Pediatric_Surgery-1

Pediatric_Surgery-1 - Pediatric Surgery Vic V. Vernenkar,...

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Pediatric Surgery Vic V. Vernenkar, D.O. St. Barnabas Hospital Dept. of Surgery
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Epiglottitis H. Influenza is most common organism A lateral xray may show edema of the epiglottis (bird’s beak) Orotracheal intubation should be performed in the OR so that an open tracheostomy can be done if needed. Never nasotracheally intubate a child because the angle between the superior and inferior glottis is too large.
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Tracheoesophageal Fistula A newborn infant has excessive salivation, choking, and regurgitation with feeding. Results from abnormal ingrowth of ectodermal ridges during the 4 th week of gestation. 25-40% of neonates are premature, low bith weight. A maternal history of polyhydramnios is common 50% of neonates with TEF have an associated anomaly (cardiovascular most common) GI malformation GU anomalies
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Tracheoesophageal Fistula Proximal and distal TEF Diagnosis Inability to pass nasogastric tube CXR to deternime length of esophageal gap Abdominal Xray with air in the stomach excludes esophageal atresia Treatment Right thoracotomy thru 4 th intercostal space Proximal esophagus blood supply is from thyrocervical trunk
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Tracheoesophageal Fistula Distally supplied by more tenuous intercostals Operation includes TEF ligation, transection, and restoration with end-to-end anastamosis. POD 5-7 esophagram, if no leak, feed, remove drain.
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Tracheoesophageal Fistula Early complications include : Anastamotic leak, recurrent TEF, tracheomalacia. Late Complications include: Anastamotic stricture (25%), reflux (50%), dysmotility (100%). Proximal atresia with distal TEF most common.
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Immunoglobulins Which immunoglobulin is secreted in breast milk? Which immunoglobulin does not cross blood brain barrier? IGA is most common antibody in breast milk, the gut, saliva, bodily secretions. IGM is large and does not cross the placenta.
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Resuscitation An 8 year old boy presents following a bicycle crash with a ruptured spleen.What is the best indicator of early shock? Tachycardia in childhood is defined as a heart rate >150 for a neonate, >120 in the first year, >100 after one year. It is the best indicator of shock. Fluid resuscitation in children:
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Resuscitation 20cc/kg crystalloid bolus for trauma If shock persists after a second bolus, give blood at 10cc/kg Children have a lower GFR in comparison to adults.
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Malrotation A healthy infant presents with bilious vomiting, abdominal distension, and shock. A surgical emergency, bilious vomiting in a newborn is malrotation until proven otherwise.
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During 6-12 week of gestation, the intestine undergoes evisceration, elongation, and eventual return to the abdominal cavity in a 270 degree counterclockwise rotation with fixation. Malrotation is associated with abnormal
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Pediatric_Surgery-1 - Pediatric Surgery Vic V. Vernenkar,...

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