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)

Which type of central venous access has the highest VTE risk?

Central Venous Access and VTE Risk
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Infographic by Francois Luks and Pramod Puligandla

[28]

What is the optimal timing for elective and urgent surgery in children with URI?

URI and Surgery
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Infographic by Benjamin Basseri and Michael Livingston

[29][30][31][32]

What are NPO guidelines for anesthesia?

NPO Guidelines
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Infographic by Veronica F. Sullins

[33][34]

What is current management of VA ECMO in adolescents?

VA ECMO in Adolescents
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[35][36][37]

What are the key differences between the Avalon and Crescent RA cannulae for​
neonatal ECMO?​

Neonatal ecmo
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[38][39][40]

When should you transfuse platelets and plasma in critically ill children?

Platelets and plasma
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[41][42][43][44]

What bowel preparation should be used for colonic surgeries?

Bowel Prep
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[45][46][47][48][49]

Are adolescent trauma patients who fill outpatient opioid prescriptions at increased risk of substance use disorder or overdose within 5 years of discharge?

Outpatient_Opioids
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[50]

What is the value of telemedicine for the pediatric surgery patient?

Telemedicine
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[51]

What patients should be screened and treated for venous thromboembolism?

VTE
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For more information: https://www.youtube.com/watch... and Venous Thromboembolism Risk Assessment Score (V-TRAS)

[52][53]

What is the current standard of management for children and adolescents with obesity?

CPG_Obesity
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Infographic by Michael Livingston

[54]

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

[55][56]

Who is ingesting button batteries, and how should they be managed?

ButtonBattery
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Infographic by Minna Wieck

[57][58][59][60][61]

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

[62][63][64] (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

[65][66][67] (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

[68][69] (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

[70][71] (for more see Congenital Diaphragmatic Hernia)

What factors help predict mortality in CDH?

Predictors of Mortality for CDH
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[72][73]

What is the role of fetoscopic tracheal occlusion (FETO) for CDH?

FETO for CDH
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Infographic by Irving Zamora

[74][75]

What is staged-management of pectus carinatum?

Pectus Carinatum
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Infographic by Dave Lal

[76]

How should CDH be diagnosed prenatally?

Prenatal CDH
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[74][77][78][79]

What is the optimal managment of severe congenital chylothorax?

Congenital chylothorax
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[80][81][82]

What is the management of Pleuropulmonary blastoma?

Pleuropulmonary blastoma
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[83][84]

What is the management of Congenital Lung Lesions?

Congenital lung lesions
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Infographic by Su Yeon Lee and Minna Wieck

[85][86][87][88]

What is the management of prenatally diagnosed CDH?

Prenatal CDH management
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[70][89][90][91]

How are children with prenatally diagnosed lung malformations risk stratified, and what are their outcomes?

PrenatalLungMalformations
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[92]

What is the evaluation and management of spontaneous pneumothorax?

SpontaneousPTX
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For more see: https://www.youtube.com/watch...

[93]

Which children with pectus excavatum are good candidates for the vacuum bell?

Pectus_Vacuum
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Infographic created by C Dichter and S Lee

[94][95][96][97]

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][98][99]

How do you manage inguinal hernias in adolescent patients?

Adolescent Inguinal Hernia
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Management of Adolescent Inguinal Hernia

Infographic by Benjamin Zendejas and Michael Livingston

[100][101][102]

What is the work-up and management for patients with groin pain syndrome?

Groin Pain
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Infographic by Brian Coakley

[103]

What are the current managment guidelines for gastroschisis?

Gastroschisis Toolbox
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[104][105]

What are the advantages and disadvantages of laparoscopic versus open inguinal hernia repairs in children?

LapOpenIHR
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[106][107][108][109]

Colorectal Disorders

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

indications for surgery in IBD

indications for surgery in IBD
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infographic by Brian Coakley

[110][111][112] (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

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

bowel management
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infographic by Michael Livingston

[113][114][115] (for more see Anorectal Malformations and Bowel Management)

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

[116][117][118] (see also Hirschsprung disease)

How do you screen and manage familial adenomatous polyposis?

Familial Adenomatous Polyposis

Familial Adenomatous Polyposis
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[119][120][121][122]

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

[110][111][112] (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

[123][124][125][126]

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

[127][128] (for more see Appendicitis)

What are the outcomes of using single drug antibiotics for perforated appendicitis?

Monotherapy for Perforated Appendicitis
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Infographic by Maia Regan and Katerina Dukleska

[129]

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

heterotaxy screening
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infographic by Brian Coakley

[130][131][132][133][134][135][136][137][138] (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

[130][131][132][133][134][135][136][137][138] (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

[139] (see also Gastroesophageal Reflux)

How do you troubleshoot common problems with gastrostomy tubes?​

gastrostomy troubleshooting
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infographic by Jennifer DeFazio

[140] (see also Enteral Access)

What are the long-term outcomes following sleeve gastrectomy?

Long-term Outcomes of Sleeve Gastrectomy
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[141]

How is meconium ileus managed?

meconium ileus management
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infographic by Gerald Gollin

[142][143] (see also Meconium Ileus)

What is the current management of pediatric intestinal failure?

Intestinal Failure Management
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Infographic by Janice Taylor

[144][145]

What is the optimal timing for cholecystecomy in patients with gallstone pancreatitis?

Timing of Cholecystectomy with Gallstone Pancreatitis
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[146]

Lap vs. Drain in NEC- Neurodevelopmental Outcomes

Laparotomy vs. Drain for NEC
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[147][148][149]

Is laparoscopic or open pyloromyotomy better?

Lap vs open pyloromyotomy
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[150][151]

How does NEC effect neurodevelopment?

Neurodevelopment in NEC
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[147][152][153][154][155]

Should you use probiotics in NEC?

Probiotics in NEC
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[156][157][158]

What is the management of idiopathic rectal prolapse?

Idiopathic rectal prolapse
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[159][160]

What is the workup and management of eosinophilic esophagitis?

EosinophilicEsophagitis
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[161][162]

How does enhanced recovery after surgery (ERAS) work for pediatric gastrointestinal surgery?

ERASforPediGI
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Also see: https://www.youtube.com/watch...

[163][164][165][166]

Can teduglutide be used in intestinal failure?

Teduglutide
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[167][168]

Necrotizing enterocolitis and spontaneous intestinal perforation: ostomy or anastomosis?

OstomyvsAnastomosis
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Infographic by Michael Livingston

[169][170]

What is the workup and management of perianal Crohn’s disease?

PerianalCrohns
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Infographic by Michael Livingston

[171][172][173]

Hepatobiliary Disorders

What is the role of indocyanine green in pediatric surgery?

ICG and Pediatric Surgery
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​

infographic by Benjamin Zendejas and Jay Meisner

[174][175][176][177] (see also NewTechnology)

What is the optimal work-up for infants with cholestatic jaundice?

Cholestatic Jaundice
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Infographic by Michael Livingston

[178][179]

When should cholecystecomty be performed in patients with gallstone pancreatitis?

Timing of Cholecystectomy with Gallstone Pancreatitis
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[146]

What is the management of choledocholithiasis?

Choledocholithiasis
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[180][181][182][183][184][185]

Trauma

Which children truly need cervical spine imaging after trauma?

cervical spine injury imaging
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infographic by Jonathan Meisel

[186][187] (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

[188][189] (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][190][191][192][193] (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

[194][195] (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

[194][195] (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
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infographic by Pramod Puligandla

[8][196][197][198] (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

[199][200][201][202][203] (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

[204][205][206] (see also Pelvic Fractures)

What are the outcomes with whole blood transfusions in injured children?

Whole Blood Transfusions in Injured Childrent
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Infographic by Steven Lee

[207]

What is the impact of cryoprecipitate use in children receiving massive transfusion protocol?

Cryoprecipitate and MTP
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Infographic by Mallory M Kane and Katerina Dukleska

[208]

What are the most recent updates in Pediatric Trauma Resusciation?

Trauma Resuscitation- Fluids and Products
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Infographic by Kathleen Morrisroe and Katerina Dukleska

[207][209][210]

What is the management of high grade pancreatic injury?

Pancreatic injury high grade
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[211][212][213]

Chest tubes for traumatic hemothorax: is bigger always better?

ChestTubes_Hemothorax
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Infographic by Joseph Lee and Romeo Ignacio

[214][215][216][217][218]

What are the outcomes from use of whole blood in hemostatic resuscitation of major bleeding in adults?

WholeBlood
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Infographic by Alicia Greene

[219][220][221][222]

How do you recognize cardiac tamponade in pediatric trauma?

CardiacTamponade
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Infographic by Erin West and Romeo Ignacio

[223][224][225][226]

What are the clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma?

FacialCT
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Infographic by Michael Livingston

[227]

What are the public health concerns regarding firearm injury in 2023?

FirearmInjury
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Infographic by Alicia Greene

[228][229][230]

What is the management of blunt renal trauma?

BluntRenalTrauma
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Infographic by Michael Livingston

[231][232][233]

What is the management of traumatic hemothorax?

TraumaticHTX
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Infographic by Michael Livingston

[215][234]

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

[235][236][237] (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

[238][239][240] (see also Neuroblastoma)

What revisions were made to the COG neuroblastoma risk startification system in 2021?

Neuroblastoma Classification- Revised
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Infographic by Jance Taylor

[241]

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

[242][243] (see also Hepatoblastoma)

What is the long-term risk of malignancy associated with CT scans?

CT Scans and Malignancy Risk
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Infographic by Steven Lee

[244]

What are the challenges faced by survivors of childhood cancer?

Childhood Cancer Survivors
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Infographic by Arin Madenci and Benjamin Zendejas

[245][246][247]

What is the work-up and management of testicular germ cell tumors?

Testicular Germ Cell Tumors
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Infographic by Michael Livingston

[248]

What factors influence the local relapse of a uniilateral Wilms tumor?

WilmsRelapse
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Infographic by Michael Livingston

[249]

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

[250][251][252] (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

[253][254][255] (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

[256][257](see also Cryptorchidism)

Does your patient have a mismatch between genetic and anatomic sex?

Congenital Adrenal Hyperplasia
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Infographic by Minna Wieck

[258][259]

What is the management of congenital ovarian cysts?

Congenital ovarian cysts
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[260][261][262][263]

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

[264][265][266][267] (for more see Pilonidal Disease)

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

hemangioma and vascular malformations
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infographic by Benjamin Zendejas and Anna McGuire

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

Can pilonidal disease resolve without resection in adolescents?

PilonidalResolution
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[269][270]

Can sirolimus be used for lymphatic malformations?

Sirolimus
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[271][272][273]

Competencies

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

surgeon wellness
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infographic by Mark Mazziotti

[274][275][276]

What is the impact of surgeons’ implicit bias?

implicit bias
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infographic by Minna Wieck

[277][278]

What is APSA’s DEI Strategy?

DEI- APSA Strategy
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Infographic by Grace Mak

[279]

Does race affect the rates of postoperative complications?

Race and Postoperative Complications
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Infographic by Raquel Gonzalez

[280]

What is the APSA "Right child, Right Surgeon" initative?

Right Child- Right Surgeon Initiative
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Infographic by Francois Luks and Pramod Puligandla

[281]

How can we empower families to partner with us in their care?

Family-Centered Care
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Infographic by Minna Wieck

[282]

How does being a surgeon effect fertility?

Fertility in surgeons
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Infographic by Monalisa Hassan and Minna Wieck

[283][284][285]

What are key principles of radiation safety?

Radiation Safety
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[286][287][288]

References

  1. Fry DE. Prevention of Infection at the Surgical Site. Surg Infect (Larchmt). 2017;18(4):377-378.  [PMID:28541805]
  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]
  6. Rouette J, Trottier H, Ducruet T, et al. Red blood cell transfusion threshold in postsurgical pediatric intensive care patients: a randomized clinical trial. Ann Surg. 2010;251(3):421-7.  [PMID:20118780]
  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]
  8. Notrica DM, Eubanks JW, Tuggle DW, et al. Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015;79(4):683-93.  [PMID:26402546]
  9. McNab S, Ware RS, Neville KA, et al. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children. Cochrane Database Syst Rev. 2014.  [PMID:25519949]
  10. Feld LG, Neuspiel DR, Foster BA, et al. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018;142(6).  [PMID:30478247]
  11. APSA critical care handbook, chapter 8
  12. Surviving Sepsis Campaign, 2020 pediatric guideline updates
  13. Gonzalez E, Moore EE, Moore HB, et al. Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays. Ann Surg. 2016;263(6):1051-9.  [PMID:26720428]
  14. Leeper CM, Gaines BA. Viscoelastic hemostatic assays in the management of the pediatric trauma patient. Semin Pediatr Surg. 2017;26(1):8-13.  [PMID:28302286]
  15. Kelley-Quon LI, Kirkpatrick MG, Ricca RL, et al. Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion. JAMA Surg. 2021;156(1):76-90.  [PMID:33175130]
  16. Brindle ME, McDiarmid C, Short K, et al. Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg. 2020;44(8):2482-2492.  [PMID:32385680]
  17. Peng Y, Xiao D, Xiao S, et al. Early enteral feeding versus traditional feeding in neonatal congenital gastrointestinal malformation undergoing intestinal anastomosis: A randomized multicenter controlled trial of an enhanced recovery after surgery (ERAS) component. J Pediatr Surg. 2021;56(9):1479-1484.  [PMID:33838898]
  18. Xu L, Gong S, Yuan LK, et al. Enhanced recovery after surgery for the treatment of congenital duodenal obstruction. J Pediatr Surg. 2020;55(11):2403-2407.  [PMID:32571537]
  19. McCann ME, de Graaff JC, Dorris L, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet. 2019;393(10172):664-677.  [PMID:30782342]
  20. Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet. 2016;387(10015):239-50.  [PMID:26507180]
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Last updated: December 20, 2023