Conference July 26, 2011

Dr. Gourineni:  Pediatric Orthopedics

1.  Remodeling:  Children have tremendous potential to remodel fractures, especially with boys <12, girls <10, often do not need to reduce fractures in younger children, especially in cases of distal radius and proximal humerus fractures, and when fracture in plane of movement of extremity.  On the other hand, valgus/varus displacements not tolerated (for example in supracondylar fx) and will more often need reduction/surgical repair.

2.  Buckle Fracture Treatment:  Literature to support minimal immobilization for simple buckle fractures (ace wrap!).  For Dr. Gourineni, velcro splint is fine.


Dr. Hoyme:  Urology Tips for the ER

1.  Hematuria:  DDx:  SHIT3.   Use large (24F) 3 way catheter for irrigation.  Manually irrigate clots out of bladder before hooking up CBI (Continuous Bladder Irrigation).

- Stone

- Hematologic (bleeding) diathesis

- Infection

- Trauma

- Tumor


2.  Foley insertion:  use plenty of lubrication; Urojet is viscous lidocaine-extremely helpful.  Be very careful to have urine return before blowing up balloon (inflated balloon in urethra --> urethral stricture).

3.  Urethral stricture:  when suspected, try small (14F) catheter, or talk to your attending about using the Urology tray (in inventory).

4.  Varicocele:  if large and doesn't reduce at all when laying flat, consider retroperitoneal tumor (obstructing venous return).

5.  Stones:  AUA guidelines, if healthy non-pregnant pt with 2 kidneys and no infection, ok to discharge if stone <10 mm and pain/nausea controlled.  Use tamsulosin and urology f/up.  Outpatient KUB to track stone passage, may take one month to pass.

6.  Sepsis + Stone:  broad spectrum antibiotics and emergent stent or nephrostomy tube.  Nephrostomy tube preferred as larger tube, can monitor drainage to ensure patency, and do not need general anesthesia for placement.