Peds - Kings County

EDUCATIONAL GOALS AND OBJECTIVES

The educational objectives for the Emergency Medicine resident while in the Pediatric ED are as follows:

Patient Care

  • Demonstrate the ability to obtain a focused history and physical exam on pediatric patients
  • Develop skill in infant/pediatric resuscitation
  • Demonstrate correct airway management including pediatric endotracheal intubation
  • Demonstrate correct performance of peak expiratory flow measurements, pulse oximetry and end-tidal CO2.
  • Demonstrate ability to obtain and utilize intravenous access including venipuncture, intraosseous needle placement, and administration of appropriate dose of emergency medications.
  • Demonstrate ability to properly perform a pediatric lumber puncture.
  • Calculate fluid and electrolyte requirements of dehydrated child.
  • Interpret a series of pediatric EKG’s showing awareness of the normal physiologic differences from adult EKG’s.
  • Demonstrate ability to properly treat patient who needs prophylaxis for rheumatic fever or sub-acute bacterial endocarditis.
  • Demonstrate ability to correctly perform and interpret the exam of the ears, nose and throat.
  • Demonstrate correct management of foreign bodies of the upper airway and ability to diagnose and arrange disposition for patients with lower airway foreign bodies.
  • Demonstrate ability to read pediatric chest x-rays.
  • Demonstrate management of patients with upper airway infection suspected of having epiglottitis.
  • Discuss the etiologies and demonstrate correct management of children with lower and upper airway disease including asthma, bronchiolitis cystic fibrosis, and pneumonia.
  • Demonstrate correct management of the pediatric patient with diabetes and/or diabetic ketoacidosis.
  • Demonstrate knowledge of the differential diagnosis and work-up of the jaundiced child.
  • Demonstrate knowledge of differential diagnosis and evaluation of children with petechiae.
  • Demonstrate knowledge of the differential facial and orbital infections and their treatment.
  • Demonstrate proper performance of a suprapubic bladder aspiration.
  • Demonstrate the ability reduce an incarcerated inguinal hernia.
  • Demonstrate x-ray interpretation and perform proper splinting for a variety of pediatric fractures including the clavicle, distal radius and ulna, and distal tibia and fibula.
  • Demonstrate ability to perform and interpret the results of an arthrocentesis.
  • Demonstrate ability to perform reduction of a dislocated joint. 
  • Manage the care of a child with immersion/drowning.
  • Demonstrate knowledge of the common poisonings of childhood and their treatments.
  • Manage the care of a child with a foreign body ingestion, discussing the complications, diagnostic steps and treatment.
  • Demonstrate ability to evaluate and treat a child with altered mental status and interpret a pediatric cranial CT scan.
  • Discuss the diagnostic work-up and disposition when child abuse and/or neglect is suspected.
  • Demonstrate ability to perform a history and physical exam of an alleged victim of sexual abuse.
  • Discuss the risk factors associated with teenage suicide.

Medical Knowledge

  • Discuss the causes, significance, and treatment of fever and infection in the child
  • Demonstrate knowledge of the significance of fever in children of various ages, and the ability to perform an “optimal resuscitation” including Yale Observation Score of the febrile child.
  • Demonstrate knowledge of common infectious diseases of childhood, including appropriate work-up and treatment of meningitis, sepsis, pneumonia, urinary tract infection, and bacteremia.
  • Discuss the causes of neonatal shock and demonstrate the ability to perform an infant resuscitation, including endotracheal intubation and insertion of an umbilical venous catheter.
  • Discuss the physiology and derangements of fluid and electrolyte management in children
  • Discuss the pathophysiology, causes, and treatment of common serious endocrine and hematological disorders of children.
  • Demonstrate knowledge of the etiologies of anemia in children and the appropriate diagnostic evaluation.
  • Correctly interpret soft tissue lateral neck X-rays in children.
  • Discuss the pathophysiology, causes, and treatment of respiratory disorders in children.
  • Demonstrate knowledge of the pathophysiology and manifestations of common and/or serious disease of the gastrointestinal tract and abdominal cavity of children, including gastroenteritis, intussusception, volvulis, Meckel’s diverticulum, anaphylactoid purpura, and appendicitis.
  • State the differential diagnosis of a child with upper and lower GI bleeding, and discuss the evaluation and treatment.
  • Demonstrate knowledge of the evaluation and treatment of children with diarrheal illness.
  • Discuss the treatment for phimosis, paraphimosis, balanitis, and testicular masses.
  • Discuss the differential diagnosis and work-up of renal failure or anuria in children.
  • State the appropriate management of children with seizures, both febrile and afebrile.
  • Demonstrate knowledge of hydrocephalus, its differential, treatment and the management of neurologic shunt problems.
  • Demonstrate familiarity with the diagnosis and management of Reye’s syndrome.
  • Discuss the differential diagnosis and acute treatment of the weak infant and child, including polio, botulism and the Landry-Gullain-Barre syndrome.
  • Discuss the manifestations and treatment of pediatric cardiac abnormalities
  • Discuss the differential diagnosis of chest pain in children and adolescents, noting differences from adults, and demonstrating knowledge of proper work-up and treatment.
  • Interpret a series of pediatric EKG’s, showing awareness of the normal physiologic differences from adult EKG’s.
  • Discuss the common pediatric dysrhythmias, their diagnosis and treatment.
  • Discuss the types of congenital cyanotic and noncyanotic heart disease, their complications and treatment.
  • Discuss the differential of congestive failure in the pediatric patient and demonstrate knowledge of appropriate treatment.
  • Discuss the findings and disposition of a patient with a suspected autoimmune syndrome such as juvenile arthritis, lupus, and dermatomyositis.
  • Correctly diagnose common pediatric exanthemas including varicella, measles, monilia, roseola, rubella, pityriasis, scabies, and erythema infectiosum.
  • Discuss the signs, symptoms, treatment and complications of Kawasaki disease.
  • Discuss the differential and required work-up for a pediatric patient with a limp.
  • Differentiate between the presentation, diagnostic test results and treatment of transient synovitis and septic arthritis.
  • Discuss the etiology and treatment of acute soft tissue infections and perform an incision and drainage.
  • Demonstrate knowledge of the significance and correct treatment of various patterns of burns in pediatric patients.
  • Demonstrate ability to evaluate children with syncope and discuss its differential diagnosis.
  • Discuss the differential of abnormal vaginal bleeding in childhood and demonstrate ability to perform a complete genital exam on children of various ages.

Practice Based Learning and Improvement

  • Demonstrate ability to obtain and appraise medical literature applicable to pediatrics.

Interpersonal and Communication Skills

  • Create and sustain a therapeutic and ethically sound relationship with patients
  • Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
  • Work effectively with others as a member or leader of a health care team

Professionalism

  • Demonstrate respect, compassion, and integrity
  • Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
  • Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

Systems-Based Practice

  • Understand how pediatric care affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their practice of Emergency Medicine

The Emergency Medicine resident will accomplish these objectives in the following manner:

  • Attend and participate in daily Pediatric ED teaching rounds
  • Attend all conferences given be the Pediatrics Department while on rotation.
  • Evaluate and manage pediatric patients under the supervision of Pediatric ED faculty and senior residents.  Progressive patient care responsibilities are at the discretion of the Pediatric ED faculty based on the resident’s clinical experiences, didactic knowledge, psychomotor skills, procedural abilities and credentialing.
  • Discuss and interpret results of all ancillary testing with supervisory faculty.
  • Perform pediatric procedures under faculty supervision commensurate with their post-graduate level of training and skill.

 

Rotation Paperwork

1. Please complete this package and return to the EM Admin office. You must present proof of citizenship and your original social security card to the GME office at SUNY Downstate as well as complete the other required forms. The GME office is located at 450 Clarkson Avenue, room BSB 2-74, Brooklyn, NY 11203. Please ask for Mr. Kwame Luke, he handles external rotators.

2. Complete the KCHC Access forms found here

3. Complete the SUNY GME Orientation hereInstructions for completion are as follows:

  1. Click on the link.
  2. Select the appropriate AME to take (Licensed Professional AME)
  3. Review the PowerPoint slides.
  4. Click on the web link to proceed to the Post Test.
  5. Provide Name, Title, Department and Email Address.
  6. Complete post-test
  7. Click on ‘Grade Your Test’ located at the bottom of the form. Retake post-test, if warranted.
  8. Print and sign certificate.

4. Complete the SUNY Compliance Training here. Please complete the following 4 courses:

  1. Professional Compliance
  2. HIPAA Compliance
  3. Documentation Integrity
  4. ICD-10.
  5. Upon completion, please print all 3 certificates.

5. Complete the KCHC Clinicolegal Correlations Course found here. Instructions for completion are as follows:

  1. Click Link
  2. Click on new user
  3. Choose Kings County Hospital
  4. Click grey submit button
  5. Fill in information
  6. Then complete course
  7. Print certificates and add them to your rotation package.

6. You need to attend the KCHC HIPPA ClassThe course is always at 2:00pm in the T-Bldg (Corner of Clarkson Ave and New York Ave), in the T-Auditorium. Below are the dates for the courses in 2016

 

ROTATION INFORMATION

Where: King's County Hospital, S-Building, First Floor. The ED Entrance is on Clarkson avenue across from Dunkin Donuts. Follow the Spongebob signs

When: Your schedule will have 8-hour (7A-3P, 3P-11P) and 12-hour shifts (7A-7P, 11A-11P, 7P-7A) assigned to you during your block. Number of shifts is dependent on your PGY

Schedule/Requests: Your schedule can be found on Tangier. Use username: erschedule and password: Residents2010. Schedule requests are to be made to the current TBHC scheduling chief who will forward your requests to the Peds scheduling chief. Requests are due at LEAST 6 WEEKS prior to the start of your rotation. The due date for your schedule requests was placed in your google calendar. If you need to call out sick, please send an email to erschedule@yahoo.com AND call the EM chief resident on call pager (917-761-1405) and leave a call back number. Only sending an email when calling out sick will not be accepted

Supervisor: Dr. Konstantinos Agoritsas

  • Phone: 718-245-4795
  • Email: konstantinos.agoritsas@nychhc.org

Coordinator: Ms. Stephanie Lane

  • Phone: 718-245-3320
  • Email: em.residency@downstate.edu

Attire: Scrubs

Expectations: Get all your paperwork done far in advance (see above). Review this intro powerpoint prior to the start of your rotation. Review the Peds section in Tintinalli's prior to the start of your rotation. Show up to your first shift ready to work. Be proactive and try to pick up the sickest patients to complement the peds experience from the TBHC peds ED.