Practicing Surgeons' Curriculum

Introduction

This collection of infographics is generated by the APSA Education Committee as a curriculum to keep currently practicing surgeons up to date.

Please submit your questions, comments and feedback (including suggestions for future topics) to think@eapsa.org.

Critical and Perioperative Care

In which areas of pediatric surgery can you impact the inappropriate use of antibiotics?

antibiotic stewardship
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[1][2][3] (for more see Surgical Infection)

video link Antibiotic Stewardship 2019 Top Educational Content talk

What is the correct transfusion threshold in critically ill or injured children?

conservative transfusion threshold
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infographic by David Notrica

[4][5][6][7][8] (for more see Transfusion and Coagulation Therapy)

video links Hemostatic Transfusion and Goal Directed Transfusion from the APSA 2020 virtual meeting

How does hospital acquired hyponatremia occur and what is the best way to prevent it?

isotonic maintenance fluids
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infographic by Pramod Puligandla

[9][10] (for more see Fluid and Electrolytes)

What are the current pediatric surviving sepsis guidelines?

surviving sepsis guidelines
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infographic by Janice Taylor

[11][12] (for more see Surgical Infection)

video link Surviving Sepsis Guidelines 2019 Top Educational Content talk)

How do you use a viscoelastic assay to guide transfusion requirements in bleeding patients?

viscoelastic assay
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infographic by Janice Taylor

[13][14] (for more see Transfusion and Coagulation Therapy )

What are the opioid prescribing guidelines for children and adolescents?

opioid stewardship
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infographic by Steven Lee

[15] (for more see Sedation and Analgesia)

What are the key elements of enhanced recovery after surgery (ERAS) in neonatal intestinal surgery?​

ERAS in neonatal intestinal surgery
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infographic by Raquel Gonzalez

[16][17][18] (see also Surgical Neonate)

What is the current consensus on the safety of general anesthesia for elective surgery in children under the age of three years?

general anesthesia under the age of 3 years
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infographic by Mary Edwards

[19][20] (see also Anesthesia)

What is the current state of management​ for pediatric intestinal failure?​

intestinal failure
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infographic by Janice Taylor

[21][22] (see also Intestinal Failure)

What surgeon’s need to know about MIS-C?

MIS-C
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infographic by Minna Wieck

[23][24][25] (see also COVID-19 for Pediatric Surgeons)

What are the indications for hemo- vs peritoneal dialysis?

hemo- vs peritoneal dialysis
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infographic by Pamela Scalise and Alex Cuenca

[26][27] (see also Fluid and Electrolytes)

Head and Neck Disorders

What are the current recommendations for the management of thyroid nodules in children?

thyroid nodules
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infographic by Pramod Puligandla

[28][29]

Thoracic Disorders

Do asymptomatic patients with a history of esophageal atresia need endoscopic surveillance?

endoscopic surveillance in esophageal atresia
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infographic by Jay Meisner and Benjamin Zendejas

[30][31][32] (for more see Esophageal Atresia and Tracheoesophageal Fistula)

What is the optimal management of thoracostomy tubes in children with parapneumonic effusions?

chest tubes in empyema
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infographic by Michael Livingston

[33][34][35] (for more see Parapneumonic Effusion and Empyema)

Does every primary spontaneous pneumothorax require an intervention?

spontaneous pneumothorax
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infographic by Brian Jones

[36][37] (for more see Spontaneous Pneumothorax)

What criteria do you use to determine when an infant with congenital diaphragmatic hernia is ready for surgical repair?

surgery for CDH
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infographic by Pramod Puligandla

[38][39] (for more see Congenital Diaphragmatic Hernia)

Abdominal Wall Disorders

What are the advantages of a sutureless closure in gastroschisis?

sutureless gastroschisis closure
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infographic by Pramod Puligandla

[22][40][41]

Gastrointestinal Disorders

How does one determine if a patient with inflammatory bowel disease will require surgery?

indications for surgery in IBD
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infographic by Brian Coakley

[42][43][44] (for more see Crohn Disease and Ulcerative Colitis)

video link The effect of biologics in the surgical management of IBD 2020 Top Educational Content talk

How do you prevent, detect and treat neonatal gas embolism during laparoscopy?

gas embolus during infant laparoscopy
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infographic by Brian Jones

[45][46][47][48]

video link Infant Gas Embolus 2020 Top Educational Content talk

What are the outcomes for nonoperative management of acute appendicitis?

nonoperative appendicitis outcomes
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infographic by Steven Lee

[49][50] (for more see Appendicitis)

What is the optimal bowel management in children with anorectal malformations?

bowel management
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infographic by Michael Livingston

[51][52][53] (for more see Anorectal Malformations and Bowel Management)

What is the role for screening upper gastrointestinal series in patients with heterotaxy syndromes?

heterotaxy screening
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infographic by Brian Coakley

[54][55][56][57][58][59][60][61][62] (see also Intestinal Rotational Abnormalities)

How does one manage the asymptomatic patient with heterotaxy syndrome and suspected intestinal rotational anomalies?

asymptomatic heterotaxy patients with malrotation
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infographic by Brian Coakley

[54][55][56][57][58][59][60][61][62] (see also Intestinal Rotational Abnormalities)

How should gastresophageal reflux disease be managed in infants and children?

strategy for GERD management
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infographic by Eunice Huang

[63] (see also Gastroesophageal Reflux)

How do you troubleshoot common problems with gastrostomy tubes?​

gastrostomy troubleshooting
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infographic by Jennifer DeFazio

[64] (see also Enteral Access)

What is the work-up and management of long term complications following surgery for Hirschsprung Disease?​

Hirschsprung disease complications
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infographic by Michael Livingston

[65][66][67] (see also Hirschsprung disease)

How is meconium ileus managed?

meconium ileus management
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infographic by Gerald Gollin

[68][69] (see also Meconium Ileus)

Hepatobiliary Disorders

What is the role of indocyanine green in pediatric surgery?​

use of ICG
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infographic by Benjamin Zendejas and Jay Meisner

[70][71][72][73] (see also NewTechnology)

Trauma

Which children truly need cervical spine imaging after trauma?

cervical spine injury imaging
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infographic by Jonathan Meisel

[74][75] (for more see Cervical Spine Trauma)

video link Cervical Spine Trauma Imaging 2019 Top Educational Content talk

What is he correct fluid to use when resuscitating a child with a burn?

burn resuscitation
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infographic by Mary Edwards

[76][77] (for more see Burns)

When should injured children receive blood rather than crystalloid?

early use of blood
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infographic by David Notrica

[8][78][79][80][81] (for more see Trauma Resuscitation and Initial Evaluation)

What is the baseline management strategy for severe pediatric traumatic brain injury?

management of traumatic brain injury
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infographic by Pramod Puligandla

[82][83] (for more see Traumatic Brain Injury)

How does one monitor a child with severe pediatric traumatic brain injury?​

monitoring in traumatic brain injury
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infographic by Pramod Puligandla

[82][83] (for more see Traumatic Brain Injury)

What are the most current APSA evidence-based guidelines regarding blunt solid organ injuries in children?

solid organ injury guidelines
Descriptive text is not available for this image

infographic by Pramod Puligandla

[8][84][85][86] (for more see Liver and Spleen Trauma)

Which pediatric trauma patients should receive venous thromboembolism prophylaxis?

venous thromboembolism prophylaxis in trauma
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infographic by Janice Taylor

[87][88][89][90][91] (for more see Transfusion and Coagulation Therapy)

How is hypotension in pelvic trauma managed?

hypotension in pelvic trauma
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infographic by (Alyssa Mowrer, John Marquart and Dave Lal)

[92][93][94] (see also Pelvic Fractures)

Oncology

What is the minimum number of lymph nodes to sample for adequate staging during a Wilms tumor resection?

Wilms tumor lymph node sampling
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infographic by Brian Jones

[95][96][97] (for more see Wilms Tumor)

How are tumors classified in the International Neuroblastoma Risk Group (INRG) staging system?

neuroblastoma risk stratification
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infographic by Brian Coakley

[98][99][100] (see also Neuroblastoma)

What are the indications for the upfront hepatic resection of pediatric liver tumors?

upfront liver tumor resection
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infographic by Leah Ott and Alex Cuenca

[101][102] (see also Hepatoblastoma)

Genitourinary Disorders

What are the considerations for gonadal preservation in disorders of sex development?

gonadal preservation in DSD
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infographic by Hannah Piper

[103][104][105] (for more see Disorders of Sex Development)

How can we optimize ovarian preservation in patients with ovarian masses?

ovarian preservation
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infographic by Eunice Huang

[106][107][108] (for more see Ovarian Tumors )

What are the basics​ of caring for a child with cryptorchidism?

cryptorchidism
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infographic by Brian Gulak

[109][110](see also Cryptorchidism)

Skin and Soft Tissue Disorders

What are the advantages of minimally invasive surgical techniques in pilonidal disease?

pilonidal excision
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infographic by Jonathan Meisel

[111][112][113][114] (for more see Pilonidal Disease)

How do you clinically differentiate hemangiomas from other vascular malformations?​

hemangioma and vascular malformations
Descriptive text is not available for this image

infographic by Benjamin Zendejas and Anna McGuire

[115](see also Vascular Tumors and Vascular Malformations)

Competencies

What factors lead to physician burnout and what impact can it have?

surgeon wellness
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infographic by Mark Mazziotti

[116][117][118]

What is the impact of surgeons’ implicit bias?

implicit bias
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infographic by Minna Wieck

[119][120]

References

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  2. Rogers SO. Surgical Perspective: Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection 2017. Surg Infect (Larchmt). 2017;18(4):383-384.  [PMID:28541803]
  3. Sartelli M, Duane TM, Catena F, et al. Antimicrobial Stewardship: A Call to Action for Surgeons. Surg Infect (Larchmt). 2016;17(6):625-631.  [PMID:27828764]
  4. Valentine SL, Bembea MM, Muszynski JA, et al. Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med. 2018;19(9):884-898.  [PMID:30180125]
  5. Steiner ME, Zantek ND, Stanworth SJ, et al. Recommendations on RBC Transfusion Support in Children With Hematologic and Oncologic Diagnoses From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med. 2018;19(9S Suppl 1):S149-S156.  [PMID:30161070]
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  7. Lacroix J, Hébert PC, Hutchison JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;356(16):1609-19.  [PMID:17442904]
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  25. Gerall CD, Duron VP, Griggs CL, et al. Multisystem Inflammatory Syndrome in Children Mimicking Surgical Pathologies: What Surgeons Need to Know about MIS-C. Ann Surg. 2021;273(4):e146-e148.  [PMID:33074884]
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  33. Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 2012;47(11):2101-10.  [PMID:23164006]
  34. Marhuenda C, Barceló C, Fuentes I, et al. Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial. Pediatrics. 2014;134(5):e1301-7.  [PMID:25349313]
  35. Livingston MH, Mahant S, Connolly B, et al. Effectiveness of Intrapleural Tissue Plasminogen Activator and Dornase Alfa vs Tissue Plasminogen Activator Alone in Children with Pleural Empyema: A Randomized Clinical Trial. JAMA Pediatr. 2020;174(4):332-340.  [PMID:32011642]
  36. Brown SGA, Ball EL, Perrin K, et al. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med. 2020;382(5):405-415.  [PMID:31995686]
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  39. Beres AL, Puligandla PS, Brindle ME, et al. Stability prior to surgery in Congenital Diaphragmatic Hernia: is it necessary? J Pediatr Surg. 2013;48(5):919-23.  [PMID:23701760]
  40. Witt RG, Zobel M, Padilla B, et al. Evaluation of Clinical Outcomes of Sutureless vs Sutured Closure Techniques in Gastroschisis Repair. JAMA Surg. 2019;154(1):33-39.  [PMID:30325977]
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  42. Fumery M, Pariente B, Sarter H, et al. Long-term outcome of pediatric-onset Crohn's disease: A population-based cohort study. Dig Liver Dis. 2019;51(4):496-502.  [PMID:30611597]
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  44. Rinawi F, Assa A, Eliakim R, et al. Risk of Colectomy in Patients With Pediatric-onset Ulcerative Colitis. J Pediatr Gastroenterol Nutr. 2017;65(4):410-415.  [PMID:28207474]
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  64. Sealock RJ, Munot K. Common Gastrostomy Feeding Tube Complications and Troubleshooting. Clin Gastroenterol Hepatol. 2018;16(12):1864-1869.  [PMID:30077033]
  65. Langer JC, Rollins MD, Levitt M, et al. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int. 2017;33(5):523-526.  [PMID:28180937]
  66. Saadai P, Trappey AF, Goldstein AM, et al. Guidelines for the management of postoperative soiling in children with Hirschsprung disease. Pediatr Surg Int. 2019;35(8):829-834.  [PMID:31201486]
  67. Lewit RA, Veras LV, Cowles RA, et al. Reducing Underdiagnosis of Hirschsprung-Associated Enterocolitis: A Novel Scoring System. J Surg Res. 2021;261:253-260.  [PMID:33460971]
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  70. Fan Z, Zong J, Lau WY, et al. Indocyanine green and its nanosynthetic particles for the diagnosis and treatment of hepatocellular carcinoma. Am J Transl Res. 2020;12(6):2344-2352.  [PMID:32655776]
  71. Paraboschi I, De Coppi P, Stoyanov D, et al. Fluorescence imaging in pediatric surgery: State-of-the-art and future perspectives. J Pediatr Surg. 2021;56(4):655-662.  [PMID:32900510]
  72. Shafy SZ, Hakim M, Lynch S, et al. Fluorescence Imaging Using Indocyanine Green Dye in the Pediatric Population. J Pediatr Pharmacol Ther. 2020;25(4):309-313.  [PMID:32461744]
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Last updated: March 15, 2022