PICU resources?

[engineeredout]

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Anyone out there have any recommendations about what an EM resident can read prior to or during a PICU month? Keeping in mind that I have never done an inpatient pediatrics rotation in my life, and honestly don't have all that much experience with truly sick kids

 

[Cytarabine]

Anyone out there have any recommendations about what an EM resident can read prior to or during a PICU month? Keeping in mind that I have never done an inpatient pediatrics rotation in my life, and honestly don't have all that much experience with truly sick kids

I'm a 4th year student who just finished a month in the PI. We had 2 different upper level EM residents while I was there, and they both did well. I don't know of a single resource that's digestible in a short amount of time, but there are a relatively narrow set of core conditions that came in during my time in the PI. I imagine if you have a decent grasp on these (uptodate has good articles on most of them) conditions plus a few miscellaneous topics, you'll be in a good place to just learn as you go along. The below was the bread and butter from my experience

shock (all variants), fluid replacement, hematologic derangements (anemia, thrombocytopenia), DKA, hypopituitarism, meningitis, status epilepticus, stroke/HIE, brain/spine injury, acute respiratory failure, pneumonia, asthma, ARDS, mechanical ventilation, ABG vs VBG vs CBG analysis, AKI.

There are also institution-specific quirks that are probably worth asking about (e.g. our PICU manages a lot of nsurg postops and ortho scoliosis postops)

 

[BigRedBeta]

1) It's a little dated last I check, but the SCCM LearnPICU resources are an ok place to start.

2) Ask questions. This is your chance to get some experience with sick kids! Use your peds residents, the nurse practitioners, the fellows if they exist, and the attendings to answer your questions! And listen to the bedside nurses too, they are an invaluable resource.

3) It's okay to be selfish - focus on the kids that are there with DKA, asthma, trauma, status epilepticus, bronchiolitis and sepsis...the things you'll be expected to start management on in the ED. Focus your understanding on how kids are different than adults - like why is an insulin push in a type 1 diabetic dangerous but not in a type 2, or why does a virus (RSV) that only causes a cold in adults end up putting some infants on the oscillator in severe respiratory failure? It's not as useful for you to manage the post-op spinal fusions, the organ transplants, trach/vent kids, or mediastinal masses. Don't ignore these learning opportunities, but gently suggest to the other residents that you really want bread and butter patients. Help out others as much as possible and it shouldnt' be a problem.

4) At least act interested! As a PICU fellow, it was really frustrating to watch the EM residents just checkout during their month, disappear on rounds, not respond to nurses, or just generally act as an asshat while on the rotation. Yes, I know that when you're in the adult ED you get much more autonomy, yes I know that you have done months in the MICU, yes I recognize that you may have vacation this month and you're looking towards that instead of the patient in front of you. I really tried to be inclusive of the ED residents but at a certain point, if the attitude didn't respond positively, it wasn't worth my time and effort.

 

[turkeyjerky]

Why is it that pediatricians always point to outdated treatments when saying that kids are different from adults. Psssst, nobody boluses insulin or gives bicarbonate in Adults w/dka anymore either.

 

[BigRedBeta]

Why is it that pediatricians always point to outdated treatments when saying that kids are different from adults. Psssst, nobody boluses insulin or gives bicarbonate in Adults w/dka anymore either.

May be outdated in academic settings, but alive and well in the community as I've easily taken care of ~ 10 patients in the last 6 months in which kids got insulin boluses. Bicarb boluses are much more rare, but as a PICU fellow the past 3 years, I averaged about 2 transport calls a year in which I had to talk the referring ED physician out of giving it.

If it didn't keep happening, I wouldn't have to harp about it.

If you'd rather we can talk about infant airway anatomy, differences in chest compliance, diaphragmatic excursion in viral bronchiolitis.

Or we could talk about how to read a chest x-ray and interpret the thymus as something other than bilateral pneumonia...

I can keep going, but you get the idea.

 

[pedsdoc123]

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