Peds Advice??

[medready2005]

Hello All,

I'm interested in Peds and I start my rotation next week. I was just wondering if you all could provide some useful/practical/helpful advice to a fellow SDNer on how to excel/get the most out of the rotation. Thanks to all in advance.

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[Pyroclast]

Yeah. Use alcohol hand cleaner constantly. I just finished peds and I've got the worst sore throat of my life right now. And I used the alcohol jell a lot. Too much is never enough.

Otherwise, it's about the only rotation where having your own otoscope can be useful, so you might think about borrowing one. A good supply of stickers goes a long way towards getting kids to cooperate. And a pocket-sized thing for blowing bubbles is awesome for getting kids to breathe deeply when you're trying to auscultate their lungs. Never doubt the power of bubble stuff on peds.

 

[Thievery Corp.]

I'll be finishing Peds here a few weeks, so I'm still going through it. That said, here are my suggestions of the most important things to know how to dx and tx:
1. AOM
2. Respiratory infections and sequela
3. Rashes
4. How to do a well-child check start to finish
5. Dehydration (this is freaking huge in kiddos.)
6. Neonatal Hyperbilirubinemia

As far as doing the PE, like they tell you always do ears and throat last. I liked the flashlight trick with the otoscope at the finger to turn it red, I didn't see a toddler that didn't love it.

Hope that is useful

 

[NewRawTick]

As above, and also...
- Bring a pocket calculator (for meds, I/Os, IVF)
- Fever algorithm
- Always remember to ask about birth hx for H&P's

 

[J-Rad]

As a resident, those things that impress residents in all fields impress me: professionalism, integrity, knowing your patient, etc...You do not have to tell me that you want to go into Peds to impress me, but don't act like you hate it even if you do (even those who think they will like it sometimes don't). Find a subject within Peds that interests you based on your own interests and explore it (if you're a future adult heme/onc guy brush up on SCD [your see a lot in peds and adult], if your a future surgeon find an area where pediatricians and peds surgeons interface a lot [ex. pyloric stenosis]) and volunteer to do a 15 minute presentation on the subject (if a presentation isn't already required). You could discuss a controversial area in the literature/practice (do we need to put kids on D51/2NS for MIVF or should most go on D5NS...) The above will help impress whether you want to go into peds or not. Then I would pick some topics to read (beyond your shelf exam study) that hit on some commonly seen things within inpatient and outpatient peds based on systems. Keep it limited though; you can't learn everything and experiential reading usually works best (thus picking out the commonly seen). Use relatively short articles (find Peds In Review in the library, "theclinics" articles in mdconsult [a little longer], www.contemporarypediatrics.com)
Examples might be (list is deliberately limited; adjust according to what is seen a lot in your facility and the time of year you're rotating there):
Neuro:
ALTE (Yield of Diagnostic Testing in Infants Who Have Had an Apparent Life-Threatening Event Pediatrics, Apr 2005; 115: 885 - 893)

Febrile Seizures
Seizures (http://www.contemporarypediatrics.c...cleDetail.jsp?id=421809&searchString=seizures)
Pulm:
Bronchiolitis (Subcommittee on Diagnosis and Management of Bronchiolitis
Diagnosis and Management of Bronchiolitis Pediatrics 2006 118: 1774-1793)
Asthma
Overview of CF (Nelson's has a pretty quick read on it)
CV:
Benign murmurs
Overview of congenital heart disease
Kawasaki Dz (not common, but not rare, often pimped on, and is on the DDx of fever with rash)
GI:
Constipation
Gastroenteritis
Endocrine:
DM1 with focus on DKA
Renal:
HUS
Nephrotic/Nephritic
Heme:
SCD
Onc:
Overview of Leukemia
ID:
AOM
MRSA
Fever in 0-36mo (read uptodate article)
Conjunctivitis (read uptodate article)
Cervical Lymphadenopathy (read uptodate article)
Trauma:
Inflicted trauma

Enjoy, it can be a fun rotation.

 

[racystacey07]

Brightfutures.org is an extremely helpful website for pediatrics (moreso for outpatient rotations). There is even a little pocket guide that you can print out and keep with you. I definitely recommend it.

 

[doctorp82]

http://www.youtube.com/watch?v=naZJw62ILPo

Try not to be one of these types. Although, sometimes you just can't avoid it. Don't feel worse as a person if you're just not good with kids.

Just for fun now,

Dr.P

 

[mdphd2b]

QUOTE=Pyroclast;5500425]Otherwise, it's about the only rotation where having your own otoscope can be useful, so you might think about borrowing one. A good supply of stickers goes a long way towards getting kids to cooperate. And a pocket-sized thing for blowing bubbles is awesome for getting kids to breathe deeply when you're trying to auscultate their lungs. Never doubt the power of bubble stuff on peds.[/QUOTE]

Hey, that's my trick too--pocket bubbles and BIG stickers!!! Usually you can find big stickers on the floor (I mean bigger than they're hand so less likely to choke on them). I also have a toy rattle for small babies and a giraffe reflex hammer. Got my on oto/ophto scope in 1st year which is quire handy, since everyone of our floor models seems to be broken or missing key parts!

Good luck

 

[size_tens]

I'm about a week out from finishing my 8 week rotation. If you want to impress your residents/attendings pay attention to the little things that are specific to peds. Make sure you plot out length/weight on growth charts, offer anticipatory guidance on outpatient visits and be aware of as many congenital conditions as possible. For example if you see a patient who seems to have had a lot of infections, calculate the total lymphocyte count and compare it to the normal range to screen for scid.

 

[doctorp82]

some history questions attendings always ask me:

"allergies?"
"medications?"
"immunizations?"
"how much tylenol/ibuprofen/whatever?"
"last temp recording?"
"# of emeses/stools/wet diapers"
"appetite/fluid intake?"
"recent sick contacts?"

Other things important in the 3-4 years and younger bunch are gestational age and any pregnancy complications, social environment like whether mom and dad are together, if they have WIC or medicaid, etc.