PICU

PICU

SITE

New York Presbyterian-Columbia Campus – CHONY

DURATION

4 weeks

MEETING PLACE

CHONY 9Central at 6:45-7:00AM: ask for the overnight resident (Columbia Peds PGY-2/3 or rotator), House MD or NP.

CALL SCHEDULE

● Call is generally every 4^th night, for a total of 7 calls in a 28 day rotation.

● Check www.amion.com. ID: chony for your schedule. Any schedule request should be made ASAP (i.e. as soon as you know your PICU month because their schedules are made 3-4 months in advance) to the EM Chiefs at nypemchiefs@gmail.com and to the Pediatric Chief Residents (see below for contact information). The PICU rotation is scheduled very early in the year, so requests may not be accommodated.

ED SICK CALL RESPONSIBILITY

None

DAILY SCHEDULE

The overnight resident pre-rounds and sign-out takes place at 7AM at the computers at the desk near patient room 14. Walking rounds with attending, fellow, resident, and nurse begin after sign-out between 8:30-9AM. During rounds notes and orders are written. On weekdays if rounding, orders and notes are completed by noon, you should attend EM noon report.

Conferences in the PICU are held every Monday and Thursday at 8AM in the Critical Care offices on the 10th floor. Topics are presented by the critical care fellows and attendance is mandatory when it does not interfere with EM conference.

EM WEDNESDAY

CONFERENCE

Wednesday conference required.

EM ROTATOR PAGER

Personal pager

CONTACT

Faculty: Stanley Hum rsh2117@columbia.edu

MD FRCPC

Assistant Professor of Clinical Pediatrics

Division of Pediatric Critical Care Medicine

Pediatric Chief Residents (p82427) chonychiefs@gmail.com

Christina Siliciano, MD

Wallace Bourgeois, MD

Chief Resident Phone: 212-305-7397

Description of Rotation: You will spend 4 weeks on 9 Central, caring for non-cardiac PICU patients. Please email pediatric chief residents at chonychiefs@nyp.org if you would like a brief orientation prior to your rotation. They can arrange for one of the fellows to meet with you. During this rotation you will spend a lot of time putting in orders and writing notes.

Educational Objectives:

• Become familiar with the diagnosis, workup, and management of critically ill pediatric patients with conditions which include, but are not limited to: profound prematurity, status epilepticus, congenital cardiac disease, respiratory failure, ARDS hepatic failure, fluid and electrolyte abnormalities, renal failure, leukemia/lymphoma, pneumonia, meningitis, sepsis, and toxic ingestions (PC, MK, PBL, SBP)
• Enhance skills in evaluating and managing pediatric patients with critical illness such as congenital cardiac disease, shock, sepsis, fluid and electrolyte abnormalities, cardiac arrhythmias, hepatic and renal failure and toxicological emergencies based on sound judgment, available evidence, and patient preference (PC, MK, PBL, SBP)

- Develop a differential diagnosis and to properly utilize laboratory, radiography and other diagnostic tests in the formulation of that diagnosis (PC, MK, SBP)

- Become familiar with the physiology of the critically ill child and to develop an understanding of the role of invasive hemodynamic monitoring (PC, MK)

- Develop a differential diagnosis and to properly utilize laboratory, radiography and other diagnostic tests in the formulation of that diagnosis (PC, MK, SBP)

- Become familiar with the pathophysiology of respiratory failure in the child and its treatment including various strategies of mechanical ventilation (PC, MK)

- Become familiar with the indications, contraindications and dosages for the commonly used vasoactive and critical care pharmacologic agents (PC, MK)

- Develop an understanding of the use of conscious sedation and pain control agents in the pediatric critically ill patient (PC, MK)

- Perform, under direct supervision, appropriate critical care procedures (PC)

- Demonstrate an understanding of the appropriate use of consultants in the care of the critically ill child (PC, SBP)

- Demonstrate an understanding of the ethical and legal principles that are applicable to the care of the critically ill child and to effectively interface with family members (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)

- 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.

Evaluations: The resident will be evaluated electronically (via the MedHub program) by the supervising attending following his/her four-week rotation in the PICU. The review will be forwarded to the Program Director and will become part of the formal semi-annual resident evaluation process. Immediate problems or areas of concern will be discussed as necessary on a case-by-case basis. The resident will evaluate the rotation via the web-based system. This evaluation will become part of the annual review of the program, which will be reviewed by the Program Director.

Survival Tips:

● Residents do not write daily notes, however, are expected to update the ‘Handoff’ tab on Eclipsys every day to ensure continuity of care. Update the Handoffs before and during rounds as this will allow you additional flexibility in the afternoon if sick patients are admitted. On your first day, ask the pediatrics residents how they prefer the handoff to be updated.

● Try to attend EM noon conference. Rounds are usually done by this time, and the fellow is generally happy for you to go. You should check in with the fellow before going to make sure that it’s okay and that they know where you are.

● Fellows will likely do a majority of the procedures as they need to gain the experience. Offer to do the procedure; if they decline, offer to help during the procedures, but be careful not to make them feel uncomfortable, as many of these procedures you will likely have done many times.

● You are expected to carry an ASCOM phone while on shift, the phone number you are assigned changes daily and is designated by the unit secretary. On your first day, ask which phone you are supposed to be carrying. Keep this phone with you at all times while on shift.

● While on call, it is fine to nap in the call room but avoid hiding all night as emergencies can occur with little to no warning.

● Spend time learning drips and gain confidence on child / weight-based dosing of medications. Sick kids are some of the scariest patients in an ED, and this rotation will give you confidence in how to manage them.

Readings:

Handouts will be distributed during the Fellows Lecture Series that will cover pertinent PICU topics.

Tintinalli, chapters 9-11, 110-136

Rosen’s, chapters 8, 9, 32, 60, 64, 160-170

Nelson’s Textbook of Pediatrics, selected chapters