Page 4 - South Florida Hospital News Nov 2021

What’s New in Pediatric Surgery

Taking a stand on But it’s not just about
firearm safety and changing the prescription,
prevention but rather the education sur-
Firearm injuries are the rounding it. It’s all in the
second leading cause of expectations and education
death in children, behind of the patient and their fami-
motor vehicle accidents. ly ahead of the procedure.
Tragically, when a child We have to educate the par-
attempts suicide with a ents, family, and the patient
firearm, they are “success- to provide expectations
ful” 95% of the time, mak- before and after. For exam-
ing firearm accidents and ple, if you have a patient with
deaths a top priority for BY CARMEN RAMOS- a hernia repair, you may say
pediatric surgeons. The IRIZARRY, MD to them, ‘This isn’t going to
laws vary from state to be too painful, and you will
state on the role that doctors can take on need Tylenol and Motrin at home, and I’ll
educating and discussing firearm choices give you a scheduled regiment.’ If you
with families, but we are now taking a say, ‘Oh, it will be painful,’ some will go
stronger stance against this incredibly back to the ER saying they need nar-
dangerous threat to children. cotics. The new guidelines and a focus on
In Florida, for example, we are not proper education on pain management
allowed to talk to patients or families will eliminate the ER visit.
about firearms, so we’d like to share data Finally, there is a necessity to educate
on suicide attempts and the damage for the entire care team on the risk of opioid
those who survive. addiction from post-medical procedure
So, the American Pediatric Surgical prescriptions, particularly in Florida,
Association recently released a policy on which has high rates of opioid use in
firearm injuries, endorsing universal teenagers. Nurses, surgeons, and anes-
background checks including for private thesiologists should all be aware of the
sales, which is a gap in the law. They are risk of prescription misuse. Florida
advocating for restricting assault weapon health care providers can check a website
purchases by children and raising the to screen for prior misuse of narcotics,
minimum purchase age of firearms to 21. including who prescribed them and the
Finally, my colleagues and I want to last time the patient used them.
encourage and advocate for schools to
train their staff on bleeding control, in Responding to child abuse
the wake of mass (and smaller) shoot- with a multi-disciplinary team
ings. The Florida child abuse situation is
bleak, as evident by the Children’s
Preventing opioid use in Advocacy Center of Florida’s 2018 statis-
children stemming from tics:
post-op prescriptions • 35% is sexual abuse
It’s startling, but one in 8 children has • 27% is physical abuse
reported trying opioids by high school. • The rest is neglect
Sixty percent of teenagers who use hero- • Just over a third of abuse victims
in say they first started by misusing opi- are ages 0-6
oids, sometimes prescribed after surgery, • 60% are female
including Percocet, Hydrocodone, and While it’s common for pediatric sur-
similar drugs. My colleagues and I are geons to treat child abuse victims in need
working to stop the problem before it of trauma-related surgeries, what’s new
starts – with that first post-op prescrip- and increasingly important is their ongo-
tion, and education surrounding opioid ing involvement on the care team, along
choices for families. with nurses, pediatricians, social work-
A task force of surgeons recently pub- ers, the family, and child protective serv-
lished the first guidelines for opioid pre- ices. We are pushing for advocacy
scriptions after surgeries for children and through this structured and multi-
adolescents, filling a gap that before had faceted team, rather than a more disjoint-
only published research relating to ed approach. Because we are very thor-
adults. This is meant to combat the prac- ough in our trauma evaluation/physical
tice of routinely prescribing opioids to exam, we identify and treat findings that
children after surgery as they would to are not immediately recognized by pedi-
those over 18. atricians.
The recommendations in the new guide- My hope is that a standardized tool to
lines essentially promote replacing routine screen for child abuse when children
opioid prescriptions for children post- arrive in hospitals and trauma centers
surgery with a schedule of Ibuprofen and will help. We support data accrual on
Acetaminophen. This is the case for mild abuse screening and diagnosis into a
and moderate pain levels in the recovery trauma registry.
period.
If opioids are necessary for pain control, Dr. Carmen Ramos-Irizarry, a pediatric
such as in more severe and major surger- surgeon at KIDZ Medical in Naples, is a
ies, the guidelines recommend a prescrip- Councilor of The American Board of Surgery
tion of three days, as any longer than that (ABS), the national certifying body for
increases the risk of addiction. More major general surgeons and related specialists.
surgeries like this might include proce- For more information, visit
dures that require opening the abdomen or www.kidzmedical.com/provider/
thorax, and/or a larger incision. carmen-ramos-md.

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4 November 2021 southfloridahospitalnews.com South Florida Hospital News