donkoski

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I've done a few TEFs, one CDH and a bunch of omphaloceles/gastroschises. Is this pretty typical or are you guys putting up significantly more by the time you are nearly done with residency?
 

urge

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I would say you are really lucky.
 
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donkoski

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Lucky to have had so few?

Lucky to have a chance to manage some really sick kids?
 
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urge

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Lucky to do so many. Not too many are born/year and you only have ~3 mo of peds during residency.


My suspicious split personality says you came here to brag.
 
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donkoski

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Not bragging about those cases, and curious about others' experiences in terms of types of cases and numbers done in residency.

Pediatric hearts is a different thing as I've done TAPVR, TOF, an LVAD, BTs and a few transplants.

Haven't done a single caudal, though, and that's probably going to bite me in the *** somewhere down the road.
 

nimbus

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Haven't done a single caudal, though, and that's probably going to bite me in the *** somewhere down the road.
No it won't. They are the easiest block you will ever do. Sounds like a busy peds service, why no caudals?
 
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donkoski

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It is a very busy service, but for some reason, caudals don't get done very often. I recently had a case that would have done well with it (inguinal hernia) but the kid had spina bifida, so my streak continues.
 

coprolalia

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Sounds a bit like my experience. We do a ton of peds, and I've already done a bunch of similar cases, including being in the pedi heart room, and I'm only a CA-2. We get a lot of crazy congenital anomalies at our institution, and not only have I personally done a couple of TEF repairs, most of our residents get to do at least 2 or 3 before completing residency - and we get all varieties of TEF.

Difference is, I could care less. We do so much peds that we get far beyond our "3 months" required by ACGME. I often get shoved in the Peds room whether I want to be there or not. I already know that I'm not doing a peds fellowship and I don't like to take care of sick kids. I'm fully able and confident in doing those cases. And, I can do them well by now (something about intubating a pregnant fire ant comes to mind). I just don't like to. Take for example the 2-mos-old craniotomy I did the other day for non-accidental injury. You guys who get your rocks off doing complex pedi cases can have my share for all I care. Peds just isn't fun or rewarding in my book. It's mostly depressing.

-copro
 

coprolalia

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It is a very busy service, but for some reason, caudals don't get done very often.
Every belly case gets a caudal at our institution. I've done at least a dozen. I've also done thoracic epidurals on older kids (e.g. four-year-olds single shot).

Why aren't you doing more caudals? "For some reason" isn't a good explanation.

-copro
 

Intubate

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Every belly case gets a caudal at our institution. I've done at least a dozen. I've also done thoracic epidurals on older kids (e.g. four-year-olds single shot).

Why aren't you doing more caudals? "For some reason" isn't a good explanation.

-copro
How about "the data is not good for most procedures and it is not without morbidity." I don't want my child to have a potentially harmful procedure that's no better than toradol for analgesia or satisfaction. For some big cases, sure, but for routine b&b cases, its not worth it.
 

coprolalia

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How about "the data is not good for most procedures and it is not without morbidity." I don't want my child to have a potentially harmful procedure that's no better than toradol for analgesia or satisfaction. For some big cases, sure, but for routine b&b cases, its not worth it.
That's fine. Do 'em. Don't do 'em. Whatever. Treating an infant is like being a veterinarian. They can't tell you what's wrong with them. Still, we never have "morbidity" with our caudals, unless you consider them not working as morbidity.

Having said that, I really don't care how their pain is treated. There's more than one way to climb a tree, and with kids so long as they're not screaming, whatever you're doing is probably working.

Caudals are slick, though, and no peds surgeon has ever said "don't put in a caudal because the data are not good and it is not without morbidity." And, trust me, knowing that bunch, they're going to be the first ones to bitch if they don't want you to do something.

I don't like ketorolac in little kids. I do like fentanyl for them. I also like 0.1% bupivacaine in a caudal catheter. Cramming 40mg/kg of tylenol up their butts seems to work wonders too. Like I said, there's more than one way to climb a tree. The standard at our institution is a caudal for belly cases (and hernias), and they usually work great with no problems. But, I don't really ultimately care what anyone does or why, because I'm not going to be treating kids when I'm done with residency.

-copro
 
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donkoski

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"Why aren't you doing more caudals? "For some reason" isn't a good explanation."

How's this one for an explanation: the attendings don't want them done.

You're still a resident, too, so you know they call the shots for another few months.

Here's another shocker: I have done ONE ax block and haven't EVEN SEEN a Bier block done.
 

VentdependenT

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I've done a few TEFs, one CDH and a bunch of omphaloceles/gastroschises. Is this pretty typical or are you guys putting up significantly more by the time you are nearly done with residency?
We do those cases during Pedi rotation at Rush because we have no peds fellows. At Childrens we dont do hearts or transplants but you'll do the TEF's and jacked up gut cases.

What do I think about em? They are great if you wanna do a pedi fellowship. They can be frustrating if you know you are only gonna be doing basic pedi stuff for the rest of your life (fractures, appy, T&A, M&T).

You know whats 10X worse than those big nasty cases (which actually aren't that nasty)? The pediatric BRONCH ROOM. Seriously dude, screw that room. Seriously.
 
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donkoski

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The pedi bronch room is something I look forward to because you get some pretty cool airway problems to manage. Doing peds stuff is worth it to me because getting lines and tubing the little guys is a skills unto itself. You never know what you'll be faced with down the road.

Vent,

Don't you guys do pedi hearts at Loyola? My friend interviewed there for a CV fellowship and she said it is by far the busiest program in Chicago. Congrats on the position.
 

VentdependenT

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The pedi bronch room is something I look forward to because you get some pretty cool airway problems to manage. Doing peds stuff is worth it to me because getting lines and tubing the little guys is a skills unto itself. You never know what you'll be faced with down the road.

Vent,

Don't you guys do pedi hearts at Loyola? My friend interviewed there for a CV fellowship and she said it is by far the busiest program in Chicago. Congrats on the position.
I wont do pedi hearts there. If I asked I could but I have ZERO interest. Loyola is busy but I'd say that the residents at Rush and Northwestern would argue the "busiest program" part.
 

epidural man

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You know whats 10X worse than those big nasty cases (which actually aren't that nasty)? The pediatric BRONCH ROOM. Seriously dude, screw that room. Seriously.
Oh yeah? I think by far the worst room is the dental room. When people say anesthesia is boring, they are thinking about the pediatric dental room. i think the only time I have fallen asleep doing anesthesia is doing anesthesia for dental cleaning, etc. (I may have even fallen off the chairs:laugh:.) After you have done 10 or so nasal intubations, they just aren't that exciting anymore.

I wanted to do some hearts when I did my children stuff but the attendings told me not to bother. They said it was an absolutely worthless experience unless I was going into pediatric anesthesia.
 

VentdependenT

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Oh yeah? I think by far the worst room is the dental room. When people say anesthesia is boring, they are thinking about the pediatric dental room. i think the only time I have fallen asleep doing anesthesia is doing anesthesia for dental cleaning, etc. (I may have even fallen off the chairs:laugh:.) After you have done 10 or so nasal intubations, they just aren't that exciting anymore.

I wanted to do some hearts when I did my children stuff but the attendings told me not to bother. They said it was an absolutely worthless experience unless I was going into pediatric anesthesia.
Yeah man you have a serious point there. An 8 hour dental case with train tracks is a total exercise in mind obliterating introspection. Its like a bad acid trip.
 
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