CHSD PICU Rotation for Pediatric Residents

CHILDREN’S HOSPITAL TRANSPORT MEDICINE/ANESTHESIA ROTATION (PICU portion)

On the first day of your rotation please go to the PICU and ask to have the fellow on call paged.  He/she will be able to tell you how to get to the outpatient surgery area and any other things you need to know for your first day.  You should also plan on making time your first day to check in with Evelyn Lizasuain, the critical care division’s secretary in the Medical Office Building, suite 115.  The fellows can help you with this as well.

Clinical opportunities:

1.      Bedside work/teaching rounds.

PICU rounds will generally start between 08:00 and 09:00, depending on the attending.  The team will go to Radiology to review radiographic studies, then to the floors and then to the PICU.  You will need to arrive early enough to see your patients in the PICU and on the floor, review their course over the last 24 hours, and write their notes. 

Rounds in the PICU are work and teaching rounds.  The nurses present patient data for the last 24 hours (data is collated by the night nurse on a separate rounds sheet) and the attending will write the notes on most patients. 

The patients on the floors need to be evaluated and have a detailed note on the chart prior to initiation of rounds as well.  You should follow and write notes on the patients you admit through the ED.  Please let the fellows know which patients you will be following.

2.      CHET (Children’s Hospital Emergency Transport).

The transport team is activated through the PICU charge nurse and a designated transport coordinator.  Please introduce yourself to the PICU charge nurse every day and give him/her your pager number so they can page you when transports are activated.  During the days and early evenings transports are also paged overhead so if you hear a page you can begin to make your way back to the PICU.  If there is more than one resident on service at a time you may need to coordinate CHET response with them.  You should have priority, and an equitable division may be to have the other resident respond to CHET in the morning and early afternoon while you are in the operating room.  Again, please let the charge nurse know whom to page.

3.      Call.

You will take call approximately every 4th night during these 2 weeks.  Please

      discuss your call schedule with the fellows on service.  While on call be sure to let the   

      PICU night charge nurse know to page you for CHETs.               

The above areas will be your main focus during this portion of the rotation.  You may also want to take advantage of the opportunity to respond to trauma team activations when in the PICU.  This gives you the opportunity to participate in evaluation and stabilization of traumatically injured pediatric patients.  A fellow is assigned daily to respond to traumas.  Let that fellow know you would like to respond with them.  (Trauma team activation will be paged on the fellow’s and attending’s pager as well as overhead)  If there is more than one resident on the service at a time, please coordinate CHET and trauma response with them so only one resident responds at a time to each.

Procedures:

In the PICU, the fellows have “first right of refusal” for most procedures.  By getting to know the fellows and attendings you will have a better chance of doing PICU procedures.  

Critical care medical staff:

There are 5 attendings that rotate in the PICU.  All are board certified in Pediatric Critical Care.  Dr Peterson is the Director of the PICU.  Drs Spear, Worthen and Fisher are pediatric anesthesiologists and intensivists.  Dr Duthie is a pediatric intensivist.

There are also 6 pediatric critical care fellows in the PICU.  2 or 3 fellows will be on service at a time.  They are great resources for you with regards to how to do things and for teaching.

There are critical care nurse practitioners that are part of our care team.  They do not rotate off service and can be extremely helpful to you. 

Critical Care Texts Available in the Library:

The first 5 books are fairly easy to read and provide good basic critical care knowledge.  The last book has more in depth pathophysiology and is aimed more at pediatric intensive care fellows.

Didactic Teaching Conferences which you should to attend:

Tuesday/Thursday conferences.

07:30 in the critical care office.  The fellows and attendings prepare these conferences.  They cover a variety of critical care topics.

Friday noon conferences.

12:30 in the small dining room near the cafeteria.