I've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.
So we agreed as an institution, if they have a normal looking chest X-ray, then they get to go home. If they don't, they get booked for next case like a nappy. Then we just take the clamp off, let it drain. And they get booked for the next available OR.
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 6 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 6 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 6 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 6 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 6 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 6 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 6 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 10 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 10 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 10 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 10 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 10 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 10 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 10 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 17 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 17 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 17 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 17 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 17 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 17 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 17 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
Shawn's statements about Colorectal / ARM & Hirschsprung6 statements
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 92 · 4:11
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 92 · 4:11
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 92 · 4:11
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 92 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
▶Ep 92 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
clinicalEffusions greater than one-third of the chest with severe respiratory symptoms typically warrant aspiration, though this threshold is arbitrary and clinical judgment is required.↗
▶Ep 2 · 5:01
clinicalPleural fluid with greater than 10,000 white blood cells defines empyema and was used as enrollment criteria for the randomized trial.↗
▶Ep 2 · 7:39
clinicalThe randomized trial comparing primary VATS to primary fibrinolysis showed no difference in length of stay between the two approaches.↗
▶Ep 2 · 11:09
clinicalRecurrent empyema after successful treatment is extremely rare because the pleural space typically becomes obliterated.↗
▶Ep 2 · 11:09
clinicalPatients receiving fibrinolysis do not get sicker during treatment, unlike some patients after VATS who can be critically ill due to trauma to both lungs.↗
▶Ep 2 · 11:09
epidemiologicalHistorical practice at Children's Mercy showed an average of 25 days total antibiotics with 19 days after becoming afebrile, with 40% of patients experiencing antibiotic-related complications.↗
▶Ep 2 · 11:09
clinicalThe current antibiotic protocol is 7 days after meeting three criteria: completing fibrinolysis, being afebrile, and being off oxygen.↗
▶Ep 2 · 11:09
quoteit really struck me that none of those kids got sicker. Yeah, I didn't even have the data yet, but what I did know is that sometimes you do a vat and with the barrel trauma to the to the good lung and beating up the bad lung, they fly pretty close to the treetop sometimes after the operation, but nobody gets sicker with the fibrinolysis.↗
▶Ep 2 · 11:09
quotethe public perception, and I certainly hear this a lot, is that I have some strong bias toward fibroanalysis and that I'm I'm biased and that I'm not approaching this as As an unbiased thoughtful person and it actually was entirely the opposite. My only bias was that I knew that was better than fiber analysis↗
▶Ep 2 · 11:09
quoteone of the fellows asked me what I would do if my daughter came in with an emphysema, and I said I would just do the fibro analysis. I don't think I'd enroll in the trial↗
▶Ep 2 · 16:03
clinicalThe fibrinolysis protocol uses 4mg TPA mixed in 40mL normal saline with 1-hour dwell time, administered at 0, 24, and 48 hours (3 doses over 48 hours).↗
▶Ep 2 · 17:34
quoteif you're getting equal results without requiring an operation, then there's no way you can recommend the operation, and there's really no way. A parent would sign up for that. You say, Well, we can take you to the operating room and do this, or we cannot, and the results are the same. Everyone's going to say, let's do the knot.↗
▶Ep 2 · 17:34
clinicalBoth the Kansas City trial and Great Ormond Street study found a 1 in 6 (approximately 16%) failure rate for fibrinolysis.↗
▶Ep 2 · 19:14
clinicalThere was no difference in operative time or blood loss for VATS performed after failed fibrinolysis compared to primary VATS.↗
▶Ep 2 · 19:14
clinicalIn 100 consecutive patients treated with fibrinolysis after the trial, results remained consistent with a 15% failure rate and similar length of stay.↗
▶Ep 2 · 20:26
clinicalPlacing a chest tube in the operating room with sedation but without intubation and positive pressure ventilation preserves some advantages of the non-operative approach.↗
▶Ep 2 · 23:14
clinicalChest X-rays are not useful for daily monitoring or determining fibrinolysis failure, as the radiographic appearance remains poor even after successful treatment.↗
▶Ep 2 · 23:58
clinicalFailure of fibrinolysis is defined clinically by persistent illness (oxygen requirement, poor feeding) at 3-4 days, not by fever alone.↗
▶Ep 2 · 26:42
clinicalA second round of fibrinolysis is indicated only when the chest tube is walled off and a separate collection exists that was not in continuity with the initial tube placement.↗
▶Ep 2 · 26:53
clinicalExtensive pulmonary necrosis is an absolute contraindication to surgical intervention, as manipulation of necrotic lung risks severe complications including bronchopleural fistula.↗
▶Ep 2 · 26:53
quotethe the the only way you can get into that bad of a situation is if you're getting into the proximal lung, um, the peripheral lung lesions heal, and that, that's only going to happen if you're operating in the field of necrosis and, and debriding that necrosis↗
▶Ep 2 · 29:11
clinicalDuring VATS for empyema, necrotic lung should be left alone rather than debrided, following the principle of cleaning the pleural space while avoiding lung manipulation.↗
▶Ep 2 · 29:50
clinicalA patient with complete pulmonary necrosis died after needle biopsy, exsanguinating into the wound and bronchi, demonstrating that necrotic lung does not tolerate being touched.↗
▶Ep 2 · 31:21
clinicalA 3-year-old with bilateral pulmonary necrosis survived after nearly one month on VV ECMO with non-operative management and came off ECMO without oxygen requirement.↗
▶Ep 2 · 31:21
quoteI'm convinced that she would have not survived if anybody would have tried to operate on that lung in either side↗
▶Ep 2 · 32:06
clinicalWell-defined peripheral pulmonary abscesses can be drained percutaneously, but multifocal or complex abscesses should be managed conservatively like necrosis.↗
▶Ep 2 · 34:27
clinicalIn the United States, TPA is the only available fibrinolytic agent for empyema since urokinase is not available and streptokinase has come off the market.↗
Empyema with Dr. Shawn St. Peter
▶Ep 3 · 4:40
clinicalMary Anne Jackson, an infectious disease physician, recommended the >10,000 white cell entry criterion for the trial, which initially seemed too soft but proved completely correct.↗
▶Ep 3 · 6:50
clinicalEmpyema is defined by pleural fluid with greater than 10,000 white blood cells, which was the enrollment criterion used in the randomized trial.↗
▶Ep 3 · 7:02
clinicalWhen pleural fluid has >10,000 white cells and the patient undergoes VATS, the pleural space appearance is consistent with typical empyema.↗
▶Ep 3 · 7:39
clinicalThe randomized trial at Children's Mercy compared primary VATS to primary fibrinolysis and found no difference in length of stay, with a 16% failure rate in the fibrinolysis group.↗
▶Ep 3 · 9:40
opinionPatients do not get sicker with fibrinolysis, unlike VATS where barrel trauma to the good lung and manipulation of the bad lung can cause patients to 'fly pretty close to the treetop' postoperatively.↗
clinicalAt Children's Mercy, the average duration of antibiotics was 25 days total with 19 days after becoming afebrile, and 40% of patients had complications from antibiotic therapy including diarrhea and fungal superinfections.↗
▶Ep 3 · 13:00
clinicalRecurrent empyema after successful treatment is extremely rare because the pleural space is typically obliterated (cemented space), making randomized trials of antibiotic duration unfeasible due to zero event rate.↗
▶Ep 3 · 13:00
clinicalThe current antibiotic protocol at Children's Mercy is 7 days after meeting three criteria: completed fibrinolysis, off oxygen, and afebrile. Antibiotics can be switched to oral if the patient is a candidate.↗
▶Ep 3 · 15:16
clinicalUltrasound has no disadvantage compared to CT for diagnosing empyema and identifying pleural stranding, and prospective studies show that placing ultrasound before CT decreases CT utilization without changing outcomes.↗
▶Ep 3 · 16:03
clinicalThe TPA protocol is 4mg mixed in 40mL normal saline, instilled into a 12 French chest tube with 1-hour dwell time, repeated at 24 and 48 hours (three doses total over 48 hours).↗
▶Ep 3 · 17:34
clinicalGreat Ormond Street published a study of 60 patients using urokinase with 4-hour dwell time that found identical results: no difference in length of stay and a 1 in 6 (approximately 16%) failure rate.↗
▶Ep 3 · 18:20
opinionWhen comparing an operation to a non-operative approach, if results are equal, there is no way to recommend the operation and no parent would choose surgery when outcomes are the same.↗
▶Ep 3 · 18:40
quoteif you're getting equal results without requiring an operation, then there's no way you can recommend the operation↗
▶Ep 3 · 19:14
clinicalIn 100 consecutive patients treated with fibrinolysis after the trial, there was no difference in operative time or blood loss for patients who required subsequent VATS compared to primary VATS, contradicting concerns that fibrinolysis makes subsequent surgery more difficult.↗
▶Ep 3 · 19:14
clinicalThree randomized trials totaling 200 patients all show the same results: no difference in length of stay between VATS and fibrinolysis, with 15-16% failure rate for fibrinolysis.↗
▶Ep 3 · 19:14
clinicalA Spanish randomized trial of 100 patients using urokinase found no difference in length of stay and a 15% failure rate, consistent with prior studies.↗
▶Ep 3 · 21:06
clinicalPlacing a 12 French chest tube under ultrasound guidance is less invasive and faster than placing a PICC line, taking less than a minute.↗
▶Ep 3 · 22:20
clinicalIn older children who are not severely tachypneic, chest tube placement can be performed with local anesthetic alone without sedation.↗
▶Ep 3 · 23:25
clinicalDaily chest X-rays after fibrinolysis are not useful because the chest will look bad for quite a while even after completing treatment, and X-ray appearance does not help determine if fibrinolysis has failed.↗
▶Ep 3 · 23:57
clinicalFailure of fibrinolysis should be defined by persistent clinical illness (oxygen requirement, poor feeding) at 3-4 days after treatment, not by fever alone, since fever may be due to parenchymal disease.↗
▶Ep 3 · 26:42
clinicalA second round of fibrinolysis is only indicated when imaging shows a walled-off collection not in continuity with the initial chest tube placement; if the tube is well-positioned and there is persistent pleural disease in continuity with the tube, a second round is not recommended.↗
▶Ep 3 · 26:53
clinicalBronchopleural fistulas only occur when operating in a field of necrosis and debriding that necrosis; peripheral lung lesions heal without this complication.↗
▶Ep 3 · 26:53
clinicalExtensive pulmonary necrosis is an absolute contraindication to surgical intervention because manipulating necrotic lung risks protracted bronchopleural fistulas requiring Heimlich valves for months.↗
▶Ep 3 · 29:11
clinicalDuring VATS for failed fibrinolysis, if the lung appears necrotic (black, necrotic-appearing), it should be left alone and only the pleural space should be debrided.↗
▶Ep 3 · 29:50
clinicalA patient with complete unilateral pulmonary necrosis who underwent needle biopsy died from exsanguination into the wound and bronchi, demonstrating that necrotic lung does not tolerate being touched.↗
▶Ep 3 · 30:50
quotethat lung does not tolerate being touched in that situation↗
▶Ep 3 · 31:21
clinicalA 3-year-old with bilateral pulmonary necrosis requiring VV ECMO for almost a month survived without surgical intervention and left the hospital without oxygen, demonstrating that necrotic lung heals with conservative management.↗
▶Ep 3 · 32:06
clinicalWell-defined peripheral pulmonary abscesses can be drained percutaneously with a drain left in place, but multifocal or complex abscesses should be managed conservatively like necrosis.↗
▶Ep 3 · 33:40
quoteI'm convinced that she would have not survived if anybody would have tried to operate on that lung in either side↗
clinicalIn the United States, TPA is the only available fibrinolytic agent for empyema since urokinase is not available and streptokinase has come off the market.↗
▶Ep 3 · 34:37
clinicalA randomized trial in adults suggested more rapid clearance by adding DNase to fibrinolytic therapy, but DNase is not approved for intrapleural use and requires an IND for pediatric study.↗
Shawn's statements about Epigastric Hernia3 statements
clinicalAt Children's Mercy Kansas City, the approach was modified so that if aspiration doesn't work perfectly, they proceed straight to VATS that same day to avoid prolonged hospital stays of 5-6 days.↗
▶Ep 3 · 5:08
quoteIf it's anything short of perfect, if the aspiration doesn't work, we're going straight to vats that day.↗
▶Ep 3 · 5:14
clinicalThe Children's Mercy approach of proceeding directly to VATS after failed aspiration turns cases into a maximum 2-3 day hospital stay instead of 4-5-6 days with back-and-forth management between water seal and suction.↗
Shawn's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus)7 statements
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 44 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 44 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 44 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 44 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 44 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 44 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 44 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
Shawn's statements about Hirschsprung disease6 statements
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 40 · 4:11
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 40 · 4:11
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 40 · 4:11
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 40 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
▶Ep 40 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
Shawn's statements about Intestinal Rehab7 statements
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 60 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 60 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 60 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 60 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 60 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 60 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 60 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
Shawn's statements about Pectus Excavatum61 statements
clinicalIn a randomized trial of 110 patients comparing epidural to PCA, maximum pain scores did not drop off in the epidural group due to day 2-3 transition pain, whereas PCA group pain decreased over 4.5 days.↗
▶Ep 23 · 4:00
quotethis is the final nail in the coffin for the epidural, because there has to be an advantage to something that is time consuming, is an extra procedure, and imposes risk↗
▶Ep 23 · 6:20
clinicalCryotherapy technique involves freezing ribs 4 through 7 for two minutes per rib; should not go to rib 8 or below due to risk of abdominal wall paralysis.↗
▶Ep 23 · 7:10
quotewhen that patient went home on post-op day one, equipoise was lost↗
▶Ep 23 · 7:20
clinicalIn prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one.↗
▶Ep 23 · 7:55
clinicalWith cryoanalgesia, length of stay that couldn't get below four days became one day, with tight range except for occasional failures that look like traditional four-day stays.↗
▶Ep 23 · 8:30
clinicalMedian morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference.↗
▶Ep 23 · 9:05
quotewhen Samuel had his, it took him two weeks before he could put his own shirt on. And he goes, this morning, Jacob took a shower, put his own shirt on↗
▶Ep 23 · 17:30
quoteif the leap is so big, that how can you then ethically randomize when you already start with such a radical difference in outcome?↗
▶Ep 23 · 18:20
quoteI'm impressed with how many kids have normal sensation, even in the early post-op phase, two, three weeks that they can feel their anterior chest↗
▶Ep 23 · 18:20
clinicalMany patients have normal anterior chest sensation even in early post-op phase (two to three weeks) after cryoanalgesia, suggesting nerve stunning rather than complete death.↗
▶Ep 23 · 19:00
epidemiologicalAdult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage.↗
▶Ep 23 · 29:24
clinicalActivity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey.↗
opinionWhen bars flip, it is always technical - related to bar sitting in funky inner space, bad spot, not wrapped tight enough, or not secured well - not related to patient activity or pain modality.↗
▶Ep 23 · 31:00
quoteYou go back to the OR and you'll find a reason why it flipped and it's not the patient↗
▶Ep 23 · 39:16
epidemiologicalIn updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience.↗
▶Ep 23 · 43:20
clinicalSub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis.↗
▶Ep 23 · 59:24
clinicalIn 15-patient magnetic repair trial, magnets were safe to place in children's chests and well-tolerated, but results were not as effective as hoped; appears most effective in young children with flexible chests.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 25 · 1:07
clinicalDr. Saint Peter's institution completed a randomized trial of 110 patients comparing epidural to PCA for pectus excavatum pain control, and epidurals did not show superior performance.↗
▶Ep 25 · 1:07
quoteWe, of course, struggled with post-operative pain management as everybody did, and we had completed a randomized trial, 110 patients to epidural and PCA.↗
▶Ep 25 · 1:07
quoteWe, of course, struggled with post-operative pain management as everybody did, and we had completed a randomized trial, 110 patients to epidural and PCA.↗
▶Ep 25 · 1:07
clinicalDr. Saint Peter's institution completed a randomized trial of 110 patients comparing epidural to PCA for pectus excavatum pain control, and epidurals did not show superior performance.↗
▶Ep 25 · 1:32
clinicalIn Dr. Saint Peter's cryoanalgesia trial with approximately 30 patients per group, equipoise was lost when patients went home on post-op day one.↗
▶Ep 25 · 1:32
clinicalIn Dr. Saint Peter's cryoanalgesia trial with approximately 30 patients per group, equipoise was lost when patients went home on post-op day one.↗
▶Ep 25 · 1:33
quoteWe had about 30 patients in each group when we tried the cryotherapy and when that patient went home on post-op day one, equipoise was lost.↗
▶Ep 25 · 1:33
quoteWe had about 30 patients in each group when we tried the cryotherapy and when that patient went home on post-op day one, equipoise was lost.↗
▶Ep 25 · 1:42
quoteOnce you, once you see it, it's, it's sort of a different game.↗
▶Ep 25 · 1:42
quoteOnce you, once you see it, it's, it's sort of a different game.↗
▶Ep 25 · 2:10
clinicalThe cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7.↗
▶Ep 25 · 2:10
clinicalThe cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7.↗
▶Ep 25 · 2:19
quoteYou literally just count down to the 4th rib and then freeze underneath it.↗
▶Ep 25 · 2:19
quoteYou literally just count down to the 4th rib and then freeze underneath it.↗
clinicalCryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis.↗
▶Ep 25 · 2:29
quoteYou're not supposed to go 8 or below because you can get some abdominal wall paralysis.↗
▶Ep 25 · 2:29
quoteYou're not supposed to go 8 or below because you can get some abdominal wall paralysis.↗
▶Ep 25 · 2:29
clinicalCryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis.↗
▶Ep 25 · 2:37
quoteWhat we saw there is the length of stay where we just couldn't get below 4 days, all of a sudden became 1.↗
▶Ep 25 · 2:37
clinicalWith cryoanalgesia, hospital length of stay decreased from 4 days to 1 day at Dr. Saint Peter's institution.↗
▶Ep 25 · 2:37
quoteWhat we saw there is the length of stay where we just couldn't get below 4 days, all of a sudden became 1.↗
▶Ep 25 · 2:37
clinicalWith cryoanalgesia, hospital length of stay decreased from 4 days to 1 day at Dr. Saint Peter's institution.↗
▶Ep 25 · 2:46
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches.↗
▶Ep 25 · 2:46
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches.↗
▶Ep 25 · 6:39
quoteSo typically if bars are going to flip, they're going to flip early and it's going to be because they were sitting in a in a funky inner space.↗
▶Ep 25 · 6:39
clinicalBar flippage typically occurs early and is caused by the bar sitting in a funky interspace, sitting in a bad spot, not being wrapped tight enough, or not being secured well.↗
▶Ep 25 · 6:39
quoteSo typically if bars are going to flip, they're going to flip early and it's going to be because they were sitting in a in a funky inner space.↗
▶Ep 25 · 6:39
clinicalBar flippage typically occurs early and is caused by the bar sitting in a funky interspace, sitting in a bad spot, not being wrapped tight enough, or not being secured well.↗
▶Ep 25 · 6:54
quoteThat bar's got to sit in a comfortable position before you start to secure it or it's probably not going to stay there.↗
▶Ep 25 · 6:54
clinicalThe bar must sit in a comfortable position before securing or it will not stay in place; securing alone does not prevent bar flippage.↗
▶Ep 25 · 6:54
clinicalThe bar must sit in a comfortable position before securing or it will not stay in place; securing alone does not prevent bar flippage.↗
▶Ep 25 · 6:54
quoteThat bar's got to sit in a comfortable position before you start to secure it or it's probably not going to stay there.↗
▶Ep 25 · 8:50
clinicalDr. Saint Peter continues to use subxiphoid incision along with thoracoscopy, sternal elevator, or vacuum bell in the operating room as safety techniques to avoid cardiac injury.↗
▶Ep 25 · 8:50
clinicalDr. Saint Peter continues to use subxiphoid incision along with thoracoscopy, sternal elevator, or vacuum bell in the operating room as safety techniques to avoid cardiac injury.↗
▶Ep 25 · 9:05
quoteThe idea is to Uh, not injure the heart. So whatever technique helps you do that, I, I think is the technique you ought to use.↗
▶Ep 25 · 9:05
opinionDr. Holcomb's principle is that whatever technique helps avoid injuring the heart is the technique that should be used.↗
▶Ep 25 · 9:54
clinicalOne surgeon learned left to right but switched to right to left and found it easier, particularly when using external elevator and thoracoscopy for safety.↗
▶Ep 25 · 9:54
clinicalOne surgeon learned left to right but switched to right to left and found it easier, particularly when using external elevator and thoracoscopy for safety.↗
▶Ep 25 · 10:12
opinionDirection of bar passage is likely surgeon preference and does not make much difference as long as the substernal space is well dissected and everything is clear.↗
▶Ep 25 · 10:12
opinionDirection of bar passage is likely surgeon preference and does not make much difference as long as the substernal space is well dissected and everything is clear.↗
Shawn's statements about Perforated Appendicitis7 statements
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 2 · 7:04
quoteI would be remiss not to mention that we were one of the two hospitals that were in this trial and we did not see a difference in abscess rate in our cohort. So the overall group was swayed entirely by Phoenix's experience.↗
▶Ep 2 · 7:04
clinicalOne participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.↗
▶Ep 2 · 7:45
epidemiologicalNSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.↗
▶Ep 2 · 12:09
quoteI don't think it's binary, so I don't think it's going to be something that we're going to be able to answer as a yes or no.↗
▶Ep 2 · 12:40
clinicalIn the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.↗
▶Ep 2 · 12:50
quoteMost of these patients went to laparotomy shortly after drain placement, so that also kind of convolutes it.↗
▶Ep 2 · 13:42
opinionPeritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.↗
clinicalMary Anne Jackson, an infectious disease physician, recommended the >10,000 white cell entry criterion for the trial, which initially seemed too soft but proved completely correct.↗
▶Ep 3 · 6:50
clinicalEmpyema is defined by pleural fluid with greater than 10,000 white blood cells, which was the enrollment criterion used in the randomized trial.↗
▶Ep 3 · 7:02
clinicalWhen pleural fluid has >10,000 white cells and the patient undergoes VATS, the pleural space appearance is consistent with typical empyema.↗
▶Ep 3 · 7:39
clinicalThe randomized trial at Children's Mercy compared primary VATS to primary fibrinolysis and found no difference in length of stay, with a 16% failure rate in the fibrinolysis group.↗
▶Ep 3 · 9:40
opinionPatients do not get sicker with fibrinolysis, unlike VATS where barrel trauma to the good lung and manipulation of the bad lung can cause patients to 'fly pretty close to the treetop' postoperatively.↗
clinicalAt Children's Mercy, the average duration of antibiotics was 25 days total with 19 days after becoming afebrile, and 40% of patients had complications from antibiotic therapy including diarrhea and fungal superinfections.↗
▶Ep 3 · 13:00
clinicalThe current antibiotic protocol at Children's Mercy is 7 days after meeting three criteria: completed fibrinolysis, off oxygen, and afebrile. Antibiotics can be switched to oral if the patient is a candidate.↗
▶Ep 3 · 13:00
clinicalRecurrent empyema after successful treatment is extremely rare because the pleural space is typically obliterated (cemented space), making randomized trials of antibiotic duration unfeasible due to zero event rate.↗
▶Ep 3 · 15:16
clinicalUltrasound has no disadvantage compared to CT for diagnosing empyema and identifying pleural stranding, and prospective studies show that placing ultrasound before CT decreases CT utilization without changing outcomes.↗
▶Ep 3 · 16:03
clinicalThe TPA protocol is 4mg mixed in 40mL normal saline, instilled into a 12 French chest tube with 1-hour dwell time, repeated at 24 and 48 hours (three doses total over 48 hours).↗
▶Ep 3 · 17:34
clinicalGreat Ormond Street published a study of 60 patients using urokinase with 4-hour dwell time that found identical results: no difference in length of stay and a 1 in 6 (approximately 16%) failure rate.↗
▶Ep 3 · 18:20
opinionWhen comparing an operation to a non-operative approach, if results are equal, there is no way to recommend the operation and no parent would choose surgery when outcomes are the same.↗
▶Ep 3 · 18:40
quoteif you're getting equal results without requiring an operation, then there's no way you can recommend the operation↗
▶Ep 3 · 19:14
clinicalA Spanish randomized trial of 100 patients using urokinase found no difference in length of stay and a 15% failure rate, consistent with prior studies.↗
▶Ep 3 · 19:14
clinicalIn 100 consecutive patients treated with fibrinolysis after the trial, there was no difference in operative time or blood loss for patients who required subsequent VATS compared to primary VATS, contradicting concerns that fibrinolysis makes subsequent surgery more difficult.↗
▶Ep 3 · 19:14
clinicalThree randomized trials totaling 200 patients all show the same results: no difference in length of stay between VATS and fibrinolysis, with 15-16% failure rate for fibrinolysis.↗
▶Ep 3 · 21:06
clinicalPlacing a 12 French chest tube under ultrasound guidance is less invasive and faster than placing a PICC line, taking less than a minute.↗
▶Ep 3 · 22:20
clinicalIn older children who are not severely tachypneic, chest tube placement can be performed with local anesthetic alone without sedation.↗
▶Ep 3 · 23:25
clinicalDaily chest X-rays after fibrinolysis are not useful because the chest will look bad for quite a while even after completing treatment, and X-ray appearance does not help determine if fibrinolysis has failed.↗
▶Ep 3 · 23:57
clinicalFailure of fibrinolysis should be defined by persistent clinical illness (oxygen requirement, poor feeding) at 3-4 days after treatment, not by fever alone, since fever may be due to parenchymal disease.↗
▶Ep 3 · 26:42
clinicalA second round of fibrinolysis is only indicated when imaging shows a walled-off collection not in continuity with the initial chest tube placement; if the tube is well-positioned and there is persistent pleural disease in continuity with the tube, a second round is not recommended.↗
▶Ep 3 · 26:53
clinicalExtensive pulmonary necrosis is an absolute contraindication to surgical intervention because manipulating necrotic lung risks protracted bronchopleural fistulas requiring Heimlich valves for months.↗
▶Ep 3 · 26:53
clinicalBronchopleural fistulas only occur when operating in a field of necrosis and debriding that necrosis; peripheral lung lesions heal without this complication.↗
▶Ep 3 · 29:11
clinicalDuring VATS for failed fibrinolysis, if the lung appears necrotic (black, necrotic-appearing), it should be left alone and only the pleural space should be debrided.↗
▶Ep 3 · 29:50
clinicalA patient with complete unilateral pulmonary necrosis who underwent needle biopsy died from exsanguination into the wound and bronchi, demonstrating that necrotic lung does not tolerate being touched.↗
▶Ep 3 · 30:50
quotethat lung does not tolerate being touched in that situation↗
▶Ep 3 · 31:21
clinicalA 3-year-old with bilateral pulmonary necrosis requiring VV ECMO for almost a month survived without surgical intervention and left the hospital without oxygen, demonstrating that necrotic lung heals with conservative management.↗
▶Ep 3 · 32:06
clinicalWell-defined peripheral pulmonary abscesses can be drained percutaneously with a drain left in place, but multifocal or complex abscesses should be managed conservatively like necrosis.↗
▶Ep 3 · 33:40
quoteI'm convinced that she would have not survived if anybody would have tried to operate on that lung in either side↗
clinicalIn the United States, TPA is the only available fibrinolytic agent for empyema since urokinase is not available and streptokinase has come off the market.↗
▶Ep 3 · 34:37
clinicalA randomized trial in adults suggested more rapid clearance by adding DNase to fibrinolytic therapy, but DNase is not approved for intrapleural use and requires an IND for pediatric study.↗
Shawn's statements about Primary Spontaneous Pneumothorax2 statements
Journal of Pediatric Surgery Article REview: August Issue 2023
▶Ep 4 · 6:15
quoteSo we agreed as an institution, if they have a normal looking chest X-ray, then they get to go home. If they don't, they get booked for next case like a nappy. Then we just take the clamp off, let it drain. And they get booked for the next available OR.↗
▶Ep 4 · 7:38
clinicalThe entire treatment algorithm for spontaneous pneumothorax is split upon whether the patient is actively leaking air or had a bleb that popped and sealed↗
Shawn's statements about Rectal Prolapse3 statements
opinionSclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes.↗
▶Ep 3 · 4:11
quoteI've got a low threshold for starting with sclerotherapy because it's, it's simple, it's innocuous, and then sometimes they just need that head start, particularly in that last case with a younger kid. They just need that window of a couple of months to not have a prolapse, and then they start seeing it less frequently.↗
▶Ep 3 · 4:28
clinicalDr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between.↗
Shawn's statements about Shortness of Breath On Exertion20 statements
clinicalDr. Saint Peter's institution completed a randomized trial of 110 patients comparing epidural to PCA for pectus excavatum pain control, and epidurals did not show superior performance.↗
▶Ep 1 · 1:07
quoteWe, of course, struggled with post-operative pain management as everybody did, and we had completed a randomized trial, 110 patients to epidural and PCA.↗
▶Ep 1 · 1:32
clinicalIn Dr. Saint Peter's cryoanalgesia trial with approximately 30 patients per group, equipoise was lost when patients went home on post-op day one.↗
▶Ep 1 · 1:33
quoteWe had about 30 patients in each group when we tried the cryotherapy and when that patient went home on post-op day one, equipoise was lost.↗
▶Ep 1 · 1:42
quoteOnce you, once you see it, it's, it's sort of a different game.↗
▶Ep 1 · 2:10
clinicalThe cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7.↗
▶Ep 1 · 2:19
quoteYou literally just count down to the 4th rib and then freeze underneath it.↗
clinicalCryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis.↗
▶Ep 1 · 2:29
quoteYou're not supposed to go 8 or below because you can get some abdominal wall paralysis.↗
▶Ep 1 · 2:37
quoteWhat we saw there is the length of stay where we just couldn't get below 4 days, all of a sudden became 1.↗
▶Ep 1 · 2:37
clinicalWith cryoanalgesia, hospital length of stay decreased from 4 days to 1 day at Dr. Saint Peter's institution.↗
▶Ep 1 · 2:46
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches.↗
▶Ep 1 · 6:39
quoteSo typically if bars are going to flip, they're going to flip early and it's going to be because they were sitting in a in a funky inner space.↗
▶Ep 1 · 6:39
clinicalBar flippage typically occurs early and is caused by the bar sitting in a funky interspace, sitting in a bad spot, not being wrapped tight enough, or not being secured well.↗
▶Ep 1 · 6:54
quoteThat bar's got to sit in a comfortable position before you start to secure it or it's probably not going to stay there.↗
▶Ep 1 · 6:54
clinicalThe bar must sit in a comfortable position before securing or it will not stay in place; securing alone does not prevent bar flippage.↗
▶Ep 1 · 8:50
clinicalDr. Saint Peter continues to use subxiphoid incision along with thoracoscopy, sternal elevator, or vacuum bell in the operating room as safety techniques to avoid cardiac injury.↗
▶Ep 1 · 9:54
clinicalOne surgeon learned left to right but switched to right to left and found it easier, particularly when using external elevator and thoracoscopy for safety.↗
▶Ep 1 · 10:12
opinionDirection of bar passage is likely surgeon preference and does not make much difference as long as the substernal space is well dissected and everything is clear.↗
Shawn's statements about Slipping Rib Syndrome2 statements
Journal of Pediatric Surgery Article REview: August Issue 2023
▶Ep 2 · 6:15
quoteSo we agreed as an institution, if they have a normal looking chest X-ray, then they get to go home. If they don't, they get booked for next case like a nappy. Then we just take the clamp off, let it drain. And they get booked for the next available OR.↗
▶Ep 2 · 7:38
clinicalThe entire treatment algorithm for spontaneous pneumothorax is split upon whether the patient is actively leaking air or had a bleb that popped and sealed↗
Shawn's statements about Spontaneous Pneumothorax20 statements
clinicalAt Children's Mercy Kansas City, the approach was modified so that if aspiration doesn't work perfectly, they proceed straight to VATS that same day to avoid prolonged hospital stays of 5-6 days.↗
▶Ep 10 · 5:08
quoteIf it's anything short of perfect, if the aspiration doesn't work, we're going straight to vats that day.↗
▶Ep 10 · 5:14
clinicalThe Children's Mercy approach of proceeding directly to VATS after failed aspiration turns cases into a maximum 2-3 day hospital stay instead of 4-5-6 days with back-and-forth management between water seal and suction.↗
Update Course Rewind 2021 - Updates in Pectus
▶Ep 11 · 3:27
clinicalIn a randomized trial of 110 patients comparing epidural to PCA, maximum pain scores did not drop off in the epidural group due to day 2-3 transition pain, whereas PCA group pain decreased over 4.5 days.↗
▶Ep 11 · 6:20
clinicalCryotherapy technique involves freezing ribs 4 through 7 for two minutes per rib; should not go to rib 8 or below due to risk of abdominal wall paralysis.↗
▶Ep 11 · 7:10
quotewhen that patient went home on post-op day one, equipoise was lost↗
▶Ep 11 · 7:20
clinicalIn prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one.↗
▶Ep 11 · 7:55
clinicalWith cryoanalgesia, length of stay that couldn't get below four days became one day, with tight range except for occasional failures that look like traditional four-day stays.↗
▶Ep 11 · 8:30
clinicalMedian morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference.↗
▶Ep 11 · 17:30
quoteif the leap is so big, that how can you then ethically randomize when you already start with such a radical difference in outcome?↗
▶Ep 11 · 18:20
clinicalMany patients have normal anterior chest sensation even in early post-op phase (two to three weeks) after cryoanalgesia, suggesting nerve stunning rather than complete death.↗
▶Ep 11 · 18:20
quoteI'm impressed with how many kids have normal sensation, even in the early post-op phase, two, three weeks that they can feel their anterior chest↗
▶Ep 11 · 19:00
epidemiologicalAdult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage.↗
▶Ep 11 · 29:24
clinicalActivity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey.↗
▶Ep 11 · 30:50
opinionWhen bars flip, it is always technical - related to bar sitting in funky inner space, bad spot, not wrapped tight enough, or not secured well - not related to patient activity or pain modality.↗
quoteYou go back to the OR and you'll find a reason why it flipped and it's not the patient↗
▶Ep 11 · 39:16
epidemiologicalIn updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience.↗
▶Ep 11 · 43:20
clinicalSub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis.↗
▶Ep 11 · 59:24
clinicalIn 15-patient magnetic repair trial, magnets were safe to place in children's chests and well-tolerated, but results were not as effective as hoped; appears most effective in young children with flexible chests.↗
Shawn's statements about Spontaneous Pneumothorax17 statements
clinicalIn a randomized trial of 110 patients comparing epidural to PCA, maximum pain scores did not drop off in the epidural group due to day 2-3 transition pain, whereas PCA group pain decreased over 4.5 days.↗
▶Ep 8 · 6:20
clinicalCryotherapy technique involves freezing ribs 4 through 7 for two minutes per rib; should not go to rib 8 or below due to risk of abdominal wall paralysis.↗
▶Ep 8 · 7:10
quotewhen that patient went home on post-op day one, equipoise was lost↗
▶Ep 8 · 7:20
clinicalIn prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one.↗
▶Ep 8 · 7:55
clinicalWith cryoanalgesia, length of stay that couldn't get below four days became one day, with tight range except for occasional failures that look like traditional four-day stays.↗
▶Ep 8 · 8:30
clinicalMedian morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference.↗
▶Ep 8 · 17:30
quoteif the leap is so big, that how can you then ethically randomize when you already start with such a radical difference in outcome?↗
▶Ep 8 · 18:20
clinicalMany patients have normal anterior chest sensation even in early post-op phase (two to three weeks) after cryoanalgesia, suggesting nerve stunning rather than complete death.↗
▶Ep 8 · 18:20
quoteI'm impressed with how many kids have normal sensation, even in the early post-op phase, two, three weeks that they can feel their anterior chest↗
▶Ep 8 · 19:00
epidemiologicalAdult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage.↗
▶Ep 8 · 29:24
clinicalActivity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey.↗
opinionWhen bars flip, it is always technical - related to bar sitting in funky inner space, bad spot, not wrapped tight enough, or not secured well - not related to patient activity or pain modality.↗
▶Ep 8 · 31:00
quoteYou go back to the OR and you'll find a reason why it flipped and it's not the patient↗
▶Ep 8 · 39:16
epidemiologicalIn updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience.↗
▶Ep 8 · 43:20
clinicalSub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis.↗
▶Ep 8 · 59:24
clinicalIn 15-patient magnetic repair trial, magnets were safe to place in children's chests and well-tolerated, but results were not as effective as hoped; appears most effective in young children with flexible chests.↗
Summaries Shawn gave as host
· 26 summaries
Recaps of other experts' statements, not Shawn's own clinical position.
host summaryShawn St. Peter summarizing a resource: Mary Anne Jackson, an infectious disease specialist, recommended the 10,000 white cell threshold as an entry criterion for the trial, which proved accurate.↗
▶Ep 2 · 5:10
host summaryShawn St. Peter summarizing a resource: Ted Carter and colleagues in Seattle proposed an algorithm categorizing effusions as small (<25%), moderate (25-50%), or large (>50%), with symptomatic versus asymptomatic branches.↗
▶Ep 2 · 11:09
host summaryShawn St. Peter summarizing a resource: The IDSA community-acquired pneumonia guidelines recommend 10 days of antibiotics after being afebrile, but this is a grade D recommendation based on no data.↗
▶Ep 2 · 15:08
host summaryShawn St. Peter summarizing a resource: Ultrasound has no disadvantage compared to CT for diagnosing pleural disease and identifying septations in empyema.↗
▶Ep 2 · 19:14
host summaryShawn St. Peter summarizing a resource: A Spanish randomized trial of 100 patients using urokinase found no difference in length of stay and a 15% failure rate, confirming earlier findings.↗
▶Ep 2 · 34:27
host summaryShawn St. Peter summarizing a resource: An adult randomized trial suggested adding DNase to TPA may provide more rapid clearance, but DNase requires an investigational new drug (IND) application for intrapleural use.↗
Empyema with Dr. Shawn St. Peter
▶Ep 3 · 5:10
host summaryShawn St. Peter summarizing a resource: Ted Carter and colleagues from Seattle proposed an algorithm for pleural effusions categorizing them as small (<25%), moderate (25-50%), or large (>50%), with symptomatic versus asymptomatic branches under each category.↗
▶Ep 3 · 11:20
host summaryShawn St. Peter summarizing a resource: The IDSA community-acquired pneumonia guidelines recommend 10 days of antibiotics after becoming afebrile, but this is a grade D recommendation based on no data.↗
Summaries Shawn gave as host · Pectus Excavatum2 summaries
host summaryShawn St. Peter summarizing the discussion: The idea is to Uh, not injure the heart. So whatever technique helps you do that, I, I think is the technique you ought to use.↗
▶Ep 25 · 9:05
host summaryShawn St. Peter summarizing the discussion: Dr. Holcomb's principle is that whatever technique helps avoid injuring the heart is the technique that should be used.↗
Summaries Shawn gave as host · Pneumonia2 summaries
host summaryShawn St. Peter summarizing a resource: Ted Carter and colleagues from Seattle proposed an algorithm for pleural effusions categorizing them as small (<25%), moderate (25-50%), or large (>50%), with symptomatic versus asymptomatic branches under each category.↗
▶Ep 3 · 11:20
host summaryShawn St. Peter summarizing a resource: The IDSA community-acquired pneumonia guidelines recommend 10 days of antibiotics after becoming afebrile, but this is a grade D recommendation based on no data.↗
Summaries Shawn gave as host · Primary Spontaneous Pneumothorax4 summaries
Journal of Pediatric Surgery Article REview: August Issue 2023
▶Ep 4 · 6:15
host summaryShawn St. Peter summarizing the discussion: Simple aspiration was successful in 33% of children with primary spontaneous pneumothorax↗
▶Ep 4 · 6:15
host summaryShawn St. Peter summarizing the discussion: Median length of stay after VATS for pneumothorax was 3 days↗
▶Ep 4 · 6:15
host summaryShawn St. Peter summarizing the discussion: Median length of stay with successful aspiration for pneumothorax was 20 hours (less than a day)↗
▶Ep 4 · 6:15
host summaryShawn St. Peter summarizing the discussion: 66% of children with primary spontaneous pneumothorax still required VATS after aspiration↗
Summaries Shawn gave as host · Shortness of Breath On Exertion2 summaries
host summaryShawn St. Peter summarizing the discussion: The idea is to Uh, not injure the heart. So whatever technique helps you do that, I, I think is the technique you ought to use.↗
▶Ep 1 · 9:05
host summaryShawn St. Peter summarizing the discussion: Dr. Holcomb's principle is that whatever technique helps avoid injuring the heart is the technique that should be used.↗
Summaries Shawn gave as host · Slipping Rib Syndrome4 summaries
Journal of Pediatric Surgery Article REview: August Issue 2023
▶Ep 2 · 6:15
host summaryShawn St. Peter summarizing the discussion: Median length of stay after VATS for pneumothorax was 3 days↗
▶Ep 2 · 6:15
host summaryShawn St. Peter summarizing the discussion: Median length of stay with successful aspiration for pneumothorax was 20 hours (less than a day)↗
▶Ep 2 · 6:15
host summaryShawn St. Peter summarizing the discussion: 66% of children with primary spontaneous pneumothorax still required VATS after aspiration↗
▶Ep 2 · 6:15
host summaryShawn St. Peter summarizing the discussion: Simple aspiration was successful in 33% of children with primary spontaneous pneumothorax↗
Summaries Shawn gave as host · Spontaneous Pneumothorax2 summaries
host summaryShawn St. Peter summarizing the discussion: this is the final nail in the coffin for the epidural, because there has to be an advantage to something that is time consuming, is an extra procedure, and imposes risk↗
▶Ep 8 · 9:05
host summaryShawn St. Peter summarizing the discussion: when Samuel had his, it took him two weeks before he could put his own shirt on. And he goes, this morning, Jacob took a shower, put his own shirt on↗
Summaries Shawn gave as host · Spontaneous Pneumothorax2 summaries
host summaryShawn St. Peter summarizing the discussion: this is the final nail in the coffin for the epidural, because there has to be an advantage to something that is time consuming, is an extra procedure, and imposes risk↗
▶Ep 11 · 9:05
host summaryShawn St. Peter summarizing the discussion: when Samuel had his, it took him two weeks before he could put his own shirt on. And he goes, this morning, Jacob took a shower, put his own shirt on↗
