirschsprung pull-through, Dr. Durham brings patients back about 2 weeks after surgery to calibrate the anus and assess for cicatrix or narrowing at the anastomosis.↗
▶Ep 90 · 1:58
quoteI personally will bring you back about 2 weeks or, um, 2 weeks after surgery and I'll calibrate the anus to make sure that anastomosis is OK.↗
▶Ep 90 · 1:58
quoteI personally will bring you back about 2 weeks or, um, 2 weeks after surgery and I'll calibrate the anus to make sure that anastomosis is OK.↗
▶Ep 90 · 2:13
clinicalProblems after Hirschsprung pull-through commonly occur later rather than very early on in the young child.↗
▶Ep 90 · 2:13
clinicalProblems after Hirschsprung pull-through commonly occur later rather than very early on in the young child.↗
▶Ep 90 · 2:13
quotevery commonly, very early on, there's not problems. It's usually a little bit later, like we'll see in this patient that problems start occurring in the, in the young child.↗
▶Ep 90 · 2:13
quotevery commonly, very early on, there's not problems. It's usually a little bit later, like we'll see in this patient that problems start occurring in the, in the young child.↗
▶Ep 90 · 5:13
clinicalAt Children's Healthcare of Atlanta, acute Hirschsprung-associated enterocolitis management does not include fixed NPO time or immediate TPN initiation.↗
▶Ep 90 · 5:13
clinicalAt Children's Healthcare of Atlanta, acute Hirschsprung-associated enterocolitis management does not include fixed NPO time or immediate TPN initiation.↗
▶Ep 90 · 5:19
clinicalChildren's Healthcare of Atlanta protocol for enterocolitis includes rectal irrigations with about 10 cc/kg normal saline every 8 hours for at least the first 24 to 48 hours.↗
▶Ep 90 · 5:19
clinicalChildren's Healthcare of Atlanta protocol for enterocolitis includes rectal irrigations with about 10 cc/kg normal saline every 8 hours for at least the first 24 to 48 hours.↗
▶Ep 90 · 5:29
clinicalIV Flagyl is typically started for Hirschsprung-associated enterocolitis at Children's Healthcare of Atlanta.↗
▶Ep 90 · 5:29
clinicalIV Flagyl is typically started for Hirschsprung-associated enterocolitis at Children's Healthcare of Atlanta.↗
▶Ep 90 · 6:18
clinicalDr. Durham would discharge a child after enterocolitis on Flagyl, laxatives, and rectal irrigations for some period of time, particularly for children who tend to dilate their colon.↗
▶Ep 90 · 6:18
clinicalDr. Durham would discharge a child after enterocolitis on Flagyl, laxatives, and rectal irrigations for some period of time, particularly for children who tend to dilate their colon.↗
▶Ep 90 · 7:05
clinicalChildren's Healthcare of Atlanta has developed a standardized teaching regimen for rectal irrigations across different campuses and a regular education process for floor nurses.↗
▶Ep 90 · 7:05
quotewe here have recently come up with a very standardized teaching regimen for our different campuses.↗
▶Ep 90 · 7:05
clinicalChildren's Healthcare of Atlanta has developed a standardized teaching regimen for rectal irrigations across different campuses and a regular education process for floor nurses.↗
▶Ep 90 · 7:05
quotewe here have recently come up with a very standardized teaching regimen for our different campuses.↗
▶Ep 90 · 7:13
quotethere was a lot of education that needs to be done on the floor while they are inpatients, and there's, because this is not an everyday common occurrence, the nursing staff very commonly will have a different level of, of education based on. Rectal irrigations, rectal enemas↗
▶Ep 90 · 7:13
clinicalNursing staff commonly have different levels of education regarding rectal irrigations and enemas because this is not an everyday common occurrence.↗
▶Ep 90 · 7:13
quotethere was a lot of education that needs to be done on the floor while they are inpatients, and there's, because this is not an everyday common occurrence, the nursing staff very commonly will have a different level of, of education based on. Rectal irrigations, rectal enemas↗
▶Ep 90 · 7:13
clinicalNursing staff commonly have different levels of education regarding rectal irrigations and enemas because this is not an everyday common occurrence.↗
▶Ep 90 · 7:27
quotewe, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.↗
▶Ep 90 · 7:27
quotewe, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.↗
▶Ep 90 · 7:37
clinicalA standardized order form with links to policy has been implemented to make rectal irrigation procedures clearer for nurses.↗
▶Ep 90 · 7:37
clinicalA standardized order form with links to policy has been implemented to make rectal irrigation procedures clearer for nurses.↗
▶Ep 90 · 8:10
guidelineDr. Langer published a guideline with the APSA Hirschsprung Disease Research Interest Group for diagnosis and management of obstructive symptoms after Hirschsprung pull-through.↗
▶Ep 90 · 8:10
guidelineDr. Langer published a guideline with the APSA Hirschsprung Disease Research Interest Group for diagnosis and management of obstructive symptoms after Hirschsprung pull-through.↗
▶Ep 90 · 9:37
clinicalObstructed Hirschsprung patients are easier to identify because not passing stool is an easy sign for parents to see, whereas hypermodal patients with fecal incontinence present a more difficult diagnostic challenge.↗
▶Ep 90 · 9:37
clinicalObstructed Hirschsprung patients are easier to identify because not passing stool is an easy sign for parents to see, whereas hypermodal patients with fecal incontinence present a more difficult diagnostic challenge.↗
▶Ep 90 · 9:37
quoteThe babies that are obstructed show up when they're a few months old or a couple of years old, because if they're not passing stool, it's a very easy sign for parents to see.↗
▶Ep 90 · 9:37
quoteThe babies that are obstructed show up when they're a few months old or a couple of years old, because if they're not passing stool, it's a very easy sign for parents to see.↗
▶Ep 90 · 10:52
clinicalIn Case 2, exam under anesthesia revealed intact sphincters and intact dentate line.↗
▶Ep 90 · 10:52
clinicalIn Case 2, exam under anesthesia revealed intact sphincters and intact dentate line.↗
▶Ep 90 · 10:56
quotehe had HAPC, so he had these high amplitude contractions that were up pressures upwards of 400 millimeters of mercury all the way down to his anus, and I don't think anybody can control. That type of pressure coming down to your anus.↗
▶Ep 90 · 10:56
clinicalThe patient in Case 2 had high-amplitude propagating contractions (HAPCs) on manometry with pressures upwards of 400 mmHg all the way down to the anus.↗
▶Ep 90 · 10:56
quotehe had HAPC, so he had these high amplitude contractions that were up pressures upwards of 400 millimeters of mercury all the way down to his anus, and I don't think anybody can control. That type of pressure coming down to your anus.↗
▶Ep 90 · 10:56
clinicalThe patient in Case 2 had high-amplitude propagating contractions (HAPCs) on manometry with pressures upwards of 400 mmHg all the way down to the anus.↗
▶Ep 90 · 11:11
opinionNobody can control the type of pressure (400 mmHg HAPCs) coming down to the anus.↗
▶Ep 90 · 11:11
opinionNobody can control the type of pressure (400 mmHg HAPCs) coming down to the anus.↗
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
▶Ep 231 · 2:07
quoteThis baby was prenatally diagnosed with tetralogy of fallot↗
▶Ep 231 · 2:07
quoteThis baby was prenatally diagnosed with tetralogy of fallot↗
▶Ep 231 · 5:23
quoteyou know the lesion that you're dealing with, the interrectal malformation lesion you're dealing with, is one of the less complicated lesions↗
▶Ep 231 · 5:23
clinicalWhite beads along the scrotal raphe with meconium smear indicate the anorectal malformation is one of the less complicated lesions with an opening somewhere along the perineal body.↗
▶Ep 231 · 5:23
clinicalWhite beads along the scrotal raphe with meconium smear indicate the anorectal malformation is one of the less complicated lesions with an opening somewhere along the perineal body.↗
▶Ep 231 · 5:23
opinionFor ARM with external opening and no cardiac defect, primary repair in the neonatal period would be the optimal choice.↗
▶Ep 231 · 5:23
quoteyou know the lesion that you're dealing with, the interrectal malformation lesion you're dealing with, is one of the less complicated lesions↗
▶Ep 231 · 5:23
opinionFor ARM with external opening and no cardiac defect, primary repair in the neonatal period would be the optimal choice.↗
▶Ep 231 · 8:33
clinicalA baby is too young to calculate a sacral ratio in the neonatal period.↗
▶Ep 231 · 8:33
clinicalA baby is too young to calculate a sacral ratio in the neonatal period.↗
clinicalVCUG is obtained if there are renal anomalies in ARM patients.↗
▶Ep 231 · 9:04
clinicalVCUG is obtained if there are renal anomalies in ARM patients.↗
▶Ep 231 · 9:14
quoteevery time that they would try to dilate, the baby would cry and then desat down to like the 60s↗
▶Ep 231 · 9:14
quoteevery time that they would try to dilate, the baby would cry and then desat down to like the 60s↗
▶Ep 231 · 10:23
clinicalIrrigating the distal rectum and evacuating stool helps keep laparoscopic pressures low in ARM patients.↗
▶Ep 231 · 10:23
quotewe initially always start out with cardiac babies around a pressure of eight, if we can get away with it↗
▶Ep 231 · 10:23
clinicalFor laparoscopy in cardiac babies, initial insufflation pressure should start around 8 mmHg if possible.↗
▶Ep 231 · 10:23
clinicalIrrigating the distal rectum and evacuating stool helps keep laparoscopic pressures low in ARM patients.↗
▶Ep 231 · 10:23
clinicalFor laparoscopy in cardiac babies, initial insufflation pressure should start around 8 mmHg if possible.↗
▶Ep 231 · 10:23
quotewe initially always start out with cardiac babies around a pressure of eight, if we can get away with it↗
▶Ep 231 · 13:36
quoteHalf of the perineal opening was anterior to the muscular complex. So, we did actually formally move the entire opening back into the center around the anal muscular complex↗
▶Ep 231 · 13:36
clinicalWhen half of the perineal fistula opening is anterior to the muscular complex, the entire opening should be formally moved back into the center around the anal muscular complex.↗
▶Ep 231 · 13:36
clinicalWhen half of the perineal fistula opening is anterior to the muscular complex, the entire opening should be formally moved back into the center around the anal muscular complex.↗
▶Ep 231 · 13:36
quoteHalf of the perineal opening was anterior to the muscular complex. So, we did actually formally move the entire opening back into the center around the anal muscular complex↗
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
▶Ep 232 · 2:07
quoteThis baby was prenatally diagnosed with tetralogy of fallot.↗
▶Ep 232 · 2:07
quoteThis baby was prenatally diagnosed with tetralogy of fallot.↗
▶Ep 232 · 3:53
quoteActually, the topic of missed ARM, that's a totally other podcast altogether.↗
▶Ep 232 · 3:53
quoteActually, the topic of missed ARM, that's a totally other podcast altogether.↗
▶Ep 232 · 4:41
quoteI don't stand in the way when the NICU gets an echo. I routinely get them all.↗
▶Ep 232 · 4:41
quoteI don't stand in the way when the NICU gets an echo. I routinely get them all.↗
▶Ep 232 · 5:24
clinicalWhite beads in the scrotal raphe with meconium smear indicate the ARM lesion is one of the less complicated lesions with an opening somewhere along the perineal body.↗
▶Ep 232 · 5:24
quoteyou could ideally do a primary repair on this patient in the neonatal period. There also would be an option to potentially send the baby home and dilate.↗
▶Ep 232 · 5:24
clinicalFor a perineal fistula with no cardiac defect, primary repair would be the optimal choice, though dilation and delayed repair is also an option.↗
▶Ep 232 · 5:24
clinicalWhite beads in the scrotal raphe with meconium smear indicate the ARM lesion is one of the less complicated lesions with an opening somewhere along the perineal body.↗
▶Ep 232 · 5:24
quoteyou could ideally do a primary repair on this patient in the neonatal period. There also would be an option to potentially send the baby home and dilate.↗
▶Ep 232 · 5:24
clinicalFor a perineal fistula with no cardiac defect, primary repair would be the optimal choice, though dilation and delayed repair is also an option.↗
clinicalDr. Durham gets a VCUG if there are renal anomalies.↗
▶Ep 232 · 8:57
clinicalDr. Durham gets a VCUG if there are renal anomalies.↗
▶Ep 232 · 9:14
clinicalEvery time they tried to dilate this baby, he would cry and desat down to the 60s due to TET spells, leading to the decision to perform colostomy.↗
▶Ep 232 · 9:14
quoteevery time that they would try to dilate, the baby would cry and then desat down to like the 60s.↗
▶Ep 232 · 9:14
quoteevery time that they would try to dilate, the baby would cry and then desat down to like the 60s.↗
▶Ep 232 · 9:14
clinicalEvery time they tried to dilate this baby, he would cry and desat down to the 60s due to TET spells, leading to the decision to perform colostomy.↗
▶Ep 232 · 10:23
quoteI always start on the babies at a flow rate of one. I'm probably a little more slow than others, and sometimes I'll increase it.↗
▶Ep 232 · 10:23
clinicalFor laparoscopy in cardiac babies, Dr. Durham starts with a pressure of eight if possible and a flow rate of one.↗
▶Ep 232 · 10:23
quoteI always start on the babies at a flow rate of one. I'm probably a little more slow than others, and sometimes I'll increase it.↗
▶Ep 232 · 10:23
clinicalFor laparoscopy in cardiac babies, Dr. Durham starts with a pressure of eight if possible and a flow rate of one.↗
▶Ep 232 · 10:23
quotewe initially always start out with cardiac babies around a pressure of eight, if we can get away with it.↗
▶Ep 232 · 10:23
quotewe initially always start out with cardiac babies around a pressure of eight, if we can get away with it.↗
▶Ep 232 · 12:33
clinicalImportant factors for continence are sensation in the anal canal, absence of the dentate line, quality of the spine, quality of the anorectal malformation, and quality of the sacrum.↗
▶Ep 232 · 12:33
quoteThis baby has a low lesion. So, basically, just had a closely approximated perineal fistula to the anal muscular complex. So, should do really well.↗
▶Ep 232 · 12:33
clinicalImportant factors for continence are sensation in the anal canal, absence of the dentate line, quality of the spine, quality of the anorectal malformation, and quality of the sacrum.↗
▶Ep 232 · 12:33
clinicalThis baby has a low lesion with closely approximated perineal fistula to the anal muscular complex and should do really well for continence.↗
▶Ep 232 · 12:33
quoteThis baby has a low lesion. So, basically, just had a closely approximated perineal fistula to the anal muscular complex. So, should do really well.↗
▶Ep 232 · 12:33
clinicalThis baby has a low lesion with closely approximated perineal fistula to the anal muscular complex and should do really well for continence.↗
▶Ep 232 · 13:41
clinicalWhen half of the perineal fistula opening is anterior to the muscular complex, the entire opening should be formally moved back into the center around the anal muscular complex.↗
▶Ep 232 · 13:41
quoteHalf of the perineal opening was anterior to the muscular complex. So, we did actually formally move the entire opening back into the center around the anal muscular complex.↗
▶Ep 232 · 13:41
clinicalWhen half of the perineal fistula opening is anterior to the muscular complex, the entire opening should be formally moved back into the center around the anal muscular complex.↗
▶Ep 232 · 13:41
quoteHalf of the perineal opening was anterior to the muscular complex. So, we did actually formally move the entire opening back into the center around the anal muscular complex.↗
clinicalAfter Hirschsprung pull-through, Dr. Durham brings patients back about 2 weeks after surgery to calibrate the anus and assess for cicatrix or narrowing at the anastomosis.↗
▶Ep 17 · 1:58
quoteI personally will bring you back about 2 weeks or, um, 2 weeks after surgery and I'll calibrate the anus to make sure that anastomosis is OK.↗
▶Ep 17 · 2:13
quotevery commonly, very early on, there's not problems. It's usually a little bit later, like we'll see in this patient that problems start occurring in the, in the young child.↗
▶Ep 17 · 2:13
clinicalProblems after Hirschsprung pull-through commonly occur later rather than very early on in the young child.↗
▶Ep 17 · 5:13
clinicalAt Children's Healthcare of Atlanta, acute Hirschsprung-associated enterocolitis management does not include fixed NPO time or immediate TPN initiation.↗
▶Ep 17 · 5:19
clinicalChildren's Healthcare of Atlanta protocol for enterocolitis includes rectal irrigations with about 10 cc/kg normal saline every 8 hours for at least the first 24 to 48 hours.↗
▶Ep 17 · 5:29
clinicalIV Flagyl is typically started for Hirschsprung-associated enterocolitis at Children's Healthcare of Atlanta.↗
▶Ep 17 · 6:18
clinicalDr. Durham would discharge a child after enterocolitis on Flagyl, laxatives, and rectal irrigations for some period of time, particularly for children who tend to dilate their colon.↗
▶Ep 17 · 7:05
clinicalChildren's Healthcare of Atlanta has developed a standardized teaching regimen for rectal irrigations across different campuses and a regular education process for floor nurses.↗
▶Ep 17 · 7:05
quotewe here have recently come up with a very standardized teaching regimen for our different campuses.↗
▶Ep 17 · 7:13
clinicalNursing staff commonly have different levels of education regarding rectal irrigations and enemas because this is not an everyday common occurrence.↗
▶Ep 17 · 7:13
quotethere was a lot of education that needs to be done on the floor while they are inpatients, and there's, because this is not an everyday common occurrence, the nursing staff very commonly will have a different level of, of education based on. Rectal irrigations, rectal enemas↗
▶Ep 17 · 7:27
quotewe, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.↗
▶Ep 17 · 7:37
clinicalA standardized order form with links to policy has been implemented to make rectal irrigation procedures clearer for nurses.↗
▶Ep 17 · 8:10
guidelineDr. Langer published a guideline with the APSA Hirschsprung Disease Research Interest Group for diagnosis and management of obstructive symptoms after Hirschsprung pull-through.↗
▶Ep 17 · 9:37
clinicalObstructed Hirschsprung patients are easier to identify because not passing stool is an easy sign for parents to see, whereas hypermodal patients with fecal incontinence present a more difficult diagnostic challenge.↗
▶Ep 17 · 9:37
quoteThe babies that are obstructed show up when they're a few months old or a couple of years old, because if they're not passing stool, it's a very easy sign for parents to see.↗
▶Ep 17 · 10:52
clinicalIn Case 2, exam under anesthesia revealed intact sphincters and intact dentate line.↗
▶Ep 17 · 10:56
clinicalThe patient in Case 2 had high-amplitude propagating contractions (HAPCs) on manometry with pressures upwards of 400 mmHg all the way down to the anus.↗
▶Ep 17 · 10:56
quotehe had HAPC, so he had these high amplitude contractions that were up pressures upwards of 400 millimeters of mercury all the way down to his anus, and I don't think anybody can control. That type of pressure coming down to your anus.↗
▶Ep 17 · 11:11
opinionNobody can control the type of pressure (400 mmHg HAPCs) coming down to the anus.↗
quoteI personally will bring you back about 2 weeks or, um, 2 weeks after surgery and I'll calibrate the anus to make sure that anastomosis is OK.↗
▶Ep 38 · 1:58
clinicalAfter Hirschsprung pull-through, Dr. Durham brings patients back about 2 weeks after surgery to calibrate the anus and assess for cicatrix or narrowing at the anastomosis.↗
▶Ep 38 · 1:58
clinicalAfter Hirschsprung pull-through, Dr. Durham brings patients back about 2 weeks after surgery to calibrate the anus and assess for cicatrix or narrowing at the anastomosis.↗
▶Ep 38 · 1:58
quoteI personally will bring you back about 2 weeks or, um, 2 weeks after surgery and I'll calibrate the anus to make sure that anastomosis is OK.↗
▶Ep 38 · 2:13
quotevery commonly, very early on, there's not problems. It's usually a little bit later, like we'll see in this patient that problems start occurring in the, in the young child.↗
▶Ep 38 · 2:13
clinicalProblems after Hirschsprung pull-through commonly occur later rather than very early on in the young child.↗
▶Ep 38 · 2:13
clinicalProblems after Hirschsprung pull-through commonly occur later rather than very early on in the young child.↗
▶Ep 38 · 2:13
quotevery commonly, very early on, there's not problems. It's usually a little bit later, like we'll see in this patient that problems start occurring in the, in the young child.↗
▶Ep 38 · 5:13
clinicalAt Children's Healthcare of Atlanta, acute Hirschsprung-associated enterocolitis management does not include fixed NPO time or immediate TPN initiation.↗
▶Ep 38 · 5:13
clinicalAt Children's Healthcare of Atlanta, acute Hirschsprung-associated enterocolitis management does not include fixed NPO time or immediate TPN initiation.↗
▶Ep 38 · 5:19
clinicalChildren's Healthcare of Atlanta protocol for enterocolitis includes rectal irrigations with about 10 cc/kg normal saline every 8 hours for at least the first 24 to 48 hours.↗
▶Ep 38 · 5:19
clinicalChildren's Healthcare of Atlanta protocol for enterocolitis includes rectal irrigations with about 10 cc/kg normal saline every 8 hours for at least the first 24 to 48 hours.↗
▶Ep 38 · 5:29
clinicalIV Flagyl is typically started for Hirschsprung-associated enterocolitis at Children's Healthcare of Atlanta.↗
▶Ep 38 · 5:29
clinicalIV Flagyl is typically started for Hirschsprung-associated enterocolitis at Children's Healthcare of Atlanta.↗
▶Ep 38 · 6:18
clinicalDr. Durham would discharge a child after enterocolitis on Flagyl, laxatives, and rectal irrigations for some period of time, particularly for children who tend to dilate their colon.↗
▶Ep 38 · 6:18
clinicalDr. Durham would discharge a child after enterocolitis on Flagyl, laxatives, and rectal irrigations for some period of time, particularly for children who tend to dilate their colon.↗
▶Ep 38 · 7:05
quotewe here have recently come up with a very standardized teaching regimen for our different campuses.↗
▶Ep 38 · 7:05
clinicalChildren's Healthcare of Atlanta has developed a standardized teaching regimen for rectal irrigations across different campuses and a regular education process for floor nurses.↗
▶Ep 38 · 7:05
quotewe here have recently come up with a very standardized teaching regimen for our different campuses.↗
▶Ep 38 · 7:05
clinicalChildren's Healthcare of Atlanta has developed a standardized teaching regimen for rectal irrigations across different campuses and a regular education process for floor nurses.↗
▶Ep 38 · 7:13
clinicalNursing staff commonly have different levels of education regarding rectal irrigations and enemas because this is not an everyday common occurrence.↗
▶Ep 38 · 7:13
quotethere was a lot of education that needs to be done on the floor while they are inpatients, and there's, because this is not an everyday common occurrence, the nursing staff very commonly will have a different level of, of education based on. Rectal irrigations, rectal enemas↗
▶Ep 38 · 7:13
clinicalNursing staff commonly have different levels of education regarding rectal irrigations and enemas because this is not an everyday common occurrence.↗
▶Ep 38 · 7:13
quotethere was a lot of education that needs to be done on the floor while they are inpatients, and there's, because this is not an everyday common occurrence, the nursing staff very commonly will have a different level of, of education based on. Rectal irrigations, rectal enemas↗
▶Ep 38 · 7:27
quotewe, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.↗
▶Ep 38 · 7:27
quotewe, we, we do have a regular education process that we do to the floor nurses to make sure they understand. And we also have come up with a standardized order form now so that it's much more clear for the nurses about types of tubes, how it's supposed to be done with a, with links to, um, policy.↗
▶Ep 38 · 7:37
clinicalA standardized order form with links to policy has been implemented to make rectal irrigation procedures clearer for nurses.↗
▶Ep 38 · 7:37
clinicalA standardized order form with links to policy has been implemented to make rectal irrigation procedures clearer for nurses.↗
▶Ep 38 · 8:10
guidelineDr. Langer published a guideline with the APSA Hirschsprung Disease Research Interest Group for diagnosis and management of obstructive symptoms after Hirschsprung pull-through.↗
▶Ep 38 · 8:10
guidelineDr. Langer published a guideline with the APSA Hirschsprung Disease Research Interest Group for diagnosis and management of obstructive symptoms after Hirschsprung pull-through.↗
▶Ep 38 · 9:37
clinicalObstructed Hirschsprung patients are easier to identify because not passing stool is an easy sign for parents to see, whereas hypermodal patients with fecal incontinence present a more difficult diagnostic challenge.↗
▶Ep 38 · 9:37
quoteThe babies that are obstructed show up when they're a few months old or a couple of years old, because if they're not passing stool, it's a very easy sign for parents to see.↗
▶Ep 38 · 9:37
quoteThe babies that are obstructed show up when they're a few months old or a couple of years old, because if they're not passing stool, it's a very easy sign for parents to see.↗
▶Ep 38 · 9:37
clinicalObstructed Hirschsprung patients are easier to identify because not passing stool is an easy sign for parents to see, whereas hypermodal patients with fecal incontinence present a more difficult diagnostic challenge.↗
▶Ep 38 · 10:52
clinicalIn Case 2, exam under anesthesia revealed intact sphincters and intact dentate line.↗
▶Ep 38 · 10:52
clinicalIn Case 2, exam under anesthesia revealed intact sphincters and intact dentate line.↗
▶Ep 38 · 10:56
clinicalThe patient in Case 2 had high-amplitude propagating contractions (HAPCs) on manometry with pressures upwards of 400 mmHg all the way down to the anus.↗
▶Ep 38 · 10:56
quotehe had HAPC, so he had these high amplitude contractions that were up pressures upwards of 400 millimeters of mercury all the way down to his anus, and I don't think anybody can control. That type of pressure coming down to your anus.↗
▶Ep 38 · 10:56
quotehe had HAPC, so he had these high amplitude contractions that were up pressures upwards of 400 millimeters of mercury all the way down to his anus, and I don't think anybody can control. That type of pressure coming down to your anus.↗
▶Ep 38 · 10:56
clinicalThe patient in Case 2 had high-amplitude propagating contractions (HAPCs) on manometry with pressures upwards of 400 mmHg all the way down to the anus.↗
▶Ep 38 · 11:11
opinionNobody can control the type of pressure (400 mmHg HAPCs) coming down to the anus.↗
▶Ep 38 · 11:11
opinionNobody can control the type of pressure (400 mmHg HAPCs) coming down to the anus.↗
