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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Administrative Issues : Resident Roles: PGY-2 & PGY-3

Notes: You are the supervising Pediatric Emergency resident. You should be seeking out the sicker, more critical patient and you will be the resident doing the initial evaluation of all new ambulance and trauma patients. Please become medic control for ambulance encodes (eg. you take the call) and be responsible for keeping track of patient flow in the ED.

You will be the person (with your current attending's backup) responsible for checking out the board to the in-coming attending. Also, please try to "run the board" with the attending every few hours.

We appreciate your taking call-ins but if it is from another hospital, it must go to the attending because of legal issues.

You will be responsible for the teaching/supervision of the third year medical students.

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.
  8. Develop further teaching and supervisory skills in the management of a pediatric ED

Activities:
Each resident will:

  1. manage the pre-hospital communication from EMS or referring physician about an incoming ill or injured child.
  2. be present at the arrival for the initial triage, resuscitation, evaluation and management of an ill or injured child (from minor to life-threatening).
  3. perform histories and physicals on a wide variety of emergent and urgent childhood injuries and illnesses, and formulate an assessment and plan.
  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. teach and supervise medical students and junior residents in the pediatric ED.
  6. supervise and oversee the efficient flow of patients through the pediatric ED.
  7. give a case-based presentation of a pediatric condition (one per upper level per month).
  8. participate in a series of mock codes.
  9. attend the pediatric emergency medicine noon conferences.
  10. review prior night cases with the pediatric emergency attending and oncoming residents on weekday mornings.

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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