Chapter 1 of 10 · Emerging & Future Directions
Gastric stimulation
Introduction and Gastric Stimulation for Gastroparesis
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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
Gastric stimulation reduces symptoms of gastroparesis in pediatric patients with persistent nausea and vomiting that does not respond to medical therapy
Temporary gastric stimulating test can be performed endoscopically before permanent implantation
High thoracoscopic sympathectomy extending to the lower stellate ganglion can shut off arrhythmias in patients with CPVT and hypertrophic cardiomyopathy who have ICDs
Partial resection of the stellate ganglion should be performed using clips and scissors, avoiding electric cautery to prevent Horner's syndrome
Sympathectomy provides 100% compliance as patients cannot skip the treatment once performed
The youngest patient to receive diaphragm pacing implantation was one year of age
Diaphragm pacing can only be used if the phrenic nerve and phrenic motor neurons are intact
Biologic mesh is not good for bridging a gap in abdominal wall reconstruction and is only a temporary solution or reinforcement
The best mesh for abdominal wall reconstruction is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in a retromuscular space
Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation
Gastroesophageal disconnection may be appropriate as a primary upfront repair for patients at high risk for fundoplication failure
Laparoscopic gastroesophageal disconnection can take 6 to 8 hours to complete
Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection
A patient with only abdominal pain after blunt trauma has approximately 5% risk of abdominal injury and almost 0% chance of needing intervention
A child with abnormal physical exam findings such as handlebar injury has about 15% chance of abdominal injury
The low-risk group for abdominal trauma (55% of population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention
Patients without abdominal wall trauma, tenderness or distention, normal chest X-ray, no abdominal pain complaints, normal AST, and no abnormal pancreatic enzymes probably do not need CT scan and can be sent home
The grade of solid organ injury is falling by the wayside in favor of clinical predictive factors
Patients who receive 20 cc/kg crystalloid and do not respond should receive 10-20 cc/kg bolus of blood
If a patient's hemoglobin drops below 7 and they need further blood totaling 40 cc/kg, they probably need to go to the operating room
Transfusion with 40 cc/kg of blood or 4 units is an indication of failure of non-operative management and the patient should go to the operating room
Stable solid organ injury patients can be admitted to the floor with vitals every 2-4 hours and hemoglobin check at 6 hours, and can go home the next day if they never needed blood
Chest CT for suspected airway foreign body has nearly 100% sensitivity and can detect both radiolucent and radiopaque foreign bodies
Using chest CT for suspected airway foreign bodies will eliminate many unnecessary bronchoscopies
Oral contrast is not needed for suspected bowel obstruction as fluid serves as the contrast agent
Patients with unsuccessful intussusception reduction should get a repeat attempt as long as there is some movement
The average range of radiation from a pediatric CT scan is 1-10 millisieverts, equivalent to living on Earth for one year
For pyloric stenosis resuscitation: if chloride is less than 85, give 3 boluses of fluid; if less than 97, give 2 boluses; if greater than 97 but bicarbonate less than 33, give 1 bolus
Patients with traumatic or non-traumatic pneumomediastinum probably do not need any imaging beyond chest X-ray
In a study of 42 TEF leak patients randomized to glycopyrrolate vs placebo, the treatment group had 124 mL chest tube output vs 370 mL in placebo, and 76% leak resolution vs 29% in placebo
The minimally invasive pilonidal procedure involves coring out pits with a trephine, removing granulation tissue and hair with a mosquito, curettage with a smaller trephine, and flushing with saline then hydrogen peroxide, leaving wounds unpacked and unsutured
For incomplete fissure during lobectomy, use a sealing device to go layer by layer until structures are identified
Contralateral main stem intubation is the best and easiest technique for single lung ventilation during thoracoscopic lobectomy
For thoracoscopic lobectomy, the scope should be placed anterior to the tip of the scapula at the mid-axillary line, not posterior, to avoid working in paradox
When sealing blood vessels during thoracoscopic lobectomy, use a sealer (not seal-divider) to seal proximally and distally, make a small nick between seals to verify complete sealing, then complete the cut