From
StayCurrentMD
What's New in Pediatric Surgery 2020 - FULL SHOW
With CCHMC Pediatric Surgery · hosted by Dr. Todd Ponsky & Dr. Rod Gerardo
Chapter 1 of 11 · Evidence & Research
Pneumothorax protocol
Introduction and Spontaneous Pneumothorax Management
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Most spontaneous pneumothorax patients presenting to the emergency department have already sealed the pleural defect by the time of evaluation.
Incarceration rate of umbilical hernias in children is incredibly low.
Approximately 80% of umbilical hernias in children resolve spontaneously.
Wrapping the base of the penis with saline-soaked gauze during monopolar electrocautery use can help prevent complications.
The penis is a highly vascular organ, and unless the dorsal artery is damaged, necrosis should not occur with proper technique.
The Gips procedure takes approximately 3 to 5 minutes to perform.
Airway instrumentation in a patient with reactive airway disease carries higher real risk than the negligible radiation from a targeted chest CT.
In the Midwest Pediatric Surgery Consortium prospective trial of spontaneous pneumothorax, 83% of patients who failed initial aspiration eventually required VATS procedure.
Among spontaneous pneumothorax patients sent home after successful aspiration, the recurrence rate was 44% with no episodes of tension pneumothorax.
In a 12-center UK retrospective review, the recurrence rate of mature and immature ovarian teratomas and serous cystadenomas was 8%.
After uncomplicated appendectomy, 84% of patients require no opioids on post-operative day one, 95% by day two, and 100% by day three.
A Riley Hospital RCT found that ad-lib feeding after pyloromyotomy decreased time to goal feeds and length of stay compared to incremental feeding protocols, without increasing post-operative vomiting or readmissions.
Patients with serum chloride less than 100 on admission for pyloric stenosis took significantly longer to reach feeding goals.
Nationwide Children's Hospital reduced stoma takedown wound infection rate from 21% to 8% with a perioperative bundle, then to 2.2% by switching antibiotics from cefoxitin to unasyn.
Changing gloves and instruments when performing fascial and skin closures during stoma takedown is believed to be the most impactful element of the infection-reduction bundle.
Enterococcus was the predominant pathogen in stoma takedown infections, and unasyn provides better enterococcal coverage than cefoxitin.
Multi-state cohort study showed umbilical hernia repair before age 4 doubles both recurrence rate and readmission rate.
A 1960s study of African-American children found that very large umbilical hernia defects had lower spontaneous closure rates than smaller defects.
In a Journal of Crohn's and Colitis multicenter study, appendectomy in patients with refractory ulcerative colitis resulted in sustained symptomatic improvement in 30%, pathologic improvement in 50%, and complete endoscopic remission in 17%.
In a Pediatric Surgery International retrospective of 24 penile necrosis cases after circumcision, monopolar electrocautery use was identified as the primary predictive factor.
Other predictive factors for penile necrosis after circumcision include post-circumcision infection, compartment syndrome, local anesthetic agent use, and methemoglobinemia.
The Gips procedure for pilonidal disease involves coring out pits with a trephine, extracting granulation tissue and hair, curettage, and flushing, with wounds left open and unpacked.
Volumetric chest CT for suspected airway foreign body has nearly 100% sensitivity and can detect radiolucent foreign bodies.
Modern pediatric CT scans deliver radiation equivalent to approximately 1 to 10 millisieverts, comparable to natural background radiation exposure over one year.
In a 133-patient series using CT triage for suspected airway foreign bodies, CT excluded foreign body in 30% of patients, avoiding unnecessary bronchoscopy.
When CT showed a foreign body, bronchoscopy confirmed findings in 94% of cases, compared to 61% yield with bronchoscopy alone without CT.
Repeat contrast enema after initial intussusception reduction failure that reached the cecum succeeds in 50% to 64% of cases.
The ATOMIC data from eight children's hospitals showed that pediatric trauma patients do better with earlier blood transfusion after only one crystalloid bolus, rather than the traditional two-bolus approach.
In pediatric trauma, total transfusion of 40 cc/kg of blood or 4 units is a strong predictor that non-operative management will fail and the patient should go to the operating room.
For stable pediatric solid organ injury patients who never require blood transfusion, hospital discharge can occur as early as the next day.
Kansas City study of 622 central venous catheters showed that obtaining chest radiographs only for symptomatic patients is safe, with no critically ill patients and only one requiring intervention.
In an RCT of glycopyrrolate for esophageal anastomotic leaks after EA repair, the treatment group had 76% leak resolution vs 29% in placebo, with chest tube output of 124 mL vs 370 mL.
Glycopyrrolate treatment enabled oral feeding in 71% of esophageal anastomotic leak patients compared to only 14% in the placebo group.
Riley Hospital environmental study found cloth skull caps had the lowest permeability and lowest microbial shedding in the surgical field.
Disposable bouffant caps had the highest particle and microbial shedding onto the surgical field of all three headgear types tested.