End of rotation reflection- QHC- Pediatrics
During 5 weeks rotation at QHC pediatrics department, the most important thing I learned is to obtain a history from parents and get a good physical examination. For pediatrics patients, history is most likely obtained from patients, which can be subjective. For example, there is one baby brought in by mother with a complaint of high fever, when I asked about fever, the mother said really high fever for 2 days, and when I specifically asked for temperature showed on the thermometer, she told me it was 98.3F oral, which won’t consider fever. If the child is taking medicine, the amount being taken, the frequency, and the name of the medicine is also very important. For physical examination, the sequence is very important for a successful examination. Skill, tact, and patience are required to gather an optional amount of information when examining a child. Get down to the child’s level and try to gain the child’s trust. I learned that for 8 months to 3 years old will usually have more success substituting the mother’s lap. And leave the ENT exam to the last, because they are irritating, and children usually do not cooperate well. I have learned that during the interview, it is important to convey to the parent interest in the child as well as the illness, the patent is allowed to talk freely at first and to express concerns in his or her own words.
For H&P, it is a little different from what I learned from surgery rotation. In the surgery rotation, HPI should include the patient’s history, acute complaints, courses in the ED, lab findings, imaging results, and treatments received in the ED. It is very important to know why the surgery team is consulted, which will determine the next step of management. For pediatrics, it is important to include their immunization status, sick contact, and recent travel in the HPI. The ED is used frequently for health care by many inadequately vaccinated children who are at risk for such diseases. Eds serve as a primary interface between hospitals and the community at large and are likely to be called on to play a prominent role in the event of an emerging infectious or biological threat. To promote health and well-being, in cases of outbreak or epidemics of vaccine-preventable diseases, emergency clinicians should help health care facilities in partnering with public health agencies to develop and implement mass vaccination programs and provide appropriate education regarding getting vaccinated. In addition, for the patients who are under 12 months old, HPI should also include delivery information, such as, which hospital, virginal delivery, C-section delivery, full-termed infant, pre-termed infant, NICU stay, and any complications.
For pediatric patients, I have learned that it is very important to look at their faces when you ask them questions. There is a 6 years old boy brought in by his parents for nausea, vomiting, diarrhea and abdominal pain for 2 days. The last episodes of vomiting and diarrhea were at last night. Parents report the patient feels better today, but just want to make sure there is no infection going on. After got history, I examined the abdomen of the patient and asked the patient if he feels any pain when I palpated. The patient reported severe pain when I pressed down with light pressure, but he was giggling, climbing down from the examination table, running around and playing with the weight machine in the room. Pain in children can be difficult to assess, health care workers need to be able to detect the signs and symptoms of pain in different age groups and determine whether these symptoms are caused by pain or other factors. In this age group, it is very important to investigate the pain-related behaviors, like nonverbal behaviors, for example, facial expression, limb movement, and crying.
I remember one case from this pediatrics rotation. The patient is a 3 months old female, pre-term, was born at 31weeks 3/7 days via c-section. The baby’s mother is positive for multiple substance abuse during the pregnancy, her Utox is positive for opioids, cocaine, heroin, and PCP. The baby is concerned for abstinence syndrome and admitted to NICU. The baby is experiencing tremors, irritability with excessive crying, sleep problems, high-pitched crying, poor feeding, vomiting, sweating, and also 4 episodes of seizures. The social worker is trying to contact the baby’s father, who is unwilling to take the baby, and the mother is still using substances. After the meeting with family, this baby will be sent to foster care after medically cleared and discharged from NICU. This is a very sad and stressful case. When a mother uses illicit substances, she places her baby at risk for many problems. A mother using drugs are less likely to seek prenatal care, which can increase the risks for her and the baby. Besides difficulties of withdrawal after birth, the baby may be premature, may have a seizure, and birth defects. Heroin case significant withdrawal in the baby up to 6 months, and cocaine use is associated with poor fetal growth, developmental delay, learning disabilities, and lower IQ. I hope all the women are pregnant or planning to be pregnant, she should avoid using addictive drugs or alcohol to help keep her baby safe.
For my next emergency medicine rotation, I will try to practice basic suturing, skin stapling, obtaining ABGs, installation of local anesthesia, abscess drainage, orthopedic are with splinting and reduction of dislocations, procedural sedation, basic hemorrhage management. If I have a chance, I will also want to perform a lumbar puncture, place NG tube, performing CPR, basic airway management with mask or bag, joint aspiration or injection, intubation, central line or chest tube placement. In the pediatrics rotation, I learned how to interact with infants, children, and their parents. For the following rotation, I will observe how clinicians interact with different age groups of patients, and how they deal with acute situations, examinations, and then practice on these procedures.