Welcome Students!!
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Transcript of Welcome Students!!
Welcome Students!!
Children’s Mercy Chief Residents
Medicine
Congratulations!! You have chosen an honorable profession
Rewarding career
Pediatrics
Important part of your medical training Main goals in studying Pediatrics:
See interesting pathophysiology Interact with younger patients Sharpen history taking skills, presentation
skills, and documentation skills Learn entities specific to pediatrics
Responsibilities
Our responsibility to you Provide ample educational
opportunity Provide basic pediatric
knowledge thru both didactics and clinical practice
Provide feedback regarding note writing as well as presentation skills
Treat you with respect and as a valued member of the team
Your responsibility to us Punctuality Professional Behavior Invest in the team and take
the initiative Appropriate use of your
time: reading, seeking out educational opportunities
Communication with your residents: communicate feedback, seek work, follow up on plans
Ask for feedback on your performance
Inpatient
Calls You choose 5 days for call until 10 pm You are required to be here until check out everyday
Days off You have 4 days off/ month total including weekends You will discuss with your team appropriate days off
Chairman’s exam You will have the morning off of your Chairman’s exam
Clinic You are required to see all your patients prior to your clinic and write
notes on them even if that morning you need to be here early Your senior residents are responsible for filling you in on the plans
once you return from clinic
Education
Inpatient Report 0700- sit towards the front and be interactive
Medical student lectures first 3 Wednesdays and last Monday pm
Monday noon lectures Wednesday noon lecture- again please sit toward the front You are responsible for presenting a minimum of 1 short 5-
minute talk to your team once during the month. Your seniors will help coordinate the topic and date
An attending physician will observe a complete history and physical exam once during the month
Daily schedule- Inpatient
Arrive no late than 6:30 am so that you can start checking out with the night team at 6:30
0700 Inpatient Report M-W 0800 Grand Rounds Thursday See your patients and write notes until 0900 Rounds 0900 Afternoon: You need to be here until check out at 1600
follow up on labs, radiology Do admissions Read Prepare presentations If you are having difficulty finding things to do:
Talk with your intern Talk with the Chief Residents
Check out at 1600
Food
You get call money for the days you are here until 10 pm (1/2 pack per call)
Mondays food is first come, first serve We have breakfast the first day of our month
and one morning in the middle of the month which you are welcome to
History and Physical- Documentation
A thorough History and Physical should be performed on all newly admitted patients and to include specifically but not limited to: Sexual history in adolescent patients Specific immunization record Medications and doses Pertinent positives and Negatives in the ROS Developmental history Growth chart plotted
Daily progress note documentation
A SOAP note should be completed daily Write a plan even before rounds, it does not
matter if you are correct but you should start thinking of formulating your own plan
The interns can not wait for students to complete notes
Presentation
We do family centered rounds- or walk rounds, on general teams often times with busy census SO efficiency is key
You do not need to present all information just the imperative- your notes will reflect the complete knowledge of your patients
EX: (Pt name) is a 4 year old previously healthy (sex) admitted (date) with (diagnosis). Overnight pt did well (or pertinent information). Pt has stable vitals overnight (or pertinent changes), physical exam unchanged or significant for (X). Our plans for today include (by systems):
Concerns or Questions
You will receive a mid rotation evaluation from either your senior resident and attending physician
If a senior resident has concerns with your work: they should contact you first.
The Chief Residents will then be involved with discussion to Dr. Talib and your attending
If you have concerns with members of your team please contact the intern or senior resident, then discuss the concern with the attending
The Chief Residents are always here to listen to your concerns and intervene when appropriate
Resources available to you
The Health Sciences Library here in the hospital
Up To Date on the computer system
Note writing
Your H&P should be as thorough as it ever will be. You should include even the most minute of details
Your SOAP note should detail significant overnight events, vitals, physical exam findings as well as your assessment of the patient and your plan of action
S- subjective, how the patient feels, O- you concrete findings, vitals, physical exam A- you comment on what is going on with the patient P- your plan of attack for the day, be specific
especially if you will get a consult- write in your note the specific question
Weight and Height
Weight in the Pediatric population is one of THE most important vital signs. We document in kilograms (1kg=2.2lb)
Look at weight everyday and note even subtle changes (Meditech under growth flowsheet)
On admission plot height, weight, head circumference, and BMI as necessary for individual patients
Try to find baseline weights An infant should gain between 15-30 grams/kg/day
Medication dosing
Based on kg weight in pediatric patient With obese children, based on ideal body
weight Having a dosing handbook with you or near
you at all times is normal
Fluids: Bolus
Bolus fluids are used when a patient is dehydrated no matter the cause: bleeding, sepsis, volume loss due to vomiting and diarrhea
Bolus fluids are isotonic (NS or LR) without glucose and without electrolytes
Bolus fluids are typically given 20mL/kg
Fluids: maintenance
Maintenance fluids are typically used for general run of the mill fluid replacement, pt is NPO for surgery, pt is ill and not eating well, pt is slightly dry
Appropriate fluid options typically include glucose (D5) as well as a ½ Normal Saline, (other fluids may be necessary based in age of patient, kidney function, sodium status, etc…)
Maintenance fluids are typically dosed as follows: 4mL/kg/hr for the first 10 kg, 2mL/kg/hr 10-20kg, and
1mL/kg/hr every kg above 20 OR 100mL/kg/day for the first 10kg, 50mL/kg/day 10-20kg,
and 10mL/kg/day for every kg above 20
Ins and Outs
This information can be found in Meditech under Assessment Forms: then feeding input and output flowsheet
Document input as mL/kg/day and should include PO as well as parenteral nutrition
Calorie counts Typical formula has 20kcal/ounce and there are
30mL/ounce Document calories as kcal/kg/day
Normal should be around 100 kcal/kg/day in typical patient
Document output as mL/kg/hr Normal should be minimum1mL/kg/hr
Truman Nursery
Arrive at 0700 and check out 1600 There is A LOT of paper work so be prepared You have 2 days off only during those 2 weeks Your responsibility includes:
Examine discharges and fill out appropriate paperwork See daily patients and write progress notes New admissions
Education: Prepare a talk Didactic type lectures 2-3 times/week Observe a circumcision
PCC
Arrive 0830 and leave when all patients are seen- last walk in time is 1630
Didactic lecture M-W am in the PCC, Grand Rounds 0800 Thursdays
Responsibilities: Pick up charts in a timely fashion See patients and check out to either attending
or 3rd year residents Present a plan as well Document appropriately and timely