Welcome to the Peds ED!
Here are a few resources that you may need throughout your shift!
FAQs:
The Pediatric ED will see patients ages 21 and under.
Patients aged 18-21 may be deemed inappropriate for the pediatric area as determined by Triage/PIT/PEM attending. These patients will go to the Adult ED.
Patients 22 and older will go directly to the Adult ED.
PGY4s will have peds shifts sprinkled into their ED blocks. Residents in the Peds ED work in staggered 8 to 10-hr shifts, meaning one resident leaves and one starts every 2-3 hours. There is therefore no large group signout in the Peds ED like there is in the Adult ED.
Also keep in mind that only EM PGY 3s or 4s or Peds PGY 2s or 3s can work 7am or overnight shifts. Be sure to email the EM Peds Chief to approve all shift swaps
EMG PGY-2 are assigned 1-2 BI PEDS shifts per 2 week shifts, which are highlighted in TEAL.
1. Pick up only one patient at a time.
– If there are two or more peds patients from the same family, please sign up for all of them. Also, if the department is exceptionally busy you may pick up more at the discretion of the fellow/attending.
2. If a fellow is working, offer to present to them first.
3. Check with your attending or fellow before ordering labs or imaging on children.
Unlike the adult ED, PEM providers are far more judicious with diagnostic studies.
4. Medication administration.
– Oftentimes, residents prepare nebs for patients instead of nurses. See below for how to make a neb:
– Medication is located in the cabinets over the sink behind the attending computer station
– How to make a neb
– Just make you let the nurses know and check off the meds on the MAR.
Minors are not allowed to be assessed or treated in the ED without verbal consent from a parent or guardian.
This rule supersedes EMTALA unless the patient is critically ill and unaccompanied. Practically speaking, this means that teenagers who walk into the ED by themselves need to provide you with a working number to contact their parent or guardian to obtain permission to treat over the phone. The exceptions to this are teenagers seeking evaluation for pregnancy, sexual assault/domestic violence, contraception, or illegal drugs.
Under orders > INHALED RESPIRATORY MEDICATION DELIVERY > COVID POSITIVE ALBUTEROL ORDERS > albuterol HFA
This is does not need to get up from the pharmacy.
For patients less than 18: Consult pediatrics first!
For patients between 18-21: Consult pediatrics first, especially if this is a first time diagnosis! They may say to call adult services, but start with the pediatrics consult if they’re in the pediatric emergency department.
For patients older than 21: Consult adults subspecialties
To the floor:
– The floor will call you for resident to resident sign out. If they do not call you within 45 min, please call the floor to give handoff and write a handoff note.
– The floor team should be taking over care within 4 hours of the admission order, even if the patient is still physically in the ED. If this does not happen, contact the floor team and let a fellow/attending know.
To the PICU:
– The PEM attending or fellow will call the PICU attending or fellow to present the case. If the patient is accepted to the PICU, the PICU resident will call you for resident to resident sign out.
– When finishing a shift, you are responsible for giving handoff for all patients physically in the ED to the next resident, including admitted ones (unless the floor team has taken over care).