CCHMC

Long distance: 9,1,#,beep, 7801011
Pager 9, pager number, wait, enter #, press pound (#)
Priority Link: 67997
IP HOSP MED GEN ADMIT
IP HOSP MED PROGRESS NOTE
CARDSDCINST
BBG - big booger getter

Communication Methods
P Plan, Engage                 PEACE - Do this when a problem is anticipate.
E Engage, Explain
A Account for Actions
C Closure
E Evaluate

L Listen                            LEAP - To diffuse a mess you're already in.
E Emphasize
A Ask Questions
P Paraphrase
S Summarize

Conflict Escalation
Serions Aggravated Aggression  - Danger Signs
Aggressive Resistance
Active Resistance
Passive Resistance
Verbal Resistance / Gestures
Compliance                               - Warning Signs

Bronchiolitis Treatment:

Assessment/Plan:

Pt is a 14 mth old boy with a h/o RAD presenting with increased WOB and congestion with presentation consistent with bronchiolitis and associated RAD, rhinovirus positive

Bronchiolitis:

Pt with RSV positive disease, presentation consistent with bronchiolitis with RAD exacerbation

-Continue bronchiolitis evidence based care guidelines - already weaned to bulb suction X 2 as tolerated (though has not required 11/25) BBG

RAD:

Continue Albuterol Q4 PRN. Will continue Orapred given significant response to albuterol as well as h/o RAD.

Dispo:

Yoesiyah can be discharged home when he is clinically stable, tolerating PO, bulb suction x2, adequate follow up arranged and family and team comfortable with the plan


Advice for CCHMC rotation. 9.12.13
To follow Laura's footsteps, here are my tips for Children's ED rotation!! 
    
  First, schedule!! 
  Schedule will be changing weekly. You are confined to a pod (AKA station) for the whole shift. Show up at pod B where the main schedule is posted. 
  3 shifts were given to me. You always will work for 10 hours shifts, for 3 days (Mon-Tues-Wed), except when you're on nights, you only do 2 days! (awesome) 
  Either 8AM-6PM, 12PM-10PM, or 6PM-4AM. 
  If your schedule is not posted on Amion and you are due pretty soon, contact Philip.Hagedorn@cchmc.org to get it.   
  Sean you're next, so get on the train! 
    
  FOOD - Always the most important topic. There are no breaks. You make your own breaks when you're waiting for labs to get back on patients, so I usually went upstairs to noon conference between 12 and 1PM to get food. Everybody does that. If you're on nights, bring some food! I heard we don't get any $$$ on our cards for ED rotations.. There are plenty of drinks available however(soft drinks, milk, juice, and coffee/tea) in the ED in a specific room. 
    
  Again, everybody is super nice, but our level of autonomy sucks. Sometimes, there is even a fellow on board, so you have to sign out to the fellow, who then signs out to the attending, even for the most ridiculous things. Depending on how a control freak the attending is, you may have a hard time here... Some are very conservative on their practice habits and it drives me nuts. Be patient! You know they pan-consult. I saw a lot of things here that I would not even bring my kid to an outpatient office for... Like a little skin abrasion for instance.. Or a runny nose x 4 hours... Geez... 
    
  Philip, you will be disappointed at the low-procedure count here. We are confined to pod A and B mostly. Procedures happen more in pod C(no residents there), or on nights when pod C is closed. You may fish for procedures but I got tired of it after getting several no's, and was told to "stay in my pod". 
    
  I don't have to say that it's a good idea to bring your scrubs (duh!) and your pager (they may need to reach you sometimes).  And no more phone calls... There are purple people who page the person you need, and when they are on the line they let you know!  
    
  This is my last shift here! I hope you will enjoy your ED rotation as much as I enjoyed mine (very sarcastically written).  
    
  Simon 
  ----- Message ----- 
     From: Barczewski, Laura, MD 
     Sent: 9/5/2012   9:45 AM 
       To: Kruti Patel, MD, Philip Hartman, MD, * 
  Subject: Children's Tips                               
    
  Hey guys!  Since I don't have a baby yet, I have time to send this message about tips for your CCHMC rotation. 
    
  FOOD - obviously the most important topic  =) 
  - Simon, you may be disappointed by the carb-abundant menu they provide, but for the rest of you, you will LOVE it.  =) 
  - free breakfast for morning report: bagels (i recommend the cinnamon-sugar ones - they're wrapped in wax paper and taste like the pretzels you can get in the mall!), yogurt, coffee, juice, oatmeal 
  - free lunch for noon conference: a buffet they bring in daily - menu changes, always vegetarian option 
  - $ on your ID badge so you can use this in the cafeteria when you're working evenings/nights/weekends - check to see how much you have at the beginning of the month by having them swipe it -- I had $69!  Seems like a random number and the actual children's residents only had $40, so not sure what was up with that.  Cafeteria opened 24 hrs/day -- just limited options at night. 
  - always left overs in the fridge on floor 8 in the resident's lounge - along with a coffee/hot chocolate/hot tea machine 
    
  ROUNDS 
  - they want your presentations to be 100% family/patient-centered so direct as much as possible to the family.   
  - you don't have to have your notes done before rounds -- just have them mostly done then add the few things you decided upon during rounds, sign, and you can have them done as you're walking out the patient's door 
  - 3 computers: 1 for the person presenting, 1 for someone to put in orders, 1 for someone to be updating the sign-out or d/c summary 
  - the senior resident and the attending don't see the patients before rounds, so it's actually nice b/c you feel like you're actually informing the team of things they don't know already (as opposed to how we do it) 
    
  D/C SUMMARY 
  - start it on day of admission and update on rounds or daily when you have time.  Share the note instead of pending or signing it.  Makes d/c a breeze. 
    
  Anyway, I guess I don't need to go into crazy detail about everything.  The main points are: 
  1. Everyone is SUPER nice and ridiculously helpful to one another. 
  2. They're really not that busy (though the people going in the winter might be singing a different tune) - so it's certainly not a stressful rotation 
  3. Just be okay with being an intern again - try to enjoy the lack of true responsibility and just go with the flow.  We really don't get the best of practice taking care of kids well in the hospital setting (based on our training here at St. E's) and Children's is a frickin' Mecca for all things that have to do with kids - so it's cool to see how they do things and all of the support they give the pts and families. 
    
  Oh yeah, a few more things... 
  - Pagers - use your own pager from St. E's but if you're going to be going home soon, page someone to the team pager instead of your personal one (the other residents have page-forward, but we can't do that) 
  - Scrubs - wear when you're on long days (8:30) or nights.  No one would really notice if you wear them more days then that, but that's the "official" rules.  Other days, dress up.  Just wear our own St. E scrubs. 
    
  Hopefully the next form of communication you get from me will be saying that I'm going into labor/had a baby.  =) 
    
  Laura 
    

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