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| PEDIATRICS |
ROTATION #3 - PEDIATRICS OUT PATIENT
Pediatric out patient was
very fun. It was different in that you circulate throughout different areas to
get a true experience of the different services offered for children’s health.
Here are the places I got to go to.
1. Pediatric Emergency – MTA (Minor treatment area)
This was similar to
emergency. As with
all emergency rooms patients are triaged based on severity. As the name suggests MTA implies non life threatening concerns. I saw
Children with Fever – Usually means the
child has a cold and the parents are concerned. First we rule out infections first such as ear, throat and urinary tract infections. Then we provide reassurance
that there is no “bad” underlying cause.
Rash – The story I came across the most
was the patient had a fever then broke out into a rash. With children rashes
are common in viral infections again reassurance is key.
Cough – This again goes with the rash
and fever. Most children develop a post-viral cough which could persists for up
to weeks after being sick.
Broken bones – I was told by one of the
docs that it is common to see broken bones in children but the key is to make
sure not to expose the child with too many x-rays. Here I saw fractures on
fingers, radial and ulnar fractures as well as displacements.
Concussion
Herpes gingivostomatitis
Ear infection
Strep throat
2. Pediatric Physiotherapist (PT) and Occupational therapist (OT)
Was able to observe what
PTs and OTs do with children with developmental delays
3. Pediatric Speech Language Therapist
Learned the approach of a
speech language therapist for children. I also learned that parents are a big influence in inducing positive changes.
4. Fetal Alcohol Spectrum Disorder Clinic
I was able to observe how
a child is screened for a possible fetal alcohol spectrum disorder
5. Shadowed a Pediatric Nurse Practitioner
Here I was able to do
some well child/baby exams as well as see some concerns such as cough and
fever.
ROTATION #4 - PEDIATRIC IN PATIENT
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| Felt like that cat in this rotation :P |
This rotation is definitely
the most different from the ones I had previously. In pediatric in patient you work with children who have been admitted to hospital. This is a typical day
7:00 am – Meeting with the team and sign over from overnight. You
are assigned your patients that you are responsible for the day. This can be between 3 - 6 depending how many people you have on your team that day.
7:30 ~ 9:00am – You pre round on your assigned patients. This includes
asking the parents how their child did overnight, any concerns ie. If they are
admitted for diarrhea ask if there were any episodes. If they are admitted
due to asthma exacerbation ask if the patient required any puffers overnight.
This also includes a focused physical exam. What is also important is
determining urine output and ins/outs. This ensures the child is well hydrated.
To calculate urine output
Urine output = Total
urine volume (mL) / Time (hr) / Weight (kg)
Ex. A kid had a urine
volume of 500mL in 8 hr and weighs 32kg
Urine output would be 1.95 cc/hr/kg
For infants urine output
should be >1cc/hr/kg for children >0.5cc/hr/kg. If less this is oliguria
and may suggest dehydration or renal problems
9:00 -12:00 – Rounds
The team including yourself, other students the sr. resident
and attending discusses and sees each patient on the service. For your patients you
introduce them ie. 5 y/o F admitted for diarrhea. Then you talk through the
problem list and the plan for each problem. You might also call other services
for consults such as pediatric cardiology and pediatric gastroenterology
Afternoon - The afternoons can be very busy. You are responsible
for calling the services that you’ve consulted for your patient and determining
if they have seen them and what they recommend. This can mean going to their
chart to see if the other services have written suggestions as well as checking
if any results has come back from any tests that were sent. You are also
responsible to write SOAP notes on
each of your patients.
S = subjective – This is what the parents told you about how
the night went or if the child said they felt pain or felt better.
O = objective – this includes vitals and lab results as well
as what you found on your physical exam
A/P = assessment/ plan – This is where you write your problem
list and your plan. Always include nutrition/hydration and discharge planning
(Disposition) Example.
1.
Diarrhea – monitor, pending labs for GI,
abdominal x-ray scheduled tomorrow
2.
N/H (nutrition/hydration) – standard pediatric
diet, monitor ins/outs, daily weights
3.
Disposition – when diarrhea has resolved and
cause has been determined.
4:00 pm
– sign over to the person on call.
ADMISSION NOTES
Another crucial thing
that you learn is how to do a thorough admission note. This includes.
1. Date/Time
2. ID & Chief complaint
3. History of present illness
- includes hydration status # diapers #stool, fluid
intake
- Emergency room – management
4. Past Medical History
- including past hospitalizations
5. Birth History
6. Medications/Allergies
7. Immunization status
8. Development – milestones
(Gross, fine motor and social, language)
9. Diet
10. Family Hx
11. Social Hx
12. Adolescent – HEADDSS (home,
education, alcohol, drugs, diet, sex, suicide, depression)
13. Review of systems
14. Physical Exam
15. Labs & Imaging
16. Impression
17. Problem List/ Plan
This would take me 2.5 –
3 hours. Take time to read through the entire chart and understand what the
issues are. The internet will be handy for this.
SUMMARY OF THE THINGS I DID/SAW
- How to present cases
- Admissions
- Fever in newborn – full
septic workup in children from newborn to around 2 months
- Croup
- Bacterial tracheitis
- Pneumonia
- Asthma exacerbation
- Diarrhea
- Constipation – fecal impaction
- Failure to thrive
- Feeding intolerance
- ALTE – acute life
threatening episodes – usually a parent saw their child go limp or saw perioral
cyanosis but the episode resolves after the parent picks the child up
- Brain lesions
- Anorexia Nervosa
- Seizure
- Social issues –
parenting/abuse
- Eczema
- Perinatal infections –
TORCH (Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19),
Rubella, Cytomegalovirus (CMV), and Herpes infections)
- UTI
- Heart murmurs
This rotation for me was
eye opening and overwhelming. Working on the wards you get to see the
relationships of the different professions ie. Nurses, residents, students and
different services. With pediatrics inpatient you need to spend time studying
around your cases. The best way to think about it is to think of what would do
if you were the sole care provider of the patients that were assigned to you. You
should be spending time looking into their problems and developing a plan. That
way during rounds you have a plan ready to present to your sr. resident and
attending.
Overall I’ve learned a
lot in the pediatric rotation as a whole. This was by far the toughest rotation
yet. :S
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| How I looked during and a few days after pediatrics inpatient :P |
