# Trauma — GCMD Library living collection

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

Updated: n/a · 10 episodes · 160 cited statements

## Episodes
### Fundamentals
- [Pediatric Gun Violence: Pediatric Trauma Series 2017](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392) — video · 22:56 · [machine version](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392.md)
- [#APSA50: Social Determinants of Health](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435) — podcast · 47:40 · [machine version](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435.md)
- [Update Course Rewind: Firearm Advocacy as a Pediatric Surgeon 2022](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777) — video · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777.md)

### Acute Management
- [VTE PPX in High Risk Trauma Patients: 2018 Pediatric Surgery Practice Gap #7](https://origin-library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452) — video · [machine version](https://origin-library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452.md)
- [ATLS 2021 Pediatric Surgery Update](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549) — podcast · 16:05 · [machine version](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549.md)
- [ATLS 2021 Pediatric Surgery Update](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355) — video · 16:06 · [machine version](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355.md)

### Evidence & Research
- [Differences Between Pediatric & Adult Trauma Centers](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334) — video · 3:39 · [machine version](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334.md)
- [Differences Between Pediatric & Adult Trauma Centers](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945) — video · 3:39 · [machine version](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945.md)
- [APSA Article of Interest: REBOA in Pediatric Trauma](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890) — video · [machine version](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890.md)

### Emerging & Future Directions
- [Surgical Skill Acquisition in the Modern Era: Comparative Technology in...](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979) — video · 13:39 · [machine version](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=0) Introduction and Setting (Ep 1)
- [0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14) Study Review: Pediatric vs Adult Trauma Centers for Adolescents (Ep 1)
- [2:57](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=177) Discussion of Imaging Practices (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0) Epidemiology of Pediatric Firearm Injuries (Ep 2)
- [7:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420) Medical Organization Policy Responses to Sandy Hook (Ep 2)
- [12:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=720) Firearms as a Public Health Problem: The Haddon Matrix (Ep 2)
- [15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900) Firearms and Youth Suicide (Ep 2)
- [18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100) Research Funding and Physician-Patient Relationship (Ep 2)
- [20:10](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1210) Discussion: Advocacy and Working with the NRA (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=0) Introduction and Setting (Ep 3)
- [0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14) Study Review: Pediatric vs Adult Trauma Centers for Adolescents (Ep 3)
- [2:57](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=177) Discussion of Imaging Differences (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=0) Historical context of surgical education and the apprenticeship model (Ep 4)
- [3:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=180) The five-step skill acquisition model (Ep 4)
- [5:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=300) Early telementoring experiences and technology evolution (Ep 4)
- [8:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=480) Advanced telestration technology and international telementoring (Ep 4)
- [11:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=660) The Akron-Tromsø project and implementation barriers (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=0) Introduction to Social Determinants of Health at APSA 50 (Ep 6)
- [1:45](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=105) Adam Foss on the Confluence of Mass Incarceration and Public Health Disparities (Ep 6)
- [4:23](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=263) Cultural Competency and Implicit Bias in Professional Training (Ep 6)
- [8:05](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=485) Structural Barriers and the Need for Lived Experience in the Workforce (Ep 6)
- [12:56](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=776) Call to Continuous Learning and Cultural Immersion (Ep 6)
- [14:57](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=897) Presidential Symposium Address: Privilege, Power, and Discomfort (Ep 6)
- [18:16](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1096) Historical Context: 50 Years of Racial Violence and Current Crisis (Ep 6)
- [21:39](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1299) Mass Incarceration Statistics and Health Disparities (Ep 6)
- [25:59](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1559) The Need for a New Civil Rights Movement (Ep 6)
- [27:41](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1661) Personal Story: The Lottery of Privilege (Ep 6)
- [32:16](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1936) Swords and Shields: Using Privilege to Protect Others (Ep 6)
- [34:51](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2091) Stanley's Case: From Cell Phone Theft to Armed Robbery (Ep 6)
- [41:54](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2514) Structural Determinants: From Toxic Stress to Incarceration (Ep 6)
- [45:54](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2754) Stanley's Outcome and Call to Action (Ep 6)
- [46:54](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2814) Closing Remarks: Extending Beyond the Operating Room (Ep 6)
- [0:00](https://origin-library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452?t=0) VTE prophylaxis in low bleeding risk trauma patients (Ep 5)
- [0:34](https://origin-library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452?t=34) VTE prophylaxis in high bleeding risk trauma patients (Ep 5)
- [0:08](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=8) Introduction and Case Presentation Format (Ep 7)
- [1:34](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=94) Airway and Breathing Assessment in Pediatric Trauma (Ep 7)
- [4:42](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=282) Surgical Airway Techniques (Ep 7)
- [7:46](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=466) Circulation and Shock Management (Ep 7)
- [11:56](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=716) Neurological Assessment and Imaging Guidelines (Ep 7)
- [0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0) REBOA in Pediatric Trauma: Registry Review (Ep 8)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- There is substantial data showing pediatric trauma centers are better for young children, but evidence for adolescents aged 15-19 is less clear. — Rich Falcone (clinical) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- A prior Ohio-only study showed no difference in outcomes for 15-19 year olds whether treated at adult or pediatric trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- The National Trauma Data Bank study included patients aged 15-19 with injury severity scores greater than 25 over a 5-year period, totaling almost 13,000 patients. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- 51% of severely injured adolescents in the study were treated at adult trauma centers and 49% at pediatric trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- The median injury severity score (ISS) in the study population was 33. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- 45% of patients in the study had Glasgow Coma Scale scores less than 8, indicating severe brain injuries. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- There was no significant difference in mortality between severely injured adolescents treated at adult versus pediatric trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Adolescents treated at adult trauma centers were approximately 81% more likely to have an imaging study performed compared to those at pediatric trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Severely injured adolescents had shorter length of stay at pediatric trauma centers compared to adult trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Severely injured adolescents had shorter ICU length of stay at pediatric trauma centers compared to adult trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- More adolescents were discharged to home (as opposed to rehab or skilled nursing facilities) when treated at pediatric trauma centers compared to adult trauma centers. — Rich Falcone (epidemiological) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Mortality is not the most important or reliable outcome for pediatric trauma because most children survive once they reach a hospital. — Rich Falcone (opinion) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Pediatric trauma centers add value for children even up into the adolescent age range (15-19 years). — Rich Falcone (opinion) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Adult trauma centers need to achieve equivalent imaging and length of stay practices to pediatric trauma centers for adolescents, since 51% of this population presents to adult facilities. — Rich Falcone (opinion) [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=14)
- Pediatric trauma centers can achieve equivalent outcomes with less imaging by trusting clinical diagnosis and examination, avoiding unnecessary radiation exposure. — Rich Falcone (clinical) [Ep 1 · 3:15](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=195)
- A recent study showed that referring hospitals had higher imaging rates than children's hospitals for appendicitis. — Todd Ponsky (epidemiological) [Ep 1 · 2:57](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-334?t=177)
- Over the last 25 years, mortality from pediatric trauma has decreased by about 50%. (epidemiological) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- Trauma is still the single most common cause of death in the pediatric population and more common than all other causes combined. (epidemiological) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- Among pediatric injury deaths at trauma centers, motor vehicle crashes are the number one cause, followed by firearms and falls (National Trauma Data Bank 2016). (epidemiological) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- For children who reach a trauma center, firearms are the most lethal mechanism—the cause most likely to result in death. (clinical) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- The number of firearm deaths in the pediatric population now is about the same as at the beginning of this century, showing little progress. (epidemiological) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- Among pediatric firearm deaths by intent, homicides are most common, followed by suicide, then unintentional injuries. (epidemiological) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- In the 15-19 age group, firearms are responsible for 84% of homicides. (epidemiological) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- In the 15-19 age group, firearms are responsible for 46% of suicides. (epidemiological) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- In the 15-19 age group, 25% of all deaths involve a firearm. (epidemiological) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=0)
- Following Sandy Hook, the American Academy of Pediatrics, American College of Surgeons, and American Pediatric Surgical Association reviewed and updated their policy statements on firearm safety and injury prevention. (guideline) [Ep 2 · 7:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420)
- Eight organizations, including the American Academy of Pediatrics, American Academy of Family Physicians, American College of Surgeons, American Psychiatric Association, American Public Health Association, and American Bar Association, published a white paper in the Annals of Internal Medicine advocating multidisciplinary collaboration to reduce firearm injuries. (guideline) [Ep 2 · 7:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420)
- A survey of American College of Surgeons Committee on Trauma members showed that every advocacy topic related to firearms had over 50% support, and nearly half had over 90% support. (epidemiological) [Ep 2 · 7:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420)
- The American Pediatric Surgical Association submitted its firearm policy statement to the entire membership for review and discussion at the annual meeting, resulting in overwhelming approval. (guideline) [Ep 2 · 7:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=420)
- Over the last 30-40 years, there has been a 17% reduction in motor vehicle-related deaths and a 77% increase in vehicle miles traveled, while firearm-related deaths increased by 15%. (epidemiological) [Ep 2 · 12:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=720)
- Motor vehicle mortality has declined from about 5 deaths per billion vehicle miles traveled to 1.14 over the last five decades. (epidemiological) [Ep 2 · 12:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=720)
- In the pediatric population, suicide is the third leading cause of death. (epidemiological) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- There are an estimated 25 suicide attempts for every completed suicide in youth. (epidemiological) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- In youth suicides, the use of a firearm is successful in 95% of cases. (epidemiological) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- Firearms are involved in almost 50% of completed youth suicides. (epidemiological) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- 90% of patients who survive a suicide attempt do not ultimately die from suicide. (epidemiological) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- Most adolescent suicides occur in the home with a firearm owned by the parent. (epidemiological) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- Many youth suicides are quite impulsive, happening in less than 5 minutes from impulse to action. (clinical) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- Suicide mortality is not reduced with trigger locks or gun safes in some cases because teenagers may have been shown where the firearm is or given the combination to protect themselves. (clinical) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=900)
- In 1992, the National Center for Injury Prevention and Control was established under the CDC. (epidemiological) [Ep 2 · 18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- Art Kellerman published a paper demonstrating that gun ownership is a risk factor for homicide in the home, which became a target of the NRA. (epidemiological) [Ep 2 · 18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- In 1996, Jay Dickey successfully added an amendment to an annual spending bill that cut CDC funding to the National Center for Injury Prevention and Control by the specific amount allocated for firearm research. (guideline) [Ep 2 · 18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- Cancer research is funded at a rate of about $4,200 per year of potential life lost, while firearm-related research is funded at $2.70 per year of potential life lost from US sources. (epidemiological) [Ep 2 · 18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- Many medical organizations recommend that physicians counsel parents regarding the risks and benefits of keeping firearms in the home. (guideline) [Ep 2 · 18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- The majority of gun-owning parents feel that physician counseling about firearm safety is appropriate. (epidemiological) [Ep 2 · 18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- Florida passed the Firearm Owners Privacy Act (Docs vs Glocks law), which restricts healthcare providers from making written inquiries or asking questions about firearm ownership, with penalties including loss of license and up to $10,000 fine. (guideline) [Ep 2 · 18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- The Florida Supreme Court overturned the Docs vs Glocks law, but the state appealed to the 11th Circuit Court of Appeals, where a three-judge panel ruled in favor of the state; the full en banc 11th Circuit then overturned the law again. (guideline) [Ep 2 · 18:20](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1100)
- The NRA has a 40-50 year head start on advocacy efforts and has been profoundly successful, particularly at the state legislative level. (opinion) [Ep 2 · 20:10](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1210)
- Most firearm legislation and activity happens at the state level, not the federal level. (opinion) [Ep 2 · 20:10](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1210)
- Firearm legislation efforts tend to happen in fits and starts, with outrage following events like Sandy Hook gradually dying down along with advocacy efforts. (opinion) [Ep 2 · 20:10](https://origin-library.globalcastmd.com/watch/pediatric-gun-violence-pediatric-trauma-series-2017-392?t=1210)
- There is plenty of data showing pediatric trauma centers are better for young children, but evidence for adolescents aged 15-19 is less clear. — Rich Falcone (epidemiological) [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Mortality is not the most important or reliable outcome for pediatric trauma because most children survive once they reach a hospital. — Rich Falcone (opinion) [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Pediatric trauma centers add value for children even up into the adolescent age range (15-19 years). — Rich Falcone (opinion) [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- 51% of severely injured adolescents are going to adult trauma centers, so adult centers need to achieve equivalent imaging practices and length of stays to pediatric trauma centers. — Rich Falcone (opinion) [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Pediatric trauma centers can care for severely injured adolescents using less imaging while achieving the same outcomes and shorter lengths of stay. — Rich Falcone (clinical) [Ep 3 · 3:15](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=195)
- Clinical diagnosis and clinical examination can be trusted in evaluating severely injured adolescents without requiring extensive imaging. — Rich Falcone (clinical) [Ep 3 · 3:15](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=195)
- Severely injured adolescents do not need radiation exposure from extensive imaging when clinical evaluation is adequate. — Rich Falcone (clinical) [Ep 3 · 3:15](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=195)
- The traditional surgical apprenticeship model involves three stages: expert performs while trainee watches, trainee performs with expert watching carefully, and trainee performs almost autonomously with minimal oversight (clinical) [Ep 4 · 1:25](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=85)
- The skill acquisition model consists of five steps: course attendance, trainee observes expert, trainee performs with expert watching, telementoring, and teleproctoring (clinical) [Ep 4 · 3:20](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=200)
- Telementoring should be introduced at step 4 of the skill acquisition model, not at step 1 (opinion) [Ep 4 · 4:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=240)
- Virtual courses allow surgeons to learn without traveling, using the internet in ways that make sense (opinion) [Ep 4 · 4:20](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=260)
- The first telementoring case used Skype for a baby requiring lung resection, with verbal pointing only and no telestration capability (clinical) [Ep 4 · 5:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=300)
- Verbal pointing without telestration was really difficult for guiding surgical procedures remotely (opinion) [Ep 4 · 5:35](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=335)
- The Visitor One solution provides robust telestration capability with integrated drawing features (clinical) [Ep 4 · 5:45](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=345)
- The Norwegian group (Etai Bogen and colleagues) developed an off-the-shelf telestration solution using Androids and iPads (clinical) [Ep 4 · 6:40](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=400)
- The surgeon performing the operation must be capable of completing it independently because technology may fail or internet connection may be lost (opinion) [Ep 4 · 8:20](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=500)
- The mentor should provide tips and tricks but not serve as a crutch for the operating surgeon (opinion) [Ep 4 · 8:35](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=515)
- An emergency 'break the glass' telementoring model could help non-pediatric trauma centers manage unstable pediatric trauma patients who cannot be transferred (opinion) [Ep 4 · 8:50](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=530)
- The emergency co-pilot or virtual first assistant model is debated because it involves guidance from someone the surgeon has never met before, without prior relationship (opinion) [Ep 4 · 9:15](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=555)
- Brian has been the leader in defining how to incorporate telementoring into the educational training model (opinion) [Ep 4 · 9:40](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=580)
- The staged skill acquisition model (course, expert performs, trainee performs with expert present, then telementoring) is becoming the more accepted approach (opinion) [Ep 4 · 9:50](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=590)
- Key barriers to telementoring implementation include medical-legal issues, licensing, credentialing, technology costs, and compensation for expert time (opinion) [Ep 4 · 10:10](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=610)
- For global-scale telementoring, experts will need justification for not spending time in their own operating rooms, suggesting volunteer goodwill alone is insufficient (opinion) [Ep 4 · 10:35](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=635)
- Project 6 and the American College of Surgeons Education Committee (David Hoyt and Sadiva) are actively pushing telementoring initiatives (clinical) [Ep 4 · 10:55](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=655)
- Demand for telementoring has come primarily from rural surgeons working alone who want assistance without sending all patients to tertiary centers (epidemiological) [Ep 4 · 11:10](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=670)
- Polling of rural surgeons confirmed they want telementoring services (epidemiological) [Ep 4 · 11:20](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=680)
- The Akron-Tromsø project tested whether laparoscopic non-mesh hernia repair could be taught using the complete skill acquisition model (clinical) [Ep 4 · 11:40](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=700)
- The Akron-Tromsø project was led by Knut, Etai Bogan, and Ralph Ole (clinical) [Ep 4 · 11:50](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=710)
- Peter Gessing is a talented general surgeon in Tromsø who also performs pediatric surgery (clinical) [Ep 4 · 12:10](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=730)
- The Akron-Tromsø project progression included: virtual course viewing, in-person demonstration by expert, trainee performing with expert present, telementoring with expert in same building, and finally telementoring from across the ocean (clinical) [Ep 4 · 12:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=720)
- The final telementoring session occurred at 3 AM (speaker's time) for a full day of cases in Tromsø using iPad drawing system (clinical) [Ep 4 · 12:55](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=775)
- True skill acquisition of new surgical techniques requires more than a simulation course or lecture alone (opinion) [Ep 4 · 13:20](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=800)
- Virtual presence can facilitate skill acquisition but must be an element of a robust model where a relationship is established and both parties become comfortable with each other (opinion) [Ep 4 · 13:30](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=810)
- The priorities when evaluating a small child with multi-system trauma are the same as for an adult patient: airway, breathing, circulation — Rich Falcone (clinical) [Ep 7 · 2:44](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=164)
- Pediatric patients have more pliable chests so the ribs don't necessarily break, but they can have a lot of pulmonary contusions and other injuries — Rich Falcone (clinical) [Ep 7 · 3:58](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=238)
- Pediatric patients are more susceptible to tension pneumothorax because their mediastinum is more mobile and will shift more easily in response to that tension — Rich Falcone (clinical) [Ep 7 · 4:20](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=260)
- For pediatric airway management, start with simple maneuvers like a jaw thrust because children have big tongues and big heads — Rich Falcone (clinical) [Ep 7 · 5:06](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=306)
- When children are laid on a backboard, their large occiput causes head flexion which can obstruct the airway; pediatric backboards have a cutout for the head or a bump to keep the torso higher and maintain ear in line with shoulder — Rich Falcone (clinical) [Ep 7 · 5:06](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=306)
- Needle cricothyroidotomy is recommended for children under 10 years old, while surgical cricothyroidotomy is for children over 10, according to ATLS guidelines — Rich Falcone (guideline) [Ep 7 · 6:13](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=373)
- Pediatric blood volume is calculated as weight in kilos times 80 mLs — Rich Falcone (clinical) [Ep 7 · 10:15](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=615)
- A 12 kg child's entire blood volume is about a liter, and a 25 kg child has about 2 liters — Rich Falcone (clinical) [Ep 7 · 10:15](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=615)
- Massive transfusion protocols have been proven to help, with more data in the adult world but also data in pediatrics — Todd Ponsky (clinical) [Ep 7 · 10:57](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=657)
- Once blood transfusion starts, it is advisable to keep track of TEG (thromboelastography) if the institution has it readily available — Todd Ponsky (opinion) [Ep 7 · 11:28](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=688)
- Glasgow Coma Scale can be performed in a nonverbal child; if they cannot talk normally, they do not lose points for the verbal component — Rich Falcone (clinical) [Ep 7 · 12:09](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=729)
- For verbal GCS scoring in nonverbal children: if they babble and say nonsense normally, they get full score; if irritable and crying, they get a 4; if just moaning, a 2; if doing nothing, that is most concerning — Rich Falcone (clinical) [Ep 7 · 12:09](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=729)
- A child who does not respond to IV stick or IO placement, or a child who is crying a lot and then suddenly stops crying, is most concerning from a neurostatus perspective in the trauma bay — Rich Falcone (opinion) [Ep 7 · 12:09](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=729)
- Kids have more diffuse brain injuries in general than the adult population — Rich Falcone (clinical) [Ep 7 · 12:57](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=777)
- Child abuse is the most common cause of severe head injury in kids less than 2 years old — Rich Falcone (epidemiological) [Ep 7 · 12:57](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=777)
- Kids are more at risk for head injury because of big heads, soft skulls, and they often fall on their head — Rich Falcone (clinical) [Ep 7 · 12:57](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=777)
- The priorities for evaluating a small child with multi-system trauma are the same as for an adult patient - ensure airway, breathing, and circulation. — Rich Falcone (guideline) [Ep 10 · 2:51](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=171)
- Pediatric patients have more pliable chests, so ribs don't necessarily break, but they can have significant pulmonary contusions and other injuries without obvious chest wall findings. — Rich Falcone (clinical) [Ep 10 · 3:58](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=238)
- Pediatric patients are more susceptible to tension pneumothorax because their mediastinum is more mobile and shifts more easily in response to tension. — Rich Falcone (clinical) [Ep 10 · 4:16](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=256)
- Children have large tongues and large heads; when placed on a backboard, the large occiput flexes the head forward and can obstruct the airway. — Rich Falcone (clinical) [Ep 10 · 5:17](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=317)
- Pediatric backboards should have a cutout for the head or a bump to keep the torso higher, maintaining the ear in line with the shoulder to prevent airway obstruction. — Rich Falcone (clinical) [Ep 10 · 5:29](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=329)
- ATLS recommends needle cricothyroidotomy for children under 10 years and surgical cricothyroidotomy for those over 10 years. — Rich Falcone (guideline) [Ep 10 · 6:13](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=373)
- A needle or surgical cricothyroidotomy is not a definitive airway; it buys time to get to the OR for a formal tracheostomy. — Rich Falcone (clinical) [Ep 10 · 6:57](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=417)
- For needle cricothyroidotomy, a 10 mL syringe with IV catheter can be used, and the IV catheter connects directly to an Ambu bag. — Rich Falcone (clinical) [Ep 10 · 7:09](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=429)
- The updated ATLS guideline recommends giving one 20 cc/kg crystalloid bolus, and if the patient shows transient or no response, proceeding directly to blood products (10 cc/kg) rather than giving a second crystalloid bolus. — Rich Falcone (guideline) [Ep 10 · 8:54](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=534)
- Pediatric blood volume is calculated as weight in kilograms times 80 mL. — Rich Falcone (clinical) [Ep 10 · 10:21](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=621)
- Massive transfusion protocols have been proven to help, with more data in adults but also supporting data in pediatrics. — Rich Falcone (clinical) [Ep 10 · 10:55](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=655)
- Glasgow Coma Scale can be assessed in nonverbal children; if a child cannot talk normally for their age, they do not lose verbal points. A normally babbling infant receives full verbal score; irritable crying scores 4; moaning scores 2; no response scores lowest. — Rich Falcone (clinical) [Ep 10 · 12:11](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=731)
- The most concerning neurologic sign in a young trauma patient is a child who does not cry or respond to painful stimuli like IV or IO placement, or a child who stops crying suddenly. — Rich Falcone (clinical) [Ep 10 · 12:42](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=762)
- Children have more diffuse brain injuries in general than adults. — Rich Falcone (clinical) [Ep 10 · 13:05](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=785)
- Child abuse is the most common cause of severe head injury in children less than 2 years old. — Rich Falcone (epidemiological) [Ep 10 · 13:10](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=790)
- Children are more at risk for head injury because of large heads, soft skulls, and tendency to fall on their heads, resulting in diffuse rather than focal injuries. — Rich Falcone (clinical) [Ep 10 · 13:11](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=791)
- For blunt abdominal trauma, a validated multi-institutional algorithm uses five criteria: abdominal pain, abdominal wall trauma/tenderness/distension, abnormal chest X-ray, AST greater than 200, or abnormal pancreatic enzymes. Patients with none of these criteria (about 35% of the population) have 0.6% risk of intra-abdominal injury and 0.0% risk of requiring intervention. — Rich Falcone (clinical) [Ep 10 · 14:22](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=862)
- Having more than one positive criterion on the abdominal trauma algorithm increases risk of intra-abdominal injury; having all four criteria confers even higher risk. — Rich Falcone (clinical) [Ep 10 · 15:16](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=916)
- This is a major public health issue with no single answer to solve this problem, and mental health is a major component. (opinion) [Ep 9 · 1:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=75)
- There are lots of reasons for gun violence and for firearm related injury in this country requiring a complexity science and multi-prong approach. (opinion) [Ep 9 · 1:28](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=88)
- Gun violence requires neighborhood transformation, mental health interventions, and availability of lock boxes and safety tools to prevent unintentional injury. (opinion) [Ep 9 · 1:43](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=103)
- The incidence of mental health problems is probably equal between the United States and Chile, with the only difference being gun availability. (opinion) [Ep 9 · 2:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=120)
- As pediatric surgeons, it is in our lane if we decide to take a stance on teaching about firearm safety. (opinion) [Ep 9 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=135)
- Patient-based advocacy for firearm violence includes screening for risk factors and trauma informed care. (guideline) [Ep 9 · 3:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=195)
- In communities with high firearm violence, patients and their families are impacted by trauma on a daily basis. (clinical) [Ep 9 · 3:30](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=210)
- Advocacy starts at the local level, including knowing your own state laws about guns and other issues like Medicaid and access to care. (guideline) [Ep 9 · 3:50](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=230)
- Children don't have a voice in policy matters, so we have to be their voice. (opinion) [Ep 9 · 4:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=285)
- Racial and socioeconomic disparities in criminal justice and public health have the same underlying causes. — Adam Foss (opinion) [Ep 6 · 1:45](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=105)
- Children in the US are disadvantaged by racism, classism, homophobia, and xenophobia, which marginalizes people not fitting the dominant narrative in every aspect of life including culturally, economically, health metrics, and the criminal justice system. — Adam Foss (epidemiological) [Ep 6 · 3:07](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=187)
- When adults are removed from communities, the economy, and healthcare through incarceration, children are forced to breach the void and fall into the same traps, creating intergenerational and sometimes intractable cycles. — Adam Foss (clinical) [Ep 6 · 3:07](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=187)
- Professional education fails to prepare practitioners for working with marginalized populations: law school does not teach about trauma or poverty despite public interest lawyers working in trauma-dictated communities, and medical school likely does not teach the history of racial bias in the United States. — Adam Foss (opinion) [Ep 6 · 4:23](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=263)
- When procedural steps are placed in the way of people living in poverty, the likelihood they complete the process decreases exponentially. — Adam Foss (epidemiological) [Ep 6 · 8:05](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=485)
- Code for America reduced steps in California's record clearance process and increased completion likelihood by 44%. — Adam Foss (epidemiological) [Ep 6 · 8:05](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=485)
- Workforce diversity is important for inclusivity, but what is most important is building pipelines for people who are impacted by the issues to reach professional positions, not just demographic representation. — Adam Foss (opinion) [Ep 6 · 11:23](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=683)
- Patients experience distrust when they enter a hospital or doctor's office and nobody looks like them, which ruins the first interaction and is critical to long-term health outcomes. — Adam Foss (clinical) [Ep 6 · 11:23](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=683)
- In 1.5 million miles of air travel, Adam Foss sat next to two black people on an airplane for the first time, and he has never sat next to a black person in first class except celebrities from television or sports. — Adam Foss (epidemiological) [Ep 6 · 14:57](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=897)
- In Fortune 100 C-suite offices (Amazon, Airbnb, Google, etc.), the only black people present are those bringing in and out the coffee. — Adam Foss (epidemiological) [Ep 6 · 14:57](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=897)
- Of approximately 90 colleges, graduations, and law schools visited, none had an African American population over 5%. — Adam Foss (epidemiological) [Ep 6 · 14:57](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=897)
- 2.3 million people are in jail and prison right now, with another 5 million on probation or parole. — Adam Foss (epidemiological) [Ep 6 · 21:39](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1299)
- 1 in 3 black men born today will spend some time in jail or prison. — Adam Foss (epidemiological) [Ep 6 · 21:39](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1299)
- 650,000 people come out of prison every year and face 50,000 collateral consequences of felony convictions that impede successful re-entry. — Adam Foss (epidemiological) [Ep 6 · 21:39](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1299)
- 70 million Americans have a criminal record that will never go away and will impede their re-entry into society. — Adam Foss (epidemiological) [Ep 6 · 21:39](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1299)
- The leading cause of death for young black men aged 18-35 in the United States is handgun homicide, which is not true of any other demographic in any other place on the planet. — Adam Foss (epidemiological) [Ep 6 · 23:19](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1399)
- Handgun homicide accounts for more deaths than the next 9 leading causes of death combined for black men aged 18-35. — Adam Foss (epidemiological) [Ep 6 · 23:19](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1399)
- In Manhattan, black women are 12 times more likely to die during childbirth than white women. — Adam Foss (epidemiological) [Ep 6 · 24:59](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1499)
- Black women and white women experience breast cancer at almost the exact same rate, but black women are almost twice as likely to die from it. — Adam Foss (epidemiological) [Ep 6 · 24:59](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1499)
- Black women have a 71% higher chance of dying of cervical cancer. — Adam Foss (epidemiological) [Ep 6 · 24:59](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1499)
- In Boston, at one intersection on Mass Ave, life expectancy drops by 25 years depending on which direction you look. — Adam Foss (epidemiological) [Ep 6 · 24:59](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1499)
- There are more segregated schools in the United States today than on the eve of Brown v. Board of Education. — Adam Foss (epidemiological) [Ep 6 · 25:59](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1559)
- There are more black people under correctional control today than there were slaves on the eve of the Civil War. — Adam Foss (epidemiological) [Ep 6 · 25:59](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1559)
- Over 400 years of the transatlantic slave trade, 12 million Africans were captured, enslaved, and killed; last year 11 million people went through US jails, recreating slavery's scale every year. — Adam Foss (epidemiological) [Ep 6 · 25:59](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1559)
- At age 19, Adam Foss was caught drug trafficking (a federal offense with a 10-year minimum mandatory sentence), but the arresting officer was his adoptive white father who took him home and loved him instead of prosecuting him. — Adam Foss (clinical) [Ep 6 · 27:41](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1661)
- Being convicted of a drug crime in the 1990s would have resulted in the label 'convicted drug felon' and deprivation of access to housing, employment, education, healthcare, and pro-social activity, which increases the likelihood of committing another crime rather than decreasing it. — Adam Foss (clinical) [Ep 6 · 27:41](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=1661)
- Children conceived to mothers living in toxic stress inherit that stress epigenetically, which changes the way their bones and brains develop and eventually the way they behave, and these changes can be traced into prison. — Adam Foss (clinical) [Ep 6 · 41:54](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2514)
- 75% of children locked up in 2015 had on average 33 interactions with the child welfare system before age 3 for abuse, neglect, and malnutrition. — Adam Foss (epidemiological) [Ep 6 · 41:54](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2514)
- Children from impoverished communities do not learn to read in underperforming schools not because they are black, brown, or poor, but because educators do not understand the stress they bring to school and blame, shame, and expel them instead. — Adam Foss (clinical) [Ep 6 · 44:14](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2654)
- If an 18-year-old boy in Massachusetts kills another 18-year-old boy, he receives a life without parole sentence at a cost of $11 million. — Adam Foss (epidemiological) [Ep 6 · 44:14](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2654)
- Stanley emigrated from the Dominican Republic at age 9 with his two older brothers to get a better education in Boston, but witnessed more violence, poverty, and trauma in the Fidelis projects than he had in a developing nation. — Adam Foss (clinical) [Ep 6 · 34:51](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2091)
- Stanley's two brothers went to prison and his father ran away due to fear of deportation after problems with law enforcement, leaving Stanley and his mother alone. — Adam Foss (clinical) [Ep 6 · 34:51](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2091)
- Stanley told Adam Foss that when robbing people, the thought of prison never entered his mind because he was worried about his mother dying, and that young people carry handguns to high school not thinking about 18 months in jail but worried about what happens if they are caught without one. — Adam Foss (clinical) [Ep 6 · 38:34](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2314)
- Stanley became the first freshman in his college's history to pitch in the national championship game (11 innings, 8 strikeouts, 2 hits), made the Dean's list for the first time, and is now a junior majoring in criminal justice applying to law school to become a prosecutor. — Adam Foss (clinical) [Ep 6 · 45:54](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=2754)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A previous study looking at Ohio data showed no difference in outcomes for adolescents aged 15-19 whether treated at adult or pediatric trauma centers. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- The study by Ashley Walther et al. used the National Trauma Data Bank and included patients aged 15-19 with injury severity scores greater than 25. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Over a 5-year period, the study identified almost 13,000 patients meeting the inclusion criteria, with 51% treated at adult trauma centers and 49% at pediatric trauma centers. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- The patient groups at adult and pediatric trauma centers were demographically very similar without significant differences. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- The median injury severity score (ISS) for the study population was 33. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- 45% of patients in the study had a Glasgow Coma Score of less than 8, indicating severe brain injuries. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- There was no significant difference in mortality between adolescents treated at adult versus pediatric trauma centers. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Adolescents treated at adult trauma centers were approximately 81% more likely to have an imaging study performed compared to those at pediatric trauma centers. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Patients at pediatric trauma centers had shorter length of stay compared to those at adult trauma centers. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Patients at pediatric trauma centers had shorter ICU length of stay compared to those at adult trauma centers. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- More patients were discharged to home (as opposed to rehab or skilled nursing facilities) when cared for at pediatric trauma centers compared to adult trauma centers. — Rich Falcone summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/differences-between-pediatric-adult-trauma-centers-945?t=14)
- Medical knowledge doubles every 18 months according to Brian's earlier statement — The host summarizing the discussion [Ep 4 · 2:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=120)
- Sir William Osler established that medical training should include residency, bringing doctors to patients rather than relying solely on lectures — The host summarizing the discussion [Ep 4 · 0:50](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=50)
- Dr. William Halstead, a surgeon, created surgical residency based on Osler's residency concept — The host summarizing the discussion [Ep 4 · 1:10](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=70)
- Telestration lines move when the camera moves during surgery, which is a technical limitation — The host summarizing the discussion [Ep 4 · 7:00](https://origin-library.globalcastmd.com/watch/surgical-skill-acquisition-in-the-modern-era-comparative-technology-in-979?t=420)
- Trauma and trauma-related injuries are still the number one killer of pediatric patients — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 7 · 0:08](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=8)
- Rich Falcone is a pediatric surgeon and the director of trauma services at Cincinnati Children's Hospital Medical Center — Rich Falcone summarizing a resource [Ep 7 · 0:40](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=40)
- MIST stands for mechanism of injury, injuries identified, Signs and symptoms, and Treatments — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 7 · 1:40](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=100)
- A cricothyroidotomy is not a definitive airway but buys time to get to the OR to do a formal tracheostomy — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 7 · 6:57](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=417)
- For needle cricothyroidotomy, a 10 mL syringe with IV catheter can be used and connects to the Ambu bag — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 7 · 7:04](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=424)
- When peripheral IV access cannot be obtained, the next step is intraosseous (IO) access — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 7 · 8:14](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=494)
- An IO can be placed in the tibia, the humeral head, or in the distal femur — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 7 · 8:28](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=508)
- The new ATLS guideline is to give one 20 cc/kg bolus of crystalloid, and if there is transient or no response, go right to blood (10 cc/kg) as the next step — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 7 · 8:54](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=534)
- For a child to start showing signs of hemorrhagic shock, they would have to lose about 50% of their total blood volume — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 7 · 10:07](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=607)
- Over 75% of pediatric trauma deaths are due to head injuries — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 7 · 11:56](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=716)
- There are validated clinical decision rules for when not to obtain head CT in pediatric trauma patients, with different criteria for children less than 2 years versus older than 2 years — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 7 · 13:27](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)
- For blunt abdominal trauma, a multi-institutional algorithm identifies patients at very low risk (0.6%) of intraabdominal injury if they answer no to: abdominal pain, abdominal wall trauma/tenderness/distension, abnormal chest X-ray, AST greater than 200, or abnormal pancreatic enzymes — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 7 · 13:27](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)
- Approximately 35% of blunt abdominal trauma patients meet low-risk criteria (all negative findings), and 0.0% of those required intraabdominal injury intervention — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 7 · 13:27](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)
- Trauma and trauma-related injuries are still the number one killer of pediatric patients. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 10 · 0:30](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=30)
- Intraosseous (IO) access can be placed in the tibia, humeral head, or distal femur; external IO is avoided in children. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 10 · 8:28](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=508)
- For a child to show signs of hemorrhagic shock (both tachycardia and hypotension), they must lose about half their total blood volume. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 10 · 9:56](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=596)
- A 12 kg child's entire blood volume is approximately 1 liter; a 25 kg child has approximately 2 liters. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 10 · 10:30](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=630)
- Over 75% of pediatric trauma deaths are due to head injuries. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 10 · 11:58](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=718)
- Clinical decision rules exist for determining when head CT can be safely avoided in pediatric trauma, with different criteria for children under 2 versus over 2 years old. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 10 · 13:41](https://origin-library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-13355?t=821)
- For the first time in recorded history, firearm injuries in children have exceeded motor vehicle crashes. — The host summarizing the discussion [Ep 9 · 0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=0)
- The deaths from suicide and homicide are both on the rise, particularly in the very young. — The host summarizing the discussion [Ep 9 · 0:10](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=10)
- Suicide rates amongst children are huge, and if someone can revisit suicidal ideation 20 minutes after the initial impulse without access to means, they can work through it. — The host summarizing the discussion [Ep 9 · 2:23](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=143)
- In patients with suicidal ideation, if there's a gun in the home, the risk of successfully committing suicide is at least three times higher. — The host summarizing the discussion [Ep 9 · 2:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-firearm-advocacy-as-a-pediatric-surgeon-2022-6777?t=165)
- REBOA stands for resuscitative endovascular balloon occlusion of the aorta — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- REBOA is a minimally invasive method of hemorrhage control where a sheath is introduced into the aorta via femoral arterial access and inflated to occlude arterial flow in zone one, two, or three of the thoracic or abdominal aorta — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- REBOA has been gaining popularity for trauma and non-trauma indications in adult centers — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- REBOA is not used at all centers even in adults — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- Over seven years, there were only 11 patients in the AAST REBOA registry that were less than 18 years old that had a REBOA placed — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- All 11 pediatric patients who received REBOA were adolescents with a median age of 17 — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- REBOA improved hemodynamics in the pediatric population studied — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- Only 30% of pediatric patients who received REBOA survived — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- REBOA has not made it into prime time for pediatric trauma yet — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- The technology might need some modifications for pediatric use — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- A better identification strategy is needed to know what patients would benefit from REBOA intervention — Brittany Levy summarizing a resource [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/apsa-article-of-interest-reboa-in-pediatric-trauma-5890?t=0)
- For low bleeding risk trauma patients, the recommendation is to use SCDs and low molecular weight heparin for VTE prophylaxis. — Alex summarizing the discussion [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452?t=0)
- For high bleeding risk trauma patients, the recommendation is to use SCDs until the patient is ambulatory, followed by a screening ultrasound on ICU day seven. — Alex summarizing the discussion [Ep 5 · 0:34](https://origin-library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452?t=34)
- In high bleeding risk trauma patients, low molecular weight heparin is withheld from the VTE prophylaxis regimen. — Alex summarizing the discussion [Ep 5 · 0:34](https://origin-library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452?t=34)
- Social determinants of health include economic stability, housing, transportation, physical and psychological safety, zip code, geography, literacy, education, hunger, poverty, community support, discrimination, stress, and provider cultural competencies, and these affect healthcare outcomes like quality of care, mortality, morbidity, life expectancy, and costs. — Alex Cassar summarizes what Dr. Adam Foss said [Ep 6 · 0:25](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=25)
- Black mothers are dying in childbirth at rates that are ridiculous compared to other groups. — Alex Cassar summarizes what Dr. Adam Foss said [Ep 6 · 6:24](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=384)
- In pediatric surgery, black and other diverse children's pain is not taken seriously—they receive fewer pain medications or are ignored when they reach out to nurses for pain. — Alex Cassar summarizes what Dr. Adam Foss said [Ep 6 · 6:24](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=384)
- Cardiologists sometimes give patients inferior stents (not the best available) based on assumptions about their cultural or socioeconomic status and likelihood of follow-up, compromising standards of care. — Alex Cassar summarizes what Dr. Adam Foss said [Ep 6 · 7:19](https://origin-library.globalcastmd.com/watch/apsa50-social-determinants-of-health-1435?t=439)

## Changelog
- Sep 24: 5 items added automatically
- Sep 17: 1 item added automatically
- Sep 16: 4 items added automatically

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