# Gastroparesis — GCMD Library living collection

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

Updated: n/a · 6 episodes · 97 cited statements

## Episodes
### Fundamentals
- [The invention of the PEG tube with Dr. Jeffrey Ponsky](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689) — podcast · 33:47 · [machine version](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689.md)

### Surgical Management
- [Gastric Neurostimulators: Update Course 2017](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410) — video · 35:22 · [machine version](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410.md)

### Evidence & Research
- [Top Ten Things to Remember from the 2017 Stay Current Annual Update Course...](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400) — podcast · 25:04 · [machine version](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400.md)
- [Top Ten Things to Remember: Update Course 2017](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401) — video · 25:04 · [machine version](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401.md)

### In-Depth Reviews
- [Top Ten Things to Remember: Update Course 2017](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486) — podcast · 25:04 · [machine version](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486.md)
- [Meet the Master: Jeffrey L. Ponsky, MD, FACS](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683) — video · 1:05:06 · [machine version](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) Introduction and Updates 10-9: Gastric Stimulation and Cardiac Sympathectomy (Ep 1)
- [3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) Updates 8-6: Diaphragm Pacing, Abdominal Wall Reconstruction, and Gastroesophageal Disconnection (Ep 1)
- [7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) Updates 5-4: Blunt Abdominal Trauma CT Criteria and ATOMAC Solid Organ Protocol (Ep 1)
- [13:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) Update 3: Radiology Advances - Volumetric CT and Contrast Use (Ep 1)
- [18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080) Update 2: Top Three Journal of Pediatric Surgery Papers (Ep 1)
- [21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260) Update 1: Minimally Invasive Pilonidal Disease Treatment (Ep 1)
- [22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) Thoracoscopic Lobectomy Technique with Steven Rothenberg (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0) Introduction and Topic #10: Gastric Stimulation (Ep 2)
- [2:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=120) Topic #9: Cardiac Sympathectomy for Arrhythmia (Ep 2)
- [6:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=360) Topic #8: Diaphragm Pacing (Ep 2)
- [8:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480) Topic #7: Abdominal Wall Reconstruction (Ep 2)
- [11:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660) Topic #6: Gastroesophageal Disconnection (Ep 2)
- [14:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840) Topic #5: CT Imaging for Blunt Abdominal Trauma (Ep 2)
- [17:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) Topic #4: ATOMAC Solid Organ Injury Protocol (Ep 2)
- [21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260) Topic #3: Radiology Updates - Foreign Body CT, Oral Contrast, Intussusception (Ep 2)
- [24:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) Topic #2: Top Three Journal of Pediatric Surgery Papers (Ep 2)
- [25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504) Topic #1: Minimally Invasive Pilonidal Disease Treatment (Ep 2)
- [25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504) Bonus: Thoracoscopic Lobectomy Technique with Dr. Rothenberg (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=0) Case 1: 17-year-old with autoimmune gastroparesis—workup and treatment decision (Ep 3)
- [5:27](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=327) Gastric stimulation mechanism and temporary trial rationale (Ep 3)
- [14:24](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=864) Stimulation parameters and device implantation technique (Ep 3)
- [21:56](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1316) Case 2: Post-Nissen wretching in neurologically impaired child (Ep 3)
- [28:45](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1725) Trial duration, placebo effect, and mechanism of action (Ep 3)
- [33:44](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2024) Safety, insurance coverage, and institutional experience (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=0) Introduction and Gastric Stimulation for Gastroparesis (Ep 4)
- [3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=180) Cardiac Sympathectomy for Arrhythmia Prevention (Ep 4)
- [7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=420) Diaphragm Pacing for Ventilator Dependence (Ep 4)
- [9:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=540) Abdominal Wall Reconstruction and Mesh Selection (Ep 4)
- [12:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=720) Gastroesophageal Disconnection for Failed Fundoplication (Ep 4)
- [15:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=900) CT Decision Rules for Blunt Abdominal Trauma (Ep 4)
- [18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1080) ATOMAC Solid Organ Injury Protocol (Ep 4)
- [22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320) Radiology Updates: CT for Foreign Body, Eliminating Oral Contrast (Ep 4)
- [26:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1560) Top Journal Articles: Pyloric Stenosis Resuscitation, Pneumomediastinum, TEF Leak Management (Ep 4)
- [25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504) Minimally Invasive Pilonidal Disease Treatment (Ep 4)
- [25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504) Thoracoscopic Lobectomy Technique Pearls (Ep 4)
- [0:08](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=8) Early Life and Path to Surgery (Ep 5)
- [3:38](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=218) Entry into Endoscopy and the Scope in the Trunk (Ep 5)
- [10:40](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=640) Invention of PEG and Early Academic Career (Ep 5)
- [22:07](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1327) Mount Sinai Years and Academic Philosophy (Ep 5)
- [28:13](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1693) Leadership in ASGE and SAGES (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Gastric emptying scan showing 90% retention at 2 hours indicates severe gastroparesis. — Ronaldo (clinical) [Ep 3 · 3:54](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=234)
- The stomach's intrinsic pacemaker (interstitial cells of Cajal) generates electrical activity at 3 cycles per minute, 20–40 millivolts. — Ronaldo (clinical) [Ep 3 · 14:49](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=889)
- Gastric electrical activity sets the pace for contractions but does not initiate them; a stomach with 3 waves/min cannot contract more than 3 times/min. — Ronaldo (clinical) [Ep 3 · 15:50](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=950)
- Gastric stimulation uses low voltage (≤7V) and low current (≤10 mA) to reorganize gastric electrical conductivity, not to directly pace the stomach. — Ronaldo (clinical) [Ep 3 · 17:15](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1035)
- Temporary gastric stimulation can be performed via nasal leads (cardiac pacing wires clipped endoscopically) or via G-tube using fetal scalp electrodes. — Ronaldo (clinical) [Ep 3 · 26:25](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1585)
- Approximately 30% of patients do not respond to permanent gastric stimulation; temporary trial predicts response. — Todd Ponsky (clinical) [Ep 3 · 19:51](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1191)
- Post-Nissen wretching in patients with intact fundoplication and delayed gastric emptying may respond to gastric stimulation. — Todd Ponsky (clinical) [Ep 3 · 11:42](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=702)
- Performing Nissen fundoplication in a chronic vomiter may convert vomiting to wretching if gastroparesis is present. — Todd Ponsky (clinical) [Ep 3 · 11:59](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=719)
- Temporary gastric stimulation trials should last more than 2–3 days to distinguish placebo effect from true response. — Todd Ponsky (clinical) [Ep 3 · 29:25](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1765)
- Gastric stimulation likely works via vagal afferent modulation affecting brainstem nausea centers, not by improving gastric emptying. — Ronaldo (opinion) [Ep 3 · 32:18](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1938)
- Adult studies have not shown significant improvement in gastric emptying with gastric stimulation. — Todd Ponsky (clinical) [Ep 3 · 32:42](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1962)
- Patients reliably report symptom recurrence when gastric stimulator batteries fail. — Ronaldo (clinical) [Ep 3 · 31:31](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1891)
- Laparoscopic gastric stimulator implantation takes approximately 5 minutes in experienced hands. — Ronaldo (clinical) [Ep 3 · 21:56](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1316)
- Stimulation parameters: 14 Hz frequency, on 3 seconds / off 2 seconds, ≤10 mA current, ≤7V voltage. — Ronaldo (clinical) [Ep 3 · 20:25](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1225)
- Some patients feel transient sensation ("butterflies") when stimulator settings are changed, but most adapt within 1–2 days. — Todd Ponsky (clinical) [Ep 3 · 18:18](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1098)
- The implantable pulse generator (anode) can cause sensation if placed too close to the dermis, especially in thin children with little subcutaneous fat. — Ronaldo (clinical) [Ep 3 · 18:45](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1125)
- Jejunal feeding is not a long-term solution for gastroparesis; it is a diagnostic test to assess symptom response to bypassing the stomach. — Todd Ponsky (opinion) [Ep 3 · 7:23](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=443)
- Performing Nissen fundoplication often improves delayed gastric emptying in pediatric patients. — Todd Ponsky (clinical) [Ep 3 · 10:43](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=643)
- Post-Nissen wretching is the most exciting outcome for gastric stimulation, with dramatic symptom relief. — Todd Ponsky (opinion) [Ep 3 · 11:42](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=702)
- Performing fundoplication for nausea alone (without reflux) is the wrong operation. — Todd Ponsky (opinion) [Ep 3 · 11:47](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=707)
- Peroral pyloromyotomy (endoscopic) is now used in adults for gastroparesis and may change management, though pediatric experience is limited. (clinical) [Ep 3 · 13:00](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=780)
- Pediatric insurance denials for gastric stimulation are rare, unlike in adult populations. — Todd Ponsky (clinical) [Ep 3 · 34:29](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2069)
- No patients who responded to temporary stimulation failed permanent implantation at the presenters' institution. — Ronaldo (clinical) [Ep 3 · 34:29](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2069)
- Some patients have initial response to gastric stimulation but experience symptom recurrence long-term, possibly due to psychosocial or other factors. — David (clinical) [Ep 3 · 30:40](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1840)
- Gastric stimulation for obesity has passed FDA trials and is approved in Europe. — Ronaldo (clinical) [Ep 3 · 33:28](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2008)
- In 1973, Dr. Ponsky was refused endoscopy training by Case Western Reserve's gastroenterology department, with the chief stating 'we're not going to train a surgeon to do endoscopy.' — Jeffrey L. Ponsky (clinical) [Ep 5 · 4:49](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=289)
- Dr. Ponsky performed approximately 500 endoscopies during a 4-6 month fellowship with Jim King in Canton, Ohio in 1974. — Jeffrey L. Ponsky (clinical) [Ep 5 · 6:06](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=366)
- Early endoscopy disinfection consisted of washing scopes with green soap and hanging them to dry, without gloves even for colonoscopy, and without high-level disinfection or washing machines. — Jeffrey L. Ponsky (clinical) [Ep 5 · 10:04](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=604)
- Dr. Ponsky published the first report of endoscopic tattooing with India ink in 1975 to mark colonic lesions for surgical localization. — Jeffrey L. Ponsky (clinical) [Ep 5 · 29:06](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1746)
- Percutaneous endoscopic gastrostomy (PEG) was developed by Dr. Ponsky and Michael Gower in May 1979, with the first 5 cases performed in infants at Rainbow Babies and Children's Hospital. — Jeffrey L. Ponsky (clinical) [Ep 5 · 15:27](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=927)
- The first adult PEG procedures were performed at Mount Sinai Hospital shortly after the initial pediatric cases in 1979. — Jeffrey L. Ponsky (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=940)
- PEG was presented at the ASGE plenary session in Salt Lake City in 1980, where Peter Cotton stated 'I'm only sorry that I didn't think of this.' — Jeffrey L. Ponsky (opinion) [Ep 5 · 16:01](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=961)
- Transillumination in infants was critical to PEG development because the light shone through the thin abdominal wall, allowing visualization of stomach apposition to the abdominal wall. — Jeffrey L. Ponsky (clinical) [Ep 5 · 17:20](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1040)
- Early PEG tubes were fashioned from Pezzer catheters with Bunsen burner tubing as bolsters and medicut IV catheters as dilators. — Jeffrey L. Ponsky (clinical) [Ep 5 · 18:02](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1082)
- The technique of stretching the rubber tube to make it thinner for easier insertion through the dilating catheter was discovered by accident while walking down a hospital hallway. — Jeffrey L. Ponsky (clinical) [Ep 5 · 18:38](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1118)
- Using a snare around the puncturing needle to grasp the suture proved more reliable than attempting to grab it with biopsy forceps during PEG placement. — Jeffrey L. Ponsky (clinical) [Ep 5 · 19:08](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1148)
- The concept underlying PEG is affixing a loop of bowel to the abdominal wall and creating a permanent tract, which can be applied to various anatomic sites including stomach, jejunum, and cecum. — Jeffrey L. Ponsky (clinical) [Ep 5 · 20:53](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1253)
- Dr. Ponsky published cecostomy using the PEG technique for Ogilvie syndrome in 1984. — Jeffrey L. Ponsky (clinical) [Ep 5 · 21:16](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1276)
- SAGES membership grew from 300 members when Dr. Ponsky became president in 1990 to 2,000 members by the end of his tenure, driven by the laparoscopic cholecystectomy revolution. — Jeffrey L. Ponsky (epidemiological) [Ep 5 · 32:48](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1968)
- Jacques Perrisat showed the first video of laparoscopic cholecystectomy at the SAGES meeting in Louisville, Kentucky in 1989. — Jeffrey L. Ponsky (clinical) [Ep 5 · 32:24](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1944)
- ASGE operates as a meritocracy requiring members to work through committees (membership, governing board, treasurer) over approximately 20 years before becoming president. — Jeffrey L. Ponsky (opinion) [Ep 5 · 33:18](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1998)
- Dr. Ponsky was the second surgeon to serve as ASGE president, after Ted Schrock. — Jeffrey L. Ponsky (clinical) [Ep 5 · 34:02](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2042)
- The Schindler Award from ASGE in 2002 was the most prestigious award in Dr. Ponsky's career because it represented recognition by gastroenterologists as an endoscopist who made significant contributions. — Jeffrey L. Ponsky (opinion) [Ep 5 · 34:11](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2051)
- The concept of NOTES originated from a laparoscopic surgeon performing needlescopic cholecystectomy who removed the gallbladder through a gastrotomy, though this was never published. — Jeffrey L. Ponsky (clinical) [Ep 5 · 36:23](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2183)
- Tony Kalloo and Sergei Kantsevoy at Johns Hopkins published animal cases of transgastric surgery using the Eagle Claw device with the Apollo Group in 2004. — Jeffrey L. Ponsky (clinical) [Ep 5 · 37:03](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2223)
- Reddy and Rao in India performed the first transgastric appendectomy and showed the video but never published the work. — Jeffrey L. Ponsky (clinical) [Ep 5 · 37:23](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2243)
- NOSCAR (Natural Orifice Surgery Consortium for Assessment and Research) was formed by surgeons and gastroenterologists doing NOTES research, with the acronym conceived by Nathaniel Soper over wine. — Jeffrey L. Ponsky (clinical) [Ep 5 · 38:24](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2304)
- PEG rescue—accessing the peritoneal cavity through a dislodged PEG tract to place a new tube—was the first NOTES procedure performed in humans in the United States under IRB protocol. — Jeffrey L. Ponsky (clinical) [Ep 5 · 38:50](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2330)
- POEM (peroral endoscopic myotomy) was first performed in humans by Haruhiro Inoue in Yokohama around 2007, though the tunneling concept was conceived earlier at IRCAD in France during the NOTES era. — Jeffrey L. Ponsky (clinical) [Ep 5 · 53:24](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3204)
- Eric Hungness at Northwestern taught Dr. Ponsky and Jeff Marks the POEM technique in the lab, then proctored their first 2 human cases approximately 7 years ago (circa 2012). — Jeffrey L. Ponsky (clinical) [Ep 5 · 54:17](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3257)
- Patients undergoing POEM report life-changing improvement, with many stating 'you changed my life' at follow-up. — Jeffrey L. Ponsky (clinical) [Ep 5 · 54:42](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3282)
- Peroral pyloromyotomy (POP) via a lesser-curve tunnel 25 cm in length has been performed in over 300 cases at Cleveland Clinic. — Jeffrey L. Ponsky (clinical) [Ep 5 · 55:15](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3315)
- Two-thirds to three-quarters of patients undergoing POP show improved or normalized gastric emptying. — Jeffrey L. Ponsky (clinical) [Ep 5 · 55:37](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3337)
- POP is essentially an outpatient procedure that does not cause significant harm. — Jeffrey L. Ponsky (clinical) [Ep 5 · 55:45](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3345)
- Intramural tunneling can be used to resect stromal tumors and leiomyomas of the esophagus and stomach. — Jeffrey L. Ponsky (clinical) [Ep 5 · 55:49](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3349)
- Zenker's diverticulotomy using a double-sided submucosal tunnel approach allows complete myotomy with mucosal closure using clips, enabling same-day discharge. — Jeffrey L. Ponsky (clinical) [Ep 5 · 56:22](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3382)
- Robotic endoscopic platforms will enable surgical techniques including tissue manipulation, knot-tying, and full-thickness resection from a console, similar to robotic surgery. — Jeffrey L. Ponsky (opinion) [Ep 5 · 57:21](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3441)
- A step trocar (radially expanding surgical trocar) can be used through a PEG tract to place a large-bore gastrostomy tube when the esophagus is too stenotic to allow standard PEG tube passage. — Jeffrey L. Ponsky (clinical) [Ep 5 · 58:45](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3525)
- Surgeons interested in making endoscopy a major part of their career should complete a fellowship in advanced endoscopy to ensure their credentials cannot be challenged. — Jeffrey L. Ponsky (opinion) [Ep 5 · 61:00](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3660)
- At age 72, Dr. Ponsky performs approximately 1,200 endoscopies annually at Cleveland Clinic, working at multiple sites including monthly trips to Florida. — Jeffrey L. Ponsky (clinical) [Ep 5 · 51:15](https://origin-library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3075)
- In the late 1970s, surgical residents were on call every other night (36 hours on, 12 hours off) for five years of training. — Jeffrey Ponsky (clinical) [Ep 6 · 15:31](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=931)
- In 1974-1975, there were no pediatric gastroenterologists, and Ponsky performed endoscopy on children, young adults, and neonates with GI problems using his personally owned scope. — Jeffrey Ponsky (clinical) [Ep 6 · 3:27](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=207)
- During neonatal endoscopy, the room would light up because babies were so thin; when pediatric surgeon Michael Gower pushed on the transilluminated light with his finger, an indentation was visible endoscopically. — Jeffrey Ponsky (clinical) [Ep 6 · 4:33](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=273)
- The first PEG tubes were constructed from OR gastrostomy tubes (small Pezzer catheters) with sutures threaded through the end and passed through an IV catheter (medicut) to create a dilator tip. — Jeffrey Ponsky (clinical) [Ep 6 · 4:59](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=299)
- The first five PEG procedures in May 1979 were performed in neonates with severe psychomotor retardation who were brain dead, fed by nasogastric tubes, had no chance of recovery, and were being sent for open gastrostomy before long-term nursing facility placement. — Jeffrey Ponsky (clinical) [Ep 6 · 5:42](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=342)
- Informed consent for the first PEG cases consisted of telling mothers that if the new technique failed, immediate laparotomy and open gastrostomy would be performed. — Jeffrey Ponsky (clinical) [Ep 6 · 6:25](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=385)
- The first PEG procedures succeeded easily within a few minutes. — Jeffrey Ponsky (clinical) [Ep 6 · 6:42](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=402)
- After the initial five neonatal cases, Ponsky moved to Mount Sinai Medical Center and began performing PEG in adult stroke patients with similar neurologic prognosis who needed feeding access. — Jeffrey Ponsky (clinical) [Ep 6 · 6:47](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=407)
- Laboratory studies on PEG tract formation, tube dwell time before safe replacement, and leakage risk were conducted after clinical implementation—the reverse of typical research-then-clinical sequence. — Jeffrey Ponsky (clinical) [Ep 6 · 7:13](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=433)
- John Mellinger, who later worked at the American Board of Surgery, conducted original research on PEG tract formation. — Jeffrey Ponsky (clinical) [Ep 6 · 7:28](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=448)
- Multiple medical device companies refused to manufacture the PEG tube initially, believing nobody would use it. — Jeffrey Ponsky (clinical) [Ep 6 · 8:39](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=519)
- A small company in Mentor, Ohio eventually manufactured the PEG tube exactly as designed by Ponsky and Gower. — Jeffrey Ponsky (clinical) [Ep 6 · 8:54](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=534)
- Ponsky and Gower never patented the PEG tube; they were more interested in publication than patents and wanted to disseminate the technique. — Jeffrey Ponsky (opinion) [Ep 6 · 9:06](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=546)
- PEG tube complications included rare colonic perforation when the tube traversed the colon en route to the stomach, which still occurs rarely today. — Jeffrey Ponsky (clinical) [Ep 6 · 9:39](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=579)
- Exit-site infection was a major early PEG complication. — Jeffrey Ponsky (clinical) [Ep 6 · 9:51](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=591)
- PEG tubes evolved from multi-piece rubber construction to one-piece silicone, but have had very few modifications in the last few years and have become a commodity product purchased by hospitals at the lowest price. — Jeffrey Ponsky (clinical) [Ep 6 · 10:24](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=624)
- The PEG technique has remained very much the same as the original with only a few modifications. — Jeffrey Ponsky (clinical) [Ep 6 · 10:50](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=650)
- Ponsky and the manufacturing company conducted dozens of animal experiments to determine tube removal pressure, tip retention, and optimal tube size for FDA approval. — Jeffrey Ponsky (clinical) [Ep 6 · 11:19](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=679)
- In 1975, Ponsky developed and published endoscopic tattooing using India ink injected alongside polypectomy sites to mark the location for potential surgical resection if cancer was found; the technique remains in use today. — Jeffrey Ponsky (clinical) [Ep 6 · 12:55](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=775)
- The PEG tube was the first and only time any instrument or needle was thrust through the abdominal wall into the GI tract and left in place. — Jeffrey Ponsky (clinical) [Ep 6 · 12:13](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=733)
- In the mid-1970s, the predominant American endoscope was the ACMI (American Cystoscope Makers Incorporated) with a joystick control, approximately 1 cm diameter, with image quality like looking through ground glass. — Jeffrey Ponsky (clinical) [Ep 6 · 17:35](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1055)
- Japanese companies (Mashida and Olympus in the US) produced fiber-optic endoscopes with crystal-clear optics that were markedly superior to American models. — Jeffrey Ponsky (clinical) [Ep 6 · 18:03](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1083)
- 1970s fiber-optic endoscopes transmitted light via fiber bundles to the lumen and returned images to the eyepiece; photography required clipping a camera to the eyepiece for film-strip images. — Jeffrey Ponsky (clinical) [Ep 6 · 18:26](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1106)
- Teaching attachments for 1970s endoscopes consisted of a wire-connected second eyepiece that provided a dim image for trainees in darkened rooms. — Jeffrey Ponsky (clinical) [Ep 6 · 18:51](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1131)
- Around 1980, video chip technology placed a camera at the endoscope tip instead of using fiber-optic image transmission, displaying images on large monitors—the technology used in current endoscopes. — Jeffrey Ponsky (clinical) [Ep 6 · 19:06](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1146)
- In the late 1970s, neonates could tolerate endoscopes approximately 9 millimeters wide, which was the limit for safe use. — Jeffrey Ponsky (clinical) [Ep 6 · 19:36](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1176)
- The original PEG procedure was performed with an adult endoscope. — Jeffrey Ponsky (clinical) [Ep 6 · 19:57](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1197)
- In the 1970s, endoscopes were cleaned between procedures using only green soap; high-level disinfection and sterilization protocols did not yet exist. — Jeffrey Ponsky (clinical) [Ep 6 · 20:56](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1256)
- The PEG tube received FDA 510(k) approval as a modification of existing gastrostomy tubes used for similar purposes, which is easier than approval for entirely novel devices. — Jeffrey Ponsky (clinical) [Ep 6 · 21:45](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1305)
- PEG indications expanded beyond feeding to include gastric decompression in gastroparesis or obstruction (including carcinomatosis), delivery of unpalatable feedings, and treatment of gastric volvulus. — Jeffrey Ponsky (clinical) [Ep 6 · 22:17](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1337)
- The PEG technique was adapted for colonic applications including sigmoid volvulus fixation and Ogilvie syndrome decompression, with multiple PEGs used for sigmoid volvulus. — Jeffrey Ponsky (clinical) [Ep 6 · 23:00](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1380)
- Many endoscopic procedures developed by surgeons, including PEG, were extensions of surgical operations already performed via laparotomy. — Jeffrey Ponsky (opinion) [Ep 6 · 23:56](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1436)
- Gastroenterologists rapidly adopted PEG as a therapeutic procedure they could easily accomplish, driving widespread dissemination. — Jeffrey Ponsky (clinical) [Ep 6 · 25:32](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1532)
- Surgeons were slower to adopt PEG initially because they were not performing as much therapeutic endoscopy at that time, but they did not offer significant resistance. — Jeffrey Ponsky (clinical) [Ep 6 · 25:56](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1556)
- A properly performed PEG procedure takes under 5 minutes when done carefully by an experienced operator. — Jeffrey Ponsky (clinical) [Ep 6 · 26:40](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1600)
- Current PEG procedures still require patient sedation or anesthesia and constitute an intervention. — Jeffrey Ponsky (clinical) [Ep 6 · 26:47](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1607)
- Radiologists perform gastrostomy tube placement using ultrasound guidance, though Ponsky does not prefer the tubes they use. — Jeffrey Ponsky (opinion) [Ep 6 · 27:43](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1663)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Gastric stimulation for pediatric gastroparesis can be tested temporarily via endoscopic placement before permanent laparoscopic or open implantation — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Reynaldo Garcia from Akron Children's Hospital presented gastric stimulation results showing significant symptom improvement in patients with persistent nausea and vomiting unresponsive to medical therapy — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Cardiac sympathectomy for CPVT (catecholaminergic polymorphic ventricular tachycardia) and hypertrophic cardiomyopathy involves high thoracoscopic approach to the lower stellate ganglion to prevent fatal arrhythmias — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Sophia Abdulhai and John Clark presented cardiac sympathectomy technique using clips and scissors for partial stellate ganglion resection, avoiding electrocautery to prevent Horner's syndrome — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Sympathectomy provides 100% compliance for arrhythmia management as patients cannot skip the intervention once performed — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Ray Anders from University Hospitals of Cleveland demonstrated diaphragm pacing for spinal cord injury, transverse myelitis, acute flaccid myelitis, and brain stem tumors, with youngest implant at one year of age — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Diaphragm pacing requires intact phrenic nerve and motor neurons; diaphragm contraction with neurostimulation must be confirmed before implantation — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Dave Carpata from Cleveland Clinic stated biologic mesh is not appropriate for bridging gaps in ventral hernia repair, only for temporary solution or reinforcement — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- The best mesh for ventral hernia repair is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in retromuscular space — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Retrorectus repair with mesh is superior to laparoscopic underlay for ventral hernia repair — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- David Lanning from Virginia Commonwealth presented gastroesophageal disconnection (esophageal division with Roux-en-Y jejunal interposition) for severe reflux after failed Nissen fundoplication — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Gastroesophageal disconnection may be appropriate as primary repair for high-risk patients predicted to fail fundoplication — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Laparoscopic gastroesophageal disconnection can take 6 to 8 hours — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Patients who took full feeds by mouth preoperatively can continue oral feeding after gastroesophageal disconnection — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Chris Druck published a five-variable prediction rule identifying low-risk population for intra-abdominal injury after blunt trauma to guide CT scan decisions — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients with only abdominal pain after trauma have approximately 5% risk of abdominal injury and nearly 0% chance of requiring intervention — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients with abnormal physical exam findings such as handlebar injury have approximately 15% chance of abdominal injury — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- The low-risk group (55% of trauma population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients without abdominal wall trauma, tenderness or distention, with normal chest X-ray, no abdominal pain complaints, normal AST, and normal pancreatic enzymes probably do not need CT scan and can be sent home — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- The ATOMAC prospective multi-institutional solid organ injury protocol de-emphasizes injury grade in favor of clinical predictive factors — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients with solid organ injury who do not respond to 20 cc/kg crystalloid bolus should receive 10-20 cc/kg blood bolus rather than second crystalloid bolus — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients requiring 40 cc/kg blood (4 units) or with hemoglobin less than 7 after blood transfusion should go to the operating room as this indicates non-operative management failure — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Stable solid organ injury patients can be admitted to the floor with vitals every 2-4 hours and hemoglobin at 6 hours, and discharged the next day if they never required blood transfusion — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Sean Saint Peter's group demonstrated stable solid organ injury patients can be discharged much more quickly than traditional prolonged admissions based on injury grade — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Mike Rubin from Akron Children's Hospital recommends chest CT for suspected airway foreign bodies in unclear cases, with nearly 100% sensitivity for detecting radiolucent and radiopaque foreign bodies — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- CT scan for suspected airway foreign body eliminates unnecessary bronchoscopies in children with respiratory virus symptoms — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Oral contrast is unnecessary for suspected bowel obstruction CT scans as intraluminal fluid serves as adequate contrast — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Eliminating oral contrast speeds up CT acquisition time and prevents nausea and vomiting in bowel obstruction patients — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Unsuccessful intussusception reduction should be reattempted if there is movement to the ileocecal valve, with second attempts mostly successful — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Modern pediatric hospital CT scans deliver 1-10 millisieverts of radiation, equivalent to one year of natural background radiation on Earth — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Dalton's pyloric stenosis resuscitation protocol: chloride less than 85 requires 3 fluid boluses, chloride less than 97 requires 2 boluses, chloride greater than 97 with bicarbonate less than 33 requires 1 bolus — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- Richer's paper showed traumatic or non-traumatic pneumomediastinum requires only chest X-ray without further imaging — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- Vella's randomized trial of 42 patients with post-TEF repair leaks showed glycopyrrolate group had 124 mL chest tube output versus 370 mL in placebo group — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- Glycopyrrolate achieved leak resolution in 76% of treatment group versus 29% of placebo group after TEF repair — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- The Gips procedure for pilonidal disease involves trephine excision of pits, mosquito extraction of granulation tissue and hair, curettage with smaller trephine, and irrigation with saline then peroxide — Todd Ponsky summarizing a resource [Ep 1 · 21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260)
- Pilonidal disease Gips procedure takes 3-5 minutes with no packing, no sutures, no drains, and no activity restrictions except avoiding swimming for 2 weeks — Todd Ponsky summarizing a resource [Ep 1 · 21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260)
- Steven Rothenberg recommends thoracoscopic lobectomy scope placement anterior to scapula tip at mid-axillary line, not posterior, to avoid working in paradox during anterior fissure dissection — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- For thoracoscopic lobectomy vessel division, seal proximally and distally separately, make test incision between seals to confirm hemostasis, then complete division rather than using seal-and-divide device — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- Understanding segmental pulmonary anatomy allows prediction of vessel relationships to bronchus, such as superior segmental artery location above lower lobe bronchus — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- Incomplete fissure during thoracoscopic lobectomy should be managed by layer-by-layer sealing like finger fracture technique until structures are identified — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- Contralateral main stem intubation is the best and easiest technique for single lung ventilation during thoracoscopic lobectomy, superior to double lumen tube, bronchial blocker, or CO2 collapse — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- Tom Abel's blinded crossover study showed 100% of patients improved on day 1 (placebo effect), but by day 3 only the stimulation-on group sustained benefit. — Todd Ponsky summarizing the discussion [Ep 3 · 29:25](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1765)
- Tom Abel demonstrated more coordinated gastric electrical waves after stimulation. — Ronaldo summarizing the discussion [Ep 3 · 32:52](https://origin-library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1972)
- Gastric stimulation is now being used in children with persistent gastroparesis who do not respond to medical therapy. — Todd Ponsky summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0)
- Patients can receive a temporary endoscopic gastric stimulating test, and if symptoms improve, they can proceed to permanent laparoscopic or open gastric stimulator placement. — Todd Ponsky summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0)
- Thoracoscopic sympathectomy extending to the lower stellate ganglion can reduce arrhythmias in patients with CPVT (catecholaminergic polymorphic ventricular tachycardia) and hypertrophic cardiomyopathy who have ICDs. — Todd Ponsky summarizing a resource [Ep 2 · 2:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=120)
- Partial resection of the stellate ganglion should be performed using clips and scissors; electric cautery should be avoided as it may damage the remaining ganglion and cause Horner's syndrome. — Todd Ponsky summarizing a resource [Ep 2 · 2:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=120)
- Sympathectomy provides 100% compliance as an intervention because once performed, the effect cannot be reversed or skipped like medication. — Todd Ponsky summarizing a resource [Ep 2 · 2:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=120)
- Diaphragm pacing is a reasonable option for children with spinal cord injury, transverse myelitis, acute flaccid myelitis, or brain stem tumors, with the youngest implant performed at one year of age. — Todd Ponsky summarizing a resource [Ep 2 · 6:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=360)
- Diaphragm pacing requires an intact phrenic nerve and phrenic motor neurons; diaphragm contraction with neurostimulation must be verified prior to implantation. — Todd Ponsky summarizing a resource [Ep 2 · 6:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=360)
- Biologic mesh is not appropriate for bridging gaps in abdominal wall reconstruction; it is only a temporary solution or reinforcement. — Todd Ponsky summarizing a resource [Ep 2 · 8:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480)
- The best mesh for abdominal wall reconstruction is macroporous monofilament, lightweight polypropylene synthetic mesh such as Marlex, which performs well even in contaminated fields when placed in the retromuscular space. — Todd Ponsky summarizing a resource [Ep 2 · 8:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480)
- Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation. — Todd Ponsky summarizing a resource [Ep 2 · 8:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480)
- The current best repair for ventral hernias is retro-rectus repair with mesh, not laparoscopic underlay. — Todd Ponsky summarizing a resource [Ep 2 · 8:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=480)
- Gastroesophageal disconnection with Roux-en-Y esophagojejunostomy is effective for children with severe reflux who have failed Nissen fundoplication. — Todd Ponsky summarizing a resource [Ep 2 · 11:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660)
- Gastroesophageal disconnection may be considered as a primary repair in patients thought to be at high risk for fundoplication failure. — Todd Ponsky summarizing a resource [Ep 2 · 11:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660)
- Laparoscopic gastroesophageal disconnection can be a long and difficult operation, taking 6 to 8 hours. — Todd Ponsky summarizing a resource [Ep 2 · 11:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660)
- Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection. — Todd Ponsky summarizing a resource [Ep 2 · 11:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=660)
- A five-variable prediction rule can identify children at low risk for intra-abdominal injury after blunt trauma: abdominal pain, physical exam findings, chest X-ray, AST level, and pancreatic enzymes. — Todd Ponsky summarizing a resource [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- Children with only abdominal pain after trauma have approximately 5% risk of abdominal injury and almost 0% chance of needing intervention. — Todd Ponsky summarizing a resource [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- Children with abnormal physical exam findings such as handlebar injury have about 15% chance of abdominal injury. — Todd Ponsky summarizing a resource [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- A low-risk group comprising 55% of trauma patients has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention. — Todd Ponsky summarizing a resource [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- Children with no abdominal wall trauma, tenderness or distention, normal chest X-ray, no abdominal pain complaints, normal AST, and normal pancreatic enzymes probably do not need CT scan and can be sent home. — Todd Ponsky summarizing a resource [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=840)
- In the ATOMAC solid organ injury protocol, injury grade is de-emphasized in favor of clinical predictive factors. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Patients who do not respond to initial 20cc/kg crystalloid bolus should receive 10-20cc/kg blood bolus rather than additional crystalloid. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Patients requiring 40cc/kg total blood transfusion (4 units) likely cannot be managed non-operatively and should go to the operating room. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Stable solid organ injury patients who never required blood transfusion can be discharged the next day. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Chest CT has nearly 100% sensitivity for airway foreign bodies, including radiolucent objects. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- Using chest CT to screen for airway foreign bodies can eliminate many unnecessary bronchoscopies in children with unclear history. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- Oral contrast is not needed for suspected bowel obstruction; luminal fluid serves as adequate contrast material. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- Eliminating oral contrast speeds up CT acquisition time and prevents nausea and vomiting in patients with bowel obstruction. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- Repeat attempts at intussusception reduction are worthwhile if there is movement all the way to the ileocecal valve. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- Modern pediatric hospital CT scans deliver 1-10 millisieverts of radiation, equivalent to one year of background radiation exposure on Earth. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- For pyloric stenosis resuscitation, if chloride is less than 85, give 3 fluid boluses; if less than 97, give 2 boluses; if greater than 97 but bicarbonate less than 33, give 1 bolus. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- Pneumomediastinum (traumatic or non-traumatic) requires only chest X-ray for imaging; further imaging is not necessary. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- Intravenous glycopyrrolate (Robinol) significantly improves leak closure rates after tracheoesophageal fistula repair: 76% resolution in treatment group versus 29% in placebo group. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- Glycopyrrolate reduces chest tube output in TEF leak patients from 370mL (placebo) to 124mL (treatment). — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- The Gips procedure for pilonidal disease involves coring out pits with trephine, extracting granulation tissue and hair, curettage with smaller trephine, and flushing with saline then hydrogen peroxide, leaving wounds open and unpacked. — Todd Ponsky summarizing a resource [Ep 2 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- The Gips procedure for pilonidal disease is minimally invasive, takes 3-5 minutes, requires no activity restrictions except avoiding swimming for two weeks, and has superior results to traditional approaches. — Todd Ponsky summarizing a resource [Ep 2 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- For thoracoscopic lobectomy, the scope should be positioned anterior to the scapula tip, nearly at the mid-axillary line, directly over the major fissure, not posterior to the scapula. — Todd Ponsky summarizing a resource [Ep 2 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- Placing the thoracoscope posterior to the scapula tip causes the surgeon to look back on themselves when working in the anterior fissure, creating a paradoxical working angle. — Todd Ponsky summarizing a resource [Ep 2 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- When dividing vessels during thoracoscopic lobectomy, use a sealing device (not seal-divider) to seal proximally and distally, make a small nick between seals to verify hemostasis, then complete the division. — Todd Ponsky summarizing a resource [Ep 2 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- Understanding segmental pulmonary anatomy allows prediction of vessel locations and their relationship to bronchi during thoracoscopic lobectomy. — Todd Ponsky summarizing a resource [Ep 2 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- Incomplete fissures during thoracoscopic lobectomy should be approached layer-by-layer with a sealing device until structures are identified. — Todd Ponsky summarizing a resource [Ep 2 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- Contralateral mainstem intubation is the best and easiest technique for single-lung ventilation during thoracoscopic lobectomy. — Todd Ponsky summarizing a resource [Ep 2 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1504)
- Gastric stimulation reduces symptoms of gastroparesis in pediatric patients with persistent nausea and vomiting unresponsive to medical therapy — Todd Ponsky summarizing a resource [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=0)
- Patients can receive temporary endoscopic gastric stimulation testing; if symptoms improve, they can proceed to permanent laparoscopic or open placement — Todd Ponsky summarizing a resource [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=0)
- Thoracoscopic sympathectomy extending to the lower stellate ganglion can reduce arrhythmias in CPVT and hypertrophic cardiomyopathy patients with ICDs — Todd Ponsky summarizing a resource [Ep 4 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=180)
- Partial stellate ganglion resection should use clips and scissors; electric cautery may damage the remaining ganglion and cause Horner's syndrome — Todd Ponsky summarizing a resource [Ep 4 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=180)
- Sympathectomy provides 100% compliance as patients cannot skip the intervention once performed — Todd Ponsky summarizing a resource [Ep 4 · 3:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=180)
- Diaphragm pacing is a reasonable option for pediatric patients with spinal cord injury, transverse myelitis, acute flaccid myelitis, or brain stem tumors who can be weaned from mechanical ventilation — Todd Ponsky summarizing a resource [Ep 4 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=420)
- The youngest patient to receive diaphragm pacing implantation was one year of age — Todd Ponsky summarizing a resource [Ep 4 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=420)
- Diaphragm pacing requires intact phrenic nerve and phrenic motor neurons; diaphragm contraction with neurostimulation must be confirmed prior to implantation — Todd Ponsky summarizing a resource [Ep 4 · 7:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=420)
- Biologic mesh is not appropriate for bridging gaps in ventral hernia repair; it is only a temporary solution or reinforcement — Todd Ponsky summarizing a resource [Ep 4 · 9:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=540)
- Macroporous monofilament lightweight polypropylene synthetic mesh (such as Marlex) is the best mesh for bridging gaps and performs well in contaminated fields in the retromuscular space — Todd Ponsky summarizing a resource [Ep 4 · 9:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=540)
- Retro-rectus repair with mesh is now preferred over laparoscopic underlay for ventral hernia repair — Todd Ponsky summarizing a resource [Ep 4 · 9:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=540)
- Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation — Todd Ponsky summarizing a resource [Ep 4 · 9:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=540)
- Gastroesophageal disconnection (dividing esophagus from stomach and creating Roux-en-Y esophagojejunostomy) has good results for severe reflux after failed Nissen fundoplication — Todd Ponsky summarizing a resource [Ep 4 · 12:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=720)
- Gastroesophageal disconnection may be appropriate as a primary operation for patients at high risk for fundoplication failure — Todd Ponsky summarizing a resource [Ep 4 · 12:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=720)
- Laparoscopic gastroesophageal disconnection can be a long and difficult operation, taking 6 to 8 hours — Todd Ponsky summarizing a resource [Ep 4 · 12:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=720)
- Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection — Todd Ponsky summarizing a resource [Ep 4 · 12:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=720)
- A five-variable prediction rule identifies pediatric blunt abdominal trauma patients at very low risk for intra-abdominal injury who can safely avoid CT imaging — Todd Ponsky summarizing a resource [Ep 4 · 15:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=900)
- Patients with only abdominal pain after blunt trauma have approximately 5% risk of abdominal injury and almost 0% chance of requiring intervention — Todd Ponsky summarizing a resource [Ep 4 · 15:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=900)
- Children with handlebar injury and abnormal abdominal exam findings have approximately 15% chance of abdominal injury — Todd Ponsky summarizing a resource [Ep 4 · 15:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=900)
- The low-risk group (no abdominal pain, normal physical exam, normal chest X-ray, normal AST, no abdominal wall trauma, no abnormal pancreatic enzymes) comprises 55% of the trauma population with less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention — Todd Ponsky summarizing a resource [Ep 4 · 15:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=900)
- In solid organ injury management, injury grade is falling by the wayside in favor of clinical predictive factors — Todd Ponsky summarizing a resource [Ep 4 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1080)
- Patients who receive 20 cc/kg crystalloid and do not respond should receive 10-20 cc/kg bolus of blood rather than additional crystalloid — Todd Ponsky summarizing a resource [Ep 4 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1080)
- If hemoglobin drops below 7 and total blood transfusion reaches 40 cc/kg (4 units), the patient likely cannot be managed non-operatively and should go to the operating room — Todd Ponsky summarizing a resource [Ep 4 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1080)
- 40 cc/kg of blood or 4 units of blood is the magic number indicating probable failure of non-operative management — Todd Ponsky summarizing a resource [Ep 4 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1080)
- Stable solid organ injury patients who never require blood transfusion can be discharged the next day — Todd Ponsky summarizing a resource [Ep 4 · 18:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1080)
- Chest CT has almost 100% sensitivity for airway foreign body detection, including radiolucent objects — Todd Ponsky summarizing a resource [Ep 4 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320)
- Using chest CT for suspected airway foreign bodies can eliminate unnecessary bronchoscopies in children with unclear history who may have respiratory viral illness — Todd Ponsky summarizing a resource [Ep 4 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320)
- Oral contrast is not needed for suspected bowel obstruction; CT can be read just as well without it, and eliminating it speeds up imaging and prevents nausea and vomiting — Todd Ponsky summarizing a resource [Ep 4 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320)
- Luminal fluid in bowel obstruction serves as the contrast agent on CT — Todd Ponsky summarizing a resource [Ep 4 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320)
- Repeat enema reduction attempts for intussusception are appropriate if there is movement all the way to the ileocecal valve — Todd Ponsky summarizing a resource [Ep 4 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320)
- Modern pediatric CT scans deliver 1-10 millisieverts of radiation, equivalent to living on Earth for one year — Todd Ponsky summarizing a resource [Ep 4 · 22:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320)
- For pyloric stenosis resuscitation: if chloride is less than 85, give 3 fluid boluses; if chloride is less than 97, give 2 boluses; if chloride is greater than 97 but bicarbonate is less than 33, give 1 bolus — Todd Ponsky summarizing a resource [Ep 4 · 26:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1560)
- For non-traumatic or traumatic pneumomediastinum, chest X-ray alone is sufficient; no further imaging is needed — Todd Ponsky summarizing a resource [Ep 4 · 26:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1560)
- In a study of 42 patients with esophageal atresia repair leaks, IV glycopyrrolate (Robinul) resulted in 76% leak resolution compared to 29% in the placebo group — Todd Ponsky summarizing a resource [Ep 4 · 26:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1560)
- Glycopyrrolate treatment reduced chest tube output to 124 mL compared to 370 mL in the placebo group for TEF repair leaks — Todd Ponsky summarizing a resource [Ep 4 · 26:00](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1560)
- The Gips procedure for pilonidal disease involves coring out pits with trephine or punch biopsy, extracting granulation tissue and hair with mosquito forceps, curetting the cavity with a smaller trephine, and flushing with saline then hydrogen peroxide — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- In the Gips pilonidal procedure, all punch openings are left unpacked and unsutured, drains are not required, and the procedure takes 3-5 minutes — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- For thoracoscopic lobectomy, the scope should be placed anterior to the tip of the scapula, almost at the mid-axillary line, directly over the major fissure — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- Operating ports for thoracoscopic lobectomy should be at the anterior axillary line — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- Placing the thoracoscope posterior to the scapula tip causes the surgeon to look back on themselves when working in the anterior fissure, creating a paradoxical working angle — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- When sealing blood vessels during thoracoscopic lobectomy, use a sealer (not sealer-divider) to seal proximally and distally, make a small nick between seals to confirm hemostasis, then complete the division — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- Understanding segmental anatomy helps predict vessel locations during lobectomy; for example, the superior segmental artery comes off the lower lobe with the bronchus directly below it — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- For incomplete fissures during lobectomy, use a sealing device to proceed layer by layer until structures are identified — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- Contralateral main-stem intubation is the best and easiest technique for single-lung ventilation during thoracoscopic lobectomy — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://origin-library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- A Mayo Clinic study by Larson demonstrated that a single perioperative antibiotic dose almost eliminated PEG exit-site infections, establishing perioperative antibiotics as standard practice. — Jeffrey Ponsky summarizing a resource [Ep 6 · 9:58](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=598)
- At the 1980 Salt Lake City GI meeting with approximately 1500 attendees, a prominent Mass General surgeon stated he could perform open gastrostomy in 30 minutes and it was not a big deal. — Jeffrey Ponsky summarizing a resource [Ep 6 · 24:45](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1485)
- At the same 1980 meeting, a world-renowned ERCP expert stated his only comment was 'I wish I had thought of it.' — Jeffrey Ponsky summarizing a resource [Ep 6 · 25:24](https://origin-library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1524)

## Changelog
- Oct 5: 1 item added automatically
- Oct 1: 1 item added automatically
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