Behind The Knife: The Surgery Podcast Behind the Knife ABSITE 2025 - Pediatric Surgery
Jan 10, 2025
Dr. Wu, a pediatric surgeon and expert in surgical education, dives into crucial pediatric surgical topics for ABSITE review. They discuss the significance of tachycardia as an early shock indicator in children, along with vital fluid resuscitation guidelines. Insights into airway sizing, differential diagnoses for vomiting, and the implications of necrotizing enterocolitis are highlighted. Dr. Wu also shares important tips on pyloric stenosis diagnosis and management, alongside quick clinical pearls to aid in mastering pediatric surgery.
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Tachycardia Is The Earliest Shock Sign
- Watch heart rate closely; tachycardia is the best early indicator of shock in children.
- Resuscitate with 20 mL/kg crystalloids and 10 mL/kg blood when indicated, monitoring urine output targets by age.
Use Weight-Based Resuscitation
- Use weight-based boluses: 20 mL/kg for crystalloids and 10 mL/kg for blood in pediatric resuscitation.
- Expect a 10 mL/kg PRBC bolus to raise hematocrit ~3–4% and adjust blood products accordingly.
Calculate Maintenance With 4-2-1 Rule
- Calculate maintenance fluids with the 4-2-1 rule: 4 mL/kg/hr for first 10 kg, 2 mL/kg/hr for next 10 kg, 1 mL/kg/hr thereafter.
- Use the rule to avoid over- or under-resuscitation in children.
