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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Administrative Issues : Resident Roles: PGY-1

Notes: This should be a month for you to see as many patients as you can, do as many procedures as you can and beef up your general pediatric knowledge, esp in relation to pediatric urgent/emergent care. Peds interns should try their best to be freed up to go to noon conference. Many early residents struggle with seeing patients efficiently - skills that will be critical regardless of what you do after residency. Do not be afraid to handle more than one patient at a time.

You should not be supervising students directly but if you have an interesting patient, please include them! Also, please don't take call-ins for patients referred in…leave that to the upper level or attending.

Enjoy!

Objectives:
Each resident will:

  1. be able to rapidly recognize a seriously ill or injured child.
  2. initiate the evaluation and management of an ill or injured child based on the presenting signs and symptoms.
  3. function as an integral component of the pediatric team.
  4. recognize his or her limitations and know when further consultation is needed.
  5. understand the role of the pediatrician, in the ED and in practice, from injury and illness prevention to evaluation and management to rehabilitation.
  6. acquire the skills to perform specific technical procedures.
  7. learn to determine appropriate disposition of a pediatric patient.

Activities:
Each resident will:

  1. be present at the arrival for the initial triage, resuscitation, evaluation and management of an ill or injured child (from minor to life-threatening).
  2. perform histories and physicals on a wide variety of emergent and urgent childhood injuries and illnesses, and formulate an assessment and plan.
  3. present each patient to the upper level resident and/or pediatric ED (or general ED) attending physician. The degree of supervision will diminish as the resident progresses through the three year program.
  4. provide information to the primary care and referring physician about the child's visit to the pediatric emergency department, and ensure appropriate follow up.
  5. participate in a series of mock codes.
  6. attend the pediatric emergency medicine noon conferences.
  7. review prior night cases with the pediatric emergency attending and oncoming residents.

Conditions seen may include:

  1. Medical
    1. Infectious-fever, sepsis, meningitis, UTI/pyelonephritis, pneumonia, STD's
    2. Respiratory-infections, asthma, respiratory distress, apnea, near drowning
    3. Poisonings-ingestions, intentional and unintentional overdoses
    4. Cardiac-congenital heart disease, CHF, cardiac arrest
    5. Neurologic-seizures, ataxia, coma, VP shunt malfunction or infection
    6. Endocrine-DKA, CAH
    7. Hematologic-sickle cell with fever, pain crisis, aplastic crisis, splenic sequestration
    8. Oncologic-new diagnosis of childhood cancers, such as leukemia or solid tumors
    9. Renal-acute or chronic renal failure, nephrotic syndrome, glomerulonephritis
    10. Fluid balance-dehydration, hyponatremia, shock
    11. Dermatologic-childhood exanthema, eczema
    12. Physical and sexual abuse
  2. Surgical
    1. Major trauma-motor vehicle collisions, falls from height
    2. Minor trauma-lacerations, suturing, fractures, splinting, nursemaid's elbow
    3. Abscess drainage
    4. Abdominal pain-appendicitis, bowel obstruction, constipation
    5. Testicular pain-torsion, epididymitis
    6. Foreign body ingestion-inhalation or esophageal
  3. Psychiatric
    1. Acute psychiatric and behavioral problems
    2. Psychosocial and language/cultural barrier problems

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