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Spontaneous Pneumothorax
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
When 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. — Shawn St. Peter, Update Course Rewind 2021 - Updates in Pectus · 30:50
Thoracoscopic Treatment of Spontaneous Pneumothorax
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video3:16 · Feb 2020
Thoracoscopic Treatment of Spontaneous Pneumothorax
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video3:16 · Feb 2020
Update Course Rewind 2021 - Updates in Pectus
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In this session from the 2021 Update Course, Dr. Steven Lee, MD presents updates in the perioperative care of patient with pectus excavatum including perioperative pain control, Nuss bar length measurements, right vs left approach, and much
video1:01:14 · May 2022
BOB in Ped Surg 2023 - PAPS Winner - Jamie Schnuck, MD
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Watch the PAPS winner, Jamie Schnuck, MD, present her presentation on "Chest tube management following lung resection in pediatric patients: a retrospective analysis."
video · Feb 2023
BOB Ped Surg 2023 - Jamie Schnuck, PAPS - Presentation
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Watch Jamie Schnuck, MD, present her presentation on "Chest tube management following lung resection in pediatric patients: a retrospective analysis."
video · Feb 2023
Traditional ATLS teaching was to give two 20cc/kg boluses of crystalloid before giving blood, but this is now changing to earlier blood administration. — Todd Ponsky, Todd Ponsky: What is new in Pediatric Surgery? Teaser · 23:53
Spontaneous Pneumothorax Rapid Fire: Update Course 2015
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Dr. Samir Pandya, Assistant Professor, Department of Surgery, Children's and Women's Physicians of Westchester, presents on spontaneous pneumothorax. He discusses pneumothorax size, thoracentesis reoccurrence, and pleurodesis versus fibrin
video9:45 · Jan 2019
Aspiration Test Predicts Need for Operation in Pediatric Spontaneous...
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Dr. Daniel von Allmen discusses a possible shift in management for patients with spontaneous pneumothorax, as he summarizes "Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax" from the Journal of Pediatric S
video · Feb 2020
What's New in Pediatric Surgery 2020 - FULL SHOW
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Cincinnati Children’s Hospital, in partnership with the Journal of Pediatric Surgery, hosted a live interactive session where we discussed some of the top practice-changing publications of 2020
video57:41 · Oct 2020
Spontaneous Pneumothorax
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This podcast is an interactive discussion about the management of spontaneous pneumothorax between Dr. Todd Ponsky and Dr. Dan Ostlie. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmi
podcast33:31 · Dec 2020
Management of Primary Spontaneous Pneumothorax in Children
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New article you should know about by Dr. Cecilia Gigena
"Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis"
Authors: Shai Stewart, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, Davi
video · Sep 2023
Manejo del neumotórax primario espontáneo en niños
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Nuevo artículo que debes conocer de la Dra. Cecilia Gigena
"Manejo del neumotórax primario espontáneo en niños: análisis del protocolo de una sola institución"
Autores: Shai Stewart, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, D
video · Sep 2023
Todd Ponsky: What is new in Pediatric Surgery? Teaser
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video1:05:21 · Jun 2026
Mechanical pleurodesis works effectively by causing only the apex of the lung to adhere, which may be sufficient to prevent tension pneumothorax without freezing the entire chest. — Mark McCollum, Supine Positioning for Bilateral VATS: Pediatric Surgery Difficult... · 14:45
Supine Positioning for Bilateral VATS: Pediatric Surgery Difficult...
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During the Pediatric Surgery Tricks of the Trade and Difficult Cases: Innovative Solutions to Common Problems Course in 2013, Dr. Nick Bruns presents a clinical case of supine positioning for bilateral video-assisted thorascopic surgery (VA
video15:50 · Sep 2018
Tricks - Supine Positioning For Bilateral VATS
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Dr. Nick Bruns gives a presentation of a clinical case of supine positioning for bilateral video-assisted thorascopic surgery (VATS). Dr. Brun's demonstration includes topics of open thoracotomy versus VATS, pleurodesis, blood patch techniq
video17:04 · Nov 2018
The consequences of talc pleurodesis are so bad should a patient ever need a chest operation on that side that there's no justification for it. — Steve, Update Course 2021: PNEUMOTHORAX · 23:14
Spontaneous Pneumothorax: Update Course 2014
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Dr. Dan Ostlie, Division of Pediatric Surgery, American Family Children's Hospital, presents on spontaneous pneumothorax. He discusses initial diagnostic evaluation, and different treatment options, including chest tube insertion, VATS, and
video15:59 · Jan 2019
Update Course Rewind: Spontaneous Pneumothorax 2021
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We've seen a lot of recent updates about the management of primary spontaneous pneumothoraces. At the recent 2021 Pediatric Surgery Update Course, Dr. Ronnie Sullins reviewed the latest literature. And now we're giving you the highlights in
video · Oct 2021
Update Course 2021: PNEUMOTHORAX
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We've seen a lot of recent updates about the management of primary spontaneous pneumothoraces. At the recent 2021 Pediatric Surgery Update Course, Dr. Ronnie Sullins, MD reviewed the latest literature regarding conservative management for p
video · May 2022
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Update Course Rewind 2021 - Updates in Pectus
In 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.
clinicalShawn St. Peter3:27 ↗
Cryotherapy 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.
clinicalShawn St. Peter6:20 ↗
In prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one.
clinicalShawn St. Peter7:20 ↗
With 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.
clinicalShawn St. Peter7:55 ↗
Median morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference.
clinicalShawn St. Peter8:30 ↗
Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs.
guidelineVictor Garcia10:40 ↗
Cryotherapy devices received FDA approval via 510(k) predicate pathway based on similarity to devices from 1976, not based on clinical trials.
guidelineVictor Garcia14:10 ↗
With erector spinae catheters, hospital stay is two days with reduced opioid requirements both in-hospital and post-discharge.
clinicalVictor Garcia28:20 ↗
When 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.
opinionShawn St. Peter30:50 ↗
Activity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey.
clinicalShawn St. Peter29:24 ↗
In Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure.
Host summaryJustin Wagner summarizing the discussion — not the host's own clinical position24:10 ↗
In past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements.
Host summaryJustin Wagner summarizing the discussion — not the host's own clinical position24:40 ↗
In Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week.
Host summaryJustin Wagner summarizing the discussion — not the host's own clinical position25:20 ↗
In Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group.
Host summaryJustin Wagner summarizing the discussion — not the host's own clinical position26:00 ↗
Bar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group.
Host summaryJustin Wagner summarizing the discussion — not the host's own clinical position26:25 ↗
In randomized epidural trial, epidural could either not be placed or was removed after one day in approximately 25% of patients.
Host summaryWhit summarizing the discussion — not the host's own clinical position26:55 ↗
Adult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage.
epidemiologicalShawn St. Peter19:00 ↗
With cryoanalgesia, 70% of patients go home on post-op day one without narcotics.
clinicalSteven Rothenberg34:00 ↗
Sternal elevator is used in about 10% of cases, primarily in older males with deep, stiff pectus where flexibility is limited.
clinicalSteven Rothenberg45:50 ↗
In updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience.
epidemiologicalShawn St. Peter39:16 ↗
Pilegaard technique uses shorter bars placed asymmetrically with right side covering two rib spaces and left side with single stabilizer, resulting in well below 1% bar flip rate.
Host summaryJustin Wagner summarizing the discussion — not the host's own clinical position37:19 ↗
Computational modeling shows flatter bars focus stress on sternum while bigger curved bars have parasitic forces causing unwanted horizontal and torque action at bar ends.
Host summaryJustin Wagner summarizing the discussion — not the host's own clinical position38:10 ↗
Sub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis.
clinicalShawn St. Peter43:20 ↗
Many 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.
clinicalShawn St. Peter18:20 ↗
Gabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect.
clinicalJustin Wagner22:40 ↗
When passing bar from left chest to right chest, the angle avoids pointing directly at the ventricle compared to right-to-left passage.
clinical41:20 ↗
In 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.
clinicalShawn St. Peter59:24 ↗
Supine Positioning for Bilateral VATS: Pediatric Surgery Difficult...
Lateral decubitus positioning was adopted from the transition from open thoracotomy to VATS but may add unnecessary morbidity including brachial plexus injury and decubitus ulcers.
Host summaryThe host summarizing the discussion — not the host's own clinical position0:03 ↗
The presented case involved a 17-year-old male with asthma presenting with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, followed by a small left spontaneous pneumothorax that resolved with observation.
Host summaryThe host summarizing the discussion — not the host's own clinical position0:30 ↗
Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in supine position with single sterile preparation, reducing operative time.
Host summaryThe host summarizing the discussion — not the host's own clinical position1:30 ↗
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