NICU elective

[Aesculapius]

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I'm an MS3 currently picking out electives for MS4. I will definitely be going into EM. My school has a heavy emphasis on outpatient medicine, and so, I feel I have had a limited exposure to really sick pediatric patients, particularly infants, a fact that is a bit anxiety provoking. I'm not looking forward to the possibility of seeing a really sick kid/infant for the first time as a resident, and not being prepared. I was wondering if anyone had any comment on the utility of doing a NICU elective for a future EP; I realize that the NICU is for treating newborns, but I am wondering if the skills would translate into taking care of very young children in general in an emergent setting.

Thanks!

 

[xaelia]

Only if they allow you to accompany the NICU team to deliveries and assist in the resuscitation of newborns.

The rest of the rotation will likely be crunching numbers for medications and feedings and completely irrelevant.

 

[kungfufishing]

the above is good advice. you won't acquire a "newborns and infants no longer make me nervous!" suit of armor via a month in the NICU. If you can obtain some working knowledge that might apply to the ED then do it, otherwise don't.

 

[Cerberus]

I think a PICU month would be more valuable for the above mentioned reasons.

 

[Agent Splat]

I think a PICU month would be more valuable for the above mentioned reasons.

Agreed.

 

[Stitch]

I think a PICU month would be more valuable for the above mentioned reasons.

Yes, PICU would probably serve you better overall, given that they see a wider array of pathology, especially if they are doing hearts. As someone else pointed out, it would be quite useful to attend deliveries and get some experience with neonatal tubes, lines and resuscitations, however the rest of the NICU will be numbers and nutrition and NEC.

Check to see who does what, as this varies by institution. Who goes to deliveries? Where do the congenital heart defects go? Who runs ECMO?

 

[Aesculapius]

Thanks for the responses, much appreciated.

 

[AmoryBlaine]

I would talk to people before scheduling a PICU month. Most of the patients in many academic PICUs are basically just grads of the NICU = chronically ill children with multiple congenital problems.

I think PICU is much less helpful for Peds EM than MICU/SICU is for adult EM if that makes sense.

To elaborate slightly: If you get a few good adult CCM months under your belt you can manage a critically ill, ventilated adult pt in your ER for basically as long as you need to if there is a bed crunch.

Any time you have a kid who is PICU sick your biggest weapon is going to be your telephone because you will be wanting that kid out the door ASAP.

 

[Stitch]

I would talk to people before scheduling a PICU month. Most of the patients in many academic PICUs are basically just grads of the NICU = chronically ill children with multiple congenital problems.

This is not true at all, especially programs that are doing hearts within an integrated unit. There will certainly be some of these kids, but the percentage will vary and rarely do they 'take over' a unit.

I think PICU is much less helpful for Peds EM than MICU/SICU is for adult EM if that makes sense.

I understand what you mean to some extent, but I think that adult physicians are often underexposed to very sick children and as a result tend to panic when one presents on their door step. A good way to deal with that is to see the sick ones and learn how to recognize the red flags. An adult CCM month won't teach you much about a sick kid. Certainly I don't mean to undermine the importance of an adult CCM rotation, however.

Any time you have a kid who is PICU sick your biggest weapon is going to be your telephone because you will be wanting that kid out the door ASAP.

Again, I agree, but exposure to pedi airways and maybe even a congenital heart or two will be helpful when you have to walk into a room of a crashing kid before you pick up that phone.