# DVT — GCMD Library living collection

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

Updated: n/a · 6 episodes · 36 cited statements

## Episodes
### Acute Management
- [Venous Thromboembolism Prophylaxis In Trauma Patients: Practice Gap...](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349) — video · 10:38 · [machine version](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349.md)
- [Update Course Rewind: DVT Prophylaxis 2024](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456) — video · [machine version](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456.md)

### Complications
- [Pediatric Vascular Access](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112) — podcast · 35:43 · [machine version](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112.md)

### Evidence & Research
- [Restrictive Transfusion Policies: 2018 Pediatric Surgery Practice Gap #10](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449) — video · [machine version](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449.md)
- [Journal Club: Review of 2018 Pediatric Surgery Practice Gaps](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603) — video · [machine version](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603.md)
- [APSA 2018 Practice Gaps](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310) — video · [machine version](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310.md)

## Chapters
- [0:00](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=0) Transition from previous topic (Ep 1)
- [0:31](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=31) Case presentation and institutional VTE prophylaxis practices (Ep 1)
- [4:18](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=258) Risk stratification and management algorithm (Ep 1)
- [8:28](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=508) Practical implementation and summary (Ep 1)
- [0:00](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=0) Introduction to APSA Practice Gaps and the 2019 Annual Update Course (Ep 2)
- [1:12](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=72) Practice Gap #10: Restrictive Transfusion Policies (Ep 2)
- [0:00](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=0) Introduction and Practice Gap #10: Restrictive Transfusion Policies (Ep 3)
- [1:35](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=95) Practice Gaps #9-8: Enteral Nutrition in Pancreatitis and Ovarian Torsion (Ep 3)
- [3:11](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=191) Practice Gaps #7-6: VTE Prophylaxis and Physician Wellness (Ep 3)
- [5:20](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=320) Practice Gaps #5-4: Firearm Injury Prevention and Maintenance Fluids (Ep 3)
- [7:51](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=471) Practice Gaps #3-2: Wilms Tumor Protocol and Non-Operative Appendicitis (Ep 3)
- [11:23](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=683) Practice Gap #1: Opioid Crisis and Stewardship (Ep 3)
- [0:00](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=0) Restrictive Transfusion Protocols and Early Enteral Feeding in Pancreatitis (Ep 4)
- [3:20](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=200) Ovarian Torsion Management, VTE Prophylaxis, and Physician Wellness (Ep 4)
- [7:39](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=459) Firearm Injury Prevention Counseling (Ep 4)
- [13:13](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=793) Isotonic Fluid Continuation and Wilms Tumor Lymph Node Sampling (Ep 4)
- [18:03](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1083) Non-Operative Management of Uncomplicated Appendicitis (Ep 4)
- [0:00](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=0) Introduction and series overview (Ep 5)
- [0:38](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=38) Catheter sizing and micro-preemie technique (Ep 5)
- [6:50](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=410) Catheter tip positioning and measurement (Ep 5)
- [10:22](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=622) Ultrasound guidance evidence and technique (Ep 5)
- [14:57](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=897) Device selection for oncology patients (Ep 5)
- [18:17](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1097) Vascular imaging and salvage techniques (Ep 5)
- [21:31](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1291) Site selection and femoral access (Ep 5)
- [23:58](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1438) Coagulopathy management and heparin protocols (Ep 5)
- [27:00](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1620) Ethanol lock for infection prevention and treatment (Ep 5)
- [28:26](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1706) Thoracoscopic salvage access technique (Ep 5)
- [31:17](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1877) Skin preparation and catheter removal (Ep 5)
- [34:48](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=2088) Closing remarks (Ep 5)
- [0:00](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=0) Introduction and case presentation (Ep 6)
- [1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71) Timing and contraindications for chemical DVT prophylaxis (Ep 6)
- [3:34](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=214) Discharge DVT prophylaxis options (Ep 6)
- [5:15](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=315) Summary and conclusions (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Pediatric surgeons historically did not routinely address VTE prophylaxis, with general teaching some time ago being that kids just didn't get this problem. — Todd Ponsky (opinion) [Ep 1 · 0:31](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=31)
- Recognition of pediatric VTE has increased significantly over the last 10-20 years, possibly to the point of overuse (e.g., SCDs for 30-minute inguinal hernia repairs). — Todd Ponsky (opinion) [Ep 1 · 0:31](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=31)
- The Midwest Pediatric Surgery Consortium is conducting a multi-center study (at 11 centers) of a standardized VTE prophylaxis protocol involving chemoprophylaxis with antithrombin 1A, compression devices, and daily ultrasound evaluation. (clinical) [Ep 1 · 2:55](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=175)
- The number of DVT complications in pediatric patients is very small but catastrophic when they occur. (epidemiological) [Ep 1 · 2:55](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=175)
- The vast majority of pediatric DVTs occur around central lines, and all central lines have a fibrin sheath if examined closely. (clinical) [Ep 1 · 3:56](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=236)
- SCDs should be activated prior to induction of anesthesia in the operating room. (guideline) [Ep 1 · 8:30](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=510)
- The Landish article (David Gourlay's article) is probably the best protocol available for pediatric VTE prophylaxis and forms the basis for the MWPSC multi-center study. (opinion) [Ep 1 · 10:00](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=600)
- In micro-preemies (1000g to 2kg), a 3-French soft silastic catheter is preferred because larger catheters as big as the vessel can cause vessel thrombosis. — Mark Wulkan (clinical) [Ep 5 · 1:30](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=90)
- Needle-hole venotomy technique: isolate the internal jugular vein, make a needle hole with the kit needle, and slide the pre-tunneled catheter into that hole without ligating the vein, preserving it for future access. — Mark Wulkan (clinical) [Ep 5 · 2:33](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=153)
- Beveling the catheter end is associated with slightly more catheter thrombosis than cutting straight across, but may be worth it to preserve the vein in micro-preemies. — Mark Wulkan (clinical) [Ep 5 · 3:23](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=203)
- Subcutaneous ports (port-a-cath, meta-port) are used for most intermittent chemotherapy; cuffed lines (Broviac) are used for highly toxic agents like Adriamycin that cause tissue necrosis if infiltrated. — Mark Wulkan (guideline) [Ep 5 · 13:36](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=816)
- Bone marrow transplant patients often require three lumens: a double-lumen perm-cath plus a single-lumen line. — Mark Wulkan (clinical) [Ep 5 · 14:32](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=872)
- The smallest mini-port available is 5-French and can be placed in a 7-8 kg infant, though it requires special order. — Mark Wulkan (clinical) [Ep 5 · 14:57](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=897)
- MRV is the gold standard for pre-operative vascular imaging in patients with multiple prior lines or history of DVT. — Mark Wulkan (guideline) [Ep 5 · 15:34](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=934)
- A glide wire can sometimes pass through venous thrombosis when a standard wire cannot, finding a channel through the clot. — Mark Wulkan (clinical) [Ep 5 · 17:53](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1073)
- Femoral lines in babies often result in leg swelling and DVT, so they are avoided in that population. — Mark Wulkan (clinical) [Ep 5 · 22:03](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1323)
- Institutional heparin lock protocol: 10 units/mL for accessed lines (ports or cuffed lines), 100 units/mL for buried ports, and 1000 units/mL for dialysis catheters (which is withdrawn before use). — Mark Wulkan (guideline) [Ep 5 · 24:40](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1480)
- Ethanol lock therapy has substantially decreased line removal rates and has very high success rates for treating line infections. — Todd Ponsky (clinical) [Ep 5 · 25:31](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1531)
- For gram-positive line infections, ethanol lock plus antibiotics through the catheter can clear the infection; for gram-negative infections, success rate is approximately 50%; for fungal infections (Candida), the line must be removed. — Mark Wulkan (guideline) [Ep 5 · 26:16](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1576)
- Antibiotic-coated and heparin-coated temporary catheters have been shown to decrease catheter-associated bloodstream infection rates. — Mark Wulkan (epidemiological) [Ep 5 · 27:41](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1661)
- Thoracoscopic-guided trans-mediastinal puncture technique: advance a needle through the thrombosed IJ track into the superior vena cava under thoracoscopic visualization; the SVC almost always recanalizes where the azygous vein enters. — Mark Wulkan (clinical) [Ep 5 · 28:26](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1706)
- For thoracoscopic salvage access in larger patients (17-year-old mentioned), the standard kit needle may not be long enough and an extra-long spinal needle is required. — Mark Wulkan (clinical) [Ep 5 · 29:53](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1793)
- There is speculation (without definitive evidence) that betadine exposure causes silicone catheter deterioration, making old lines chalky and difficult to remove. — Mark Wulkan (opinion) [Ep 5 · 31:17](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1877)
- Broviac cuffs placed far from the exit site are designed to break away with slow, steady traction, allowing bedside removal without cuff excision. — Mark Wulkan (clinical) [Ep 5 · 32:46](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1966)
- In 17-18 years of practice, only one retained cuff developed infection requiring incision and drainage. — Mark Wulkan (clinical) [Ep 5 · 33:14](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1994)
- Some hospitals have rewritten protocols so the trauma surgeon, not neurosurgery, decides whether to give DVT prophylaxis (clinical) [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- DVT prophylaxis can be given in solid organ injuries once the patient is stable (clinical) [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- Patients with unstable head injury who may need ICP monitor or craniotomy should probably not receive DVT prophylaxis (clinical) [Ep 6 · 3:34](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=214)
- Aspirin compliance at home is likely better than enoxaparin injections (opinion) [Ep 6 · 3:34](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=214)
- Sickle cell disease is an exception to restrictive transfusion protocols, requiring hematocrit around 30 or HBSS below 50-60% (clinical) [Ep 4 · 2:01](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=121)
- Institutional policy at one center applies VTE prophylaxis with low molecular weight heparin to patients age 12 and over (clinical) [Ep 4 · 5:55](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=355)
- High risk criteria for VTE in trauma include femur fractures, cervical spine fracture, and intubation (clinical) [Ep 4 · 5:55](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=355)
- Kids with IBD are probably the most at-risk group for deep venous thrombosis — Rae Hanke (clinical) [Ep 4 · 6:52](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- In Wilms tumor with pulmonary metastases, it is still important to take lymph nodes because local disease treatment has an impact on abdominal disease treatment regardless of lung mets (clinical) [Ep 4 · 19:21](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1161)
- In a survey for a Seattle-based multi-institutional study, parents stated they would accept a 50% chance of success as acceptable for enrolling in non-operative appendicitis management study (epidemiological) [Ep 4 · 23:50](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1430)
- At a lot of hospitals, when you want to take a NICU baby to the operating room, they mandate that the patient has a hemoglobin of 10. — Alex (clinical) [Ep 2 · 2:05](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=125)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The theoretically correct answer for the case is screening ultrasound on ICU day 7, because pharmacologic prophylaxis is contraindicated due to significant head bleed. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- A 2017 seminars summary by Dr. Perry (current chair of the Abstinence trauma Committee) provides a comprehensive review of pediatric VTE prophylaxis in trauma. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- VTE incidence in pediatric trauma patients is estimated between 0.16% and 1%, probably on the order of 1% or less in general. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- In adult trauma patients, VTE incidence is about 3-5%. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- In adult neuro trauma patients, VTE incidence is significantly higher at 10-15%. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- Pediatric VTE risk factors include central catheters, inflammatory bowel disease (chronic inflammatory states), blood transfusion, and obesity. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- According to the Landish schema, high-risk patients are defined as those greater than 12 years with one or more risk factors, or less than 12 years with more than 4 risk factors. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- For high-risk patients without bleeding concerns, treatment is low molecular weight heparin plus SCDs until ambulatory. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- For high-risk patients who are not candidates for pharmacologic prophylaxis, treatment is SCDs until ambulatory plus screening ultrasound on day 7. — Todd Ponsky summarizing the discussion [Ep 1 · 4:37](https://team.globalcastmd.com/watch/venous-thromboembolism-prophylaxis-in-trauma-patients-practice-gap-349?t=277)
- The atrial-caval junction is actually much deeper on chest X-ray than most surgeons think, not at the visible indentation where the silhouette widens. — Mark Wulkan summarizing a resource [Ep 5 · 9:13](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=553)
- A 2013 JACS study by Sanj Dutta, Sean St. Peter and others showed ultrasound guidance achieved first-stick success in 65% of patients versus 45% with landmark technique, and 95% success by three attempts versus 74%. — Mark Wulkan summarizing a resource [Ep 5 · 10:25](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=625)
- In the adult literature, the number of needle sticks is a good proxy marker for the risk of complications. — Mark Wulkan summarizing a resource [Ep 5 · 11:25](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=685)
- The APSA Outcomes Committee meta-analysis in 2011 found Class A or B evidence that chlorhexidine-alcohol prep decreases line infections compared to betadine. — Mark Wulkan summarizing a resource [Ep 5 · 31:17](https://team.globalcastmd.com/watch/pediatric-vascular-access-6112?t=1877)
- Chemical DVT prophylaxis within 24 hours of injury reduces DVT risk in trauma patients compared to later initiation — The host summarizing the discussion [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- A recent cohort study showed chemical VTE prophylaxis was safe, did not cause bleeding complications, and should be done within 24 hours to prevent VTE — The host summarizing the discussion [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- Pediatric trauma patients with low bleeding risk and stable head, pelvic, or solid organ injuries should receive chemical VTE prophylaxis — The host summarizing the discussion [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- Patients with continued bleeding and unstable injuries should not receive chemical VTE prophylaxis — The host summarizing the discussion [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- EAST guidelines recommend prophylaxis for adolescent patients with ISS greater than 25 — The host summarizing the discussion [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- ISS (injury severity score) is calculated based on the worst injury of six body systems — The host summarizing the discussion [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- If ISS is less than 25 or patient has major bleeding risk, avoid DVT prophylaxis — The host summarizing the discussion [Ep 6 · 1:11](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=71)
- A 2023 NEJM randomized controlled trial by the Major Extremity Trauma Research Consortium included 6,000 adults on aspirin and 6,000 on enoxaparin with orthopedic injuries — The host summarizing the discussion [Ep 6 · 3:34](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=214)
- In the 2023 NEJM trial, aspirin was non-inferior to enoxaparin for DVT prophylaxis in adult orthopedic trauma patients — The host summarizing the discussion [Ep 6 · 3:34](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=214)
- Pediatric trauma surgeons are applying the adult aspirin non-inferiority data to pediatric patients and discharging them on aspirin — The host summarizing the discussion [Ep 6 · 3:34](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=214)
- Cincinnati Children's has started discharging pediatric trauma patients on aspirin, recognizing the adult data is not perfect but aspirin is effective and better than enoxaparin or nothing — Lizzie Lee summarizing the discussion [Ep 6 · 5:15](https://team.globalcastmd.com/watch/update-course-rewind-dvt-prophylaxis-2024-9456?t=315)
- Restrictive transfusion protocols using target hemoglobin of 7 instead of 8, 9, or 10 show no difference in mortality — Alex Gibbons summarizing the discussion [Ep 4 · 0:27](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=27)
- Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality — Alex Gibbons summarizing the discussion [Ep 4 · 2:27](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=147)
- Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and equally tolerated — Alex Gibbons summarizing the discussion [Ep 4 · 2:27](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=147)
- Ultrasound is not a great tool for diagnosis of ovarian torsion — Rae Hanke summarizing the discussion [Ep 4 · 4:11](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=251)
- In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still recover and this helps preserve fertility — Alejandro Cassar summarizing the discussion [Ep 4 · 4:39](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=279)
- For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin — Rae Hanke summarizing the discussion [Ep 4 · 4:59](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=299)
- For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7 — Rae Hanke summarizing the discussion [Ep 4 · 4:59](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=299)
- Burnout directly impacts patient care and outcomes — Rae Hanke summarizing the discussion [Ep 4 · 6:52](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- Support systems for physician wellness need to be proactive because when burnt out, surgeons are not likely to seek help — Rae Hanke summarizing the discussion [Ep 4 · 6:52](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=412)
- Physicians should ask parents if there is a firearm in the home, how it is stored, whether it is locked and loaded, whether ammunition is kept separate, and who has access — The host summarizing the discussion [Ep 4 · 12:19](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=739)
- Current strategy should be to continue isotonic fluids throughout hospitalization rather than switching to hypotonic maintenance fluids — Alex Gibbons summarizing the discussion [Ep 4 · 13:13](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=793)
- Continuing isotonic fluids decreases the risk of hyponatremia and had similar mortality otherwise — Alex Gibbons summarizing the discussion [Ep 4 · 13:13](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=793)
- In Wilms tumor surgery, failing to take lymph nodes automatically upstages the patient — Alex Gibbons summarizing the discussion [Ep 4 · 17:10](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1030)
- Pulmonary metastasis in Wilms tumor does not preclude doing a primary nephrectomy — Alex Gibbons summarizing the discussion [Ep 4 · 17:10](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1030)
- Non-operative management of uncomplicated appendicitis has decreased days of hospitalization, decreased days of disability, and equal outcome measures otherwise — Rae Hanke summarizing the discussion [Ep 4 · 19:49](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1189)
- In the adult IMPACT trial from Finland at 5 years, 41% of the non-operative appendicitis management group underwent appendectomy — Alex Gibbons summarizing the discussion [Ep 4 · 22:45](https://team.globalcastmd.com/watch/apsa-2018-practice-gaps-2310?t=1365)
- A practice gap is the distance between what is best practices or evidence-based and what you should be doing and what actually happens. — Alex summarizing the discussion [Ep 3 · 0:27](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=27)
- Transfusing to a target hemoglobin of seven instead of nine or ten has no difference in mortality. — Alex summarizing the discussion [Ep 3 · 0:27](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=27)
- Blood transfusions increase the risk of DVT in patients. — Alex summarizing the discussion [Ep 3 · 0:27](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=27)
- The restrictive transfusion policy of 7 not 9 or 10 applies across the board to pediatric patients, not just trauma, including NICU patients and other general surgery patients. — The host summarizing the discussion [Ep 3 · 1:35](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=95)
- Early enteral feedings when not associated with vomiting decreases morbidity, infectious risk and mortality in pancreatitis. — Ray summarizing the discussion [Ep 3 · 2:01](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=121)
- NG feeds are equally as tolerated as NJ feeds in pancreatitis. — Ray summarizing the discussion [Ep 3 · 2:01](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=121)
- We should be operating earlier for gallstone pancreatitis. — Ray summarizing the discussion [Ep 3 · 2:01](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=121)
- Ultrasounds right now are not very good in terms of ruling out ovarian torsion. — Alex summarizing the discussion [Ep 3 · 3:11](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=191)
- In a patient with suspected ovarian torsion, you have to go to the operating room, and when you're there, you don't take the ovary out even if it's black in order to preserve fertility. — The host summarizing the discussion [Ep 3 · 3:37](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=217)
- Even if there's Doppler flow in a suspected ovarian torsion, you still need to go to the operating room because it could be intermittently torsing or there may be a part that has blood flow and some that doesn't. — The host summarizing the discussion [Ep 3 · 4:31](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=271)
- For low bleeding risk trauma patients, it's okay to do SCDs and low molecular weight heparin for VTE prophylaxis. — Alex summarizing the discussion [Ep 3 · 4:56](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=296)
- For high bleeding risk trauma patients, they recommend SCDs until they're ambulatory, and then a screening ultrasound on ICU day seven. — Alex summarizing the discussion [Ep 3 · 4:56](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=296)
- Burnout directly impacts patient care and establishing support systems should be a focus throughout education and practice. — Ray summarizing the discussion [Ep 3 · 5:20](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=320)
- The most effective state laws in reducing pediatric firearm injuries are those that hold adults criminally liable for negligently storing firearms. — The host summarizing the discussion [Ep 3 · 6:39](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=399)
- You should continue with isotonic fluids instead of switching from isotonic to hypotonic once you reach maintenance space because this decreases the risk of hyponatremia without any adverse consequences. — The host summarizing the discussion [Ep 3 · 7:51](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=471)
- We need to be sure that we're taking out lymph nodes when doing Wilms tumor nephrectomy because that automatically upstages our patients if we're not taking out the nodes. — The host summarizing the discussion [Ep 3 · 8:37](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=517)
- Pulmonary metastases do not preclude a primary nephrectomy in Wilms tumor. — The host summarizing the discussion [Ep 3 · 8:37](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=517)
- Treating appendicitis with antibiotics had equal outcome measures compared to initial operative management, with a 15% risk of recurrence at one-year follow-up, but decreased hospital stays and decreased days of disability. — The host summarizing the discussion [Ep 3 · 9:42](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=582)
- You don't need to be giving opioids for incision and drainages or for breast biopsies. — Alex summarizing the discussion [Ep 3 · 11:23](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=683)
- Tylenol plus NSAIDs like Motrin are equally as effective as narcotics in kids. — Alex summarizing the discussion [Ep 3 · 11:23](https://team.globalcastmd.com/watch/journal-club-review-of-2018-pediatric-surgery-practice-gaps-1603?t=683)
- The APSA Practice Development Committee identified areas that pediatric surgeons don't know about, and specifically areas where surgeons don't know that they don't know about them. — Alex summarizing a resource [Ep 2 · 0:28](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=28)
- A practice gap is the distance between what is best practices or evidence based (what you should be doing) and what actually happens. — Alex summarizing a resource [Ep 2 · 0:28](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=28)
- Transfusing to a target hemoglobin of 7 instead of 9 or 10 has no difference in mortality. — Alex summarizing a resource [Ep 2 · 1:12](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=72)
- Blood transfusions increase the risk of DVT in patients. — Alex summarizing a resource [Ep 2 · 1:12](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=72)
- The restrictive transfusion policy of 7 (not 9 or 10) will have no difference in mortality, and this applies across the board to pediatric patients, not just trauma patients. — The host summarizing a resource [Ep 2 · 1:38](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=98)
- You don't need hemoglobin of 10 for NICU babies going to the OR; if the patient is doing well clinically, they can tolerate lower hemoglobin levels. — Alex summarizing a resource [Ep 2 · 2:05](https://team.globalcastmd.com/watch/restrictive-transfusion-policies-2018-pediatric-surgery-practice-gap-10-1449?t=125)

## Changelog
- Sep 24: Published again automatically — condition is back above threshold
- Sep 24: 6 items added automatically
- Sep 24: 5 items no longer name DVT
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: 5 items added automatically

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