The Peds rotation at HCMC consists of 2 weeks of Peds EM done in Team center C and 2 weeks of inpatient Peds. 

The inpatient Peds rotation is set up 1 weeks of inpatient medicine, 1 week in the Nursery or 1 week in the HCMC Pediatrics clinic.  Depending on when you come on you will do a combination of two of these rotations.  Regardless of which rotation you are on you will be on call Q4.  The schedule will be explained at orientation

Inpatient

The patients you admit will either go to the floor where you will staff them with your attending for the week or to the PICU where you will staff them with the Peds intensivist on that week.  There are two inpatient teams at any time:  the red and blue teams. 

Locations:  The PICU is on the 7th floor of the orange building, down the hall from the MICU.  The peds inpatient floor is next to the PICU on the 7th floor.  The conference room where most of their conferences are is across the hall from the PICU.

Admissions:  Your senior resident will page you with admissions.  The Peds service has their own form H&P you should use with sections they prompt you to fill out.  You will staff your patients with your senior resident who will then call the Attending if it is at night and staff the patient with them.  If it is during the days and your attending is around and available you may staff with the Attending yourself after you staff with your resident.  You usually fill out the admission orders with your resident, sometimes by yourself after staffing.  There are no preset order forms for admission.

You will usually round in the PICU first, then with your Peds attending on the floor.  Both inpatient teams will round in the PICU together.  They round apart on the floor with their separate attendings.   Rounds usually start around 8am in the PICU but your senior will know when they are for that day.

Usually you check out to the on call team when you are done for the day.  The only time that you won’t is if your sister team (the other team of your color) is on call during their clinic week, you will take admissions until they finish (usually 5pm).

Nursery

The nursery team is responsible for seeing all babies delivered by the OB and nurse-midwife services.  Babies delivered by FP doctors will be seen by FP residents.  Every baby needs a full physical within 24 hours of birth.  The nursery team does these when they are there during the day, in the evening the on-call team does this until 11pm, then all overnight deliveries are seen by the Nursery team in the AM. 

The nursery is on the 3rd floor of the orange bulding next to the OB floor.  It is controlled access.  The nurse midwife unit is across the hall from L&D. 

New babies need a full H&P.  There are forms for this.  The history involves getting history from the mother’s chart on the OB floor.  The elements of the physical are detailed on the back of the form.  When examining babies you must wear the gowns they have and use their stethoscopes.  No white coats!

After the first day babies only need SOAP notes in their chart.  You need to include weight changes, PO intake, and # wet diapers

There will be a neonatologist on during the week that sees and staffs all the babies.  There is usually a lecture by the neonatologist on most afternoons.

If the baby is not in the nursery you can go to get him or her.  There are plastic cards with numbers for each baby.  Take this and show it to the mother, then bring the baby in it’s crib/cart to the nursery for your exam.  This is how they prevent abductions.

In the nurse midwife unit you will examine the babies in the mother’s room.  They have gowns as well.  They also have containers with all the tools you need for your exam that you can take into the room with you.

Babies usually go home on the 2nd day after a vaginal delivery 3rd day after a cesarean delivery (this is how long most mothers stay) but some may leave earlier if the mother wishes.  There is discharge paperwork that must be filled out on each baby.

Clinic

The Peds clinic is located on the 4th floor of the Red building (in the area above the ER).  It’s a clinic you see patient’s and staff them.  Enough said.

Conferences

There is usually a noon conference you are expected to go to every day.  It is in the conference room across from the PICU.   There is no food provided but you should get food from the cafeteria to eat during conference (it’s usually a lecture).

PEDS EM

You will do all your rotations in Team Center C.  This is just like the C shifts you do when you are not on the rotation.  Things to know, (epi neb for croup and look up Dr. Tsai’s flow sheet for fever, in vomiting child get UA and if won’t take Pedialyte don’t be afraid to bolus).