Peds ED

Pediatric Emergency Medicine

SITE

Columbia PEDIATRIC ER

DURATION

4 weeks

MEETING PLACE

• The resident will report to the front area (also known as the subacute side) of the CHONY Pediatric ED at 7:30am the morning of his or her first shift.

• If questions, e-mail Dr. Alice Ruscica (amr2250@cumc.columbia.edu) or Dr. Kerrin DePeter (kcd2126@cumc.columbia.edu).

ROUNDS

• Attending/Housestaff rounds will take place at 7:30AM. Noon to midnight residents will sign out with the overnight resident at 12MN.

• In the event of illness or late arrival to your shift, please contact the Pediatric Attending on duty at (212) 305-6628. Sick call must also be reported to the EM Chief Resident on call by paging 17242.

ED SICK CALL RESPONSIBILITY

None

DAILY SCHEDULE

Residents will be scheduled for 5 shifts per week, allowing for both clinical time as well as didactic sessions as follows:

Week 1: Monday to Friday 7:30am-7:30pm (Subacute); Weekend OFF

Week 2: Monday to Friday 7:30am-7:30pm (Subacute); Weekend OFF

Week 3: Monday to Friday noon-midnight (Acute); Weekend OFF

Week 4: Monday to Friday 7:30pm to 7:30am (Acute); Weekend OFF

EM WEDNESDAY

CONFERENCE

Expected during Weeks 1 and 2.

EM ROTATOR PAGER

none

CONTACT

Dr. Alice Ruscica amr2250@cumc.columbia.edu

Dr. Kerrin DePeter kcd2126@cumc.columbia.edu

Ms. Mayra Duarte (212) 305-9825

Administrative Assistant

Pediatric Chief Residents (p82427) chonychiefs@gmail.com :

Sarah Ann Anderson-Burnett, MD

Jessica LaRosa, MD

Chief Resident Phone: 212-305-7397

Description of Rotation: The resident will learn how to properly evaluate and treat the acutely ill child. Emphasis will be placed on pointing out essential differences between adults and pediatric patients with regard to: H&P, differential diagnoses, treatments, drug dosing, fluid management, and resuscitations. The resident will also learn about diseases and ED clinical presentations unique to pediatrics. The disease spectrum will include well children with acute illness, chronically ill children with acute illness or exacerbations of their chronic diseases, and children with surgical illnesses including trauma. EM1 residents will provide care with the constant close supervision of pediatric EM fellows and attendings. They will participate in resuscitations as part of the team.

Over the course of the rotation, they will be required to review and discuss the EM Core Pediatric Curriculum on a weekly to bi-weekly basis with attendings. Tutorials will reinforce the core knowledge (see below) through a case-based format and review.

Your Training Focus:

The focus of your training will be on the three areas of most relevance and concern for the emergency-trained physician who practices emergency pediatrics in the community hospital ED setting:

1) Diagnosis and management of the most common pediatric emergencies

2) Diagnosis and management of the very sick child

3) Early recognition and diagnosis of the child who appears well, but is really very sick.

Clinical Shifts:

WEEKS ONE & TWO: Subacute ED Shifts (Hours: 7:30am-7:30pm) During these two weeks, you will evaluate and manage mild to moderate acuity patients, become familiar with the differential diagnoses and management for the most common ED pediatrics presentations (i.e. fever, respiratory illness, GI complaints), hone your H&P skills, and master the PGY-1 core curriculum knowledge base (See “Core Curriculum & Didactics” below). These first 2 weeks aim to prepare you to be able to function at a higher level and see much sicker patients in the acute area of the pediatric ED, during the second half of your rotation.

WEEKS THREE & FOUR: Acute ED Shifts (Hours: Week 3—12pm-12am starting with noon report then report promptly to the Peds ED after; Week 4—7:30pm-7:30am ending after morning signout rounds)

During these last 2 weeks, the intern will get to manage the highest acuity and most challenging cases by applying the basic skills and principles acquired earlier in the rotation to a much sicker patient population.

ALWAYS Present to the Attending Prior to Initiating Any Workups or Treatment:

Patients must ALWAYS be presented to the attending before initiating any workup or treatment. This is because the threshold for testing is much different in pediatric patients compared with adult patients with similar presentations. Part of your learning process in the Peds ED, once you’ve formulated your own impression and plan, is a discussion with your attending prior to initiating the workup as to what is an appropriate workup in a pediatric patient compared to an adult patient with the same complaint.

Exception: respiratory emergency (teal folder). Know your asthma meds. See patient immediately. Tell attending you are going to begin to treat and have the nurse do so.

Noon Report:

You are required to attend Noon Report (Mondays to Fridays at 12pm) and have protected time to do so. Please be mindful of the following 2 caveats:

1) Please always inform the attending(s) you are working with that you are leaving the ED for Noon Report. You are required to sign-out your patients to another resident when you leave for Noon Report, unless there is a clear understanding between you and the attending to the contrary. The Peds ED culture is such that attending(s) assume and expect you to always sign out your patient(s) to another resident when you leave, unless otherwise arranged by you and the attending.

2) As in the Adult ED, if you are caring for a critically-ill patient and your help is needed or have the opportunity to perform a procedure (i.e. IO, intubation, LP, etc), then that learning opportunity takes priority over Noon Report.

Core Curriculum & Didactics;

You are responsible for self-paced learning of the PGY-1 Core Curriculum, which you can access via The Pediatrics for Emergency Physicians website at:

www.thepepnetwork.com

To obtain your Username/Password, email the EM chiefs approximately one week prior to the start of your rotation. The Intern core curriculum consists of Modules 1 thru 5, which are to be completed during the first 2 weeks of the rotation.

Pediatric Emergency Medicine Core Curriculum Requirements for PGY-1 EM residents:

Estimating normal vital signs and weights for age

Pediatric ACLS and Airway Management/RSI

Fever in Infants

Pediatric Respiratory Illness

Pediatric GI ED Presentations

Seizures and Status Epilepticus

Sepsis and Septic Shock

Deadly Diagnoses Not to Miss

Educational Objectives:

• Train residents who are capable of delivering high quality emergency care to the pediatric patient, both as an autonomous practitioner and in collaboration with other physicians (PC, MK, ICS)
• Demonstrate the ability to be able to recognize, evaluate, and resuscitate all critically ill and injured children (PC, MK)
• Promptly recognize, evaluate and initiate treatment of all acutely ill or injured children or those with an exacerbation of chronic illness (PC, MK)
• Utilize appropriate laboratories and radiographic studies to establish the correct diagnosis (PBL, SBP)
• Create treatment plans based on sound judgment, available evidence, and patient preference (PC, MK, PBL, P)
• Acquire proficiency in the technical/procedural skills needed for the emergency management of the acutely ill or injured child (PC) -- except pediatric intubations
• Become familiar with the use of pharmacologic agents that will be used in the care of the patient with a pediatric illness (PC, MK)
• Demonstrate an understanding of the appropriate use of consultants in the care of the patient with pediatric illness (PC, ICS, SBP)
• Demonstrate an understanding of the ethical and legal principles applicable to the care of the pediatric patient (PC, ICS, SBP)
• Demonstrate effective use of informational resources, scientific studies and technology to enhance patient care and pursue self improvement and self education (PBL, SBP)
• Demonstrate good interpersonal skills among patients, families and professional colleagues (PC, ICS, P)
• Demonstrate in an objective manner, through supervised H&P’s and written examination, that the resident has gained the knowledge and skills required to care for pediatric patients.
• Always demonstrate respect, compassion, integrity and honesty (P)
• Always advocate for quality patient care (P)

KEY: PC – Patient Care; MK – Medical Knowledge; PBL – Practice-Based Learning; ICS – Interpersonal & Communication Skills; P – Professionalism; SBP – System-Based Practice. Please refer to Section VI of this manual for a full description of ACGME’s Core and General Competencies.

Evaluation:

The resident will receive a core competency-based evaluation by the supervising attending following his/her 4-week rotation on the Pediatric EM Service. These evaluations will be completed utilizing the residency web based information system. After review by the Program Director, these evaluations will be electronically forwarded to the resident. Additionally, immediate problems or areas of concern will be discussed as necessary or a case-by-case basis. The residents will also receive a formal semi-annual review from the Program Director or Associate Director. The Program leadership and faculty are also available at any time, to discuss matters of concern regarding performance or curriculum.

Readings:

Pediatric Emergency Medicine Core Curriculum for NYP Emergency Medicine Residency:

Available online at nypem.org.

Emergency Medicine Concepts and Clinical Practice, Rosen 5^th Edition, Mosby.

Emergency Medicine: A Comprehensive Study Guide, Tintinalli 5^th Edition, McGraw Hill.

Important: Residents are strongly discouraged from using the internet for non-academic purposes during clinical shifts. Any resident found doing so will receive a verbal warning from certain attendings. A second offense will result in suspension of clinical privileges and a meeting with the administration.

Survival Tips:

- Prior to your first shift, log onto the PEP network and review Module 1 with the goal of learning (and memorizing) the pediatric vital signs. You may be quizzed the first day (especially if you are working with Dr. Berezow).

- Take the rotation seriously. Most ED doctors feel like peds is their weakest subject, and CHONY hospital is remarkable for its reputation and its pathology. We should take this opportunity to learn seriously.

• Learn to do an infant LP on the model early, and practice a few times. Then by week 3, when there is an infant LP, you are prepared and can say confidently you are ready.

- LASTLY, make a good impression to peds EM attendings and the peds residents. We are primarily trained in the adult ED, and therefore we are guests in their house.