PICU (Peds 421/Surs 421)
Welcome to the PICU! We are excited that you will be starting and will be looking for you on Monday. Below are some general tidbits about the rotation.
Rounds start at 0730 in the PICU during the week and 0800 on Sat/Sun. On your first day, you may want to get there a few minutes early (0715) just to get settled in and meet the group. They generally congregate outside of room 2c10 and 2c11 in front of ‘the board’-a large TV screen in the middle of the unit with patient names and room numbers. You will work out your call schedule with the residents when you arrive. You are expected to take 4 overnight calls, one of which should be a Saturday or a Sunday (so you only need to work 1 weekend). Don’t take call the first night and don’t take call with another student. Do not take call any more frequently than every 3rd day/night. Make your schedule so that it’s not strictly q4 so that you have the opportunity to work with different residents (they take a q4 call schedule). You do not need to come to work on weekends unless you are on call!! Also, on your weekend call you are NOT expected to post call round. The resident and attending call schedule is posted on the “resident reference shelf” near “the board”. You can add your call schedule here so that everyone knows when to expect you.
You should receive a copy of the power point of the student orientation. As MS4s you should not carry more than 2-3 patients at any one time and you should refrain from carrying any one patient for more than a week (at the most). These limitations are suggested for two reasons. 1) Your primary goal should be exposure to as many disease processes as possible, this is why we suggest not following patients for more than 1 week at a time. 2) If you carry too many patients you will be too focused on ‘getting work done’ and you won’t have as much time for learning.
You will be following patients in cooperation with a resident. You should pre-round, examine and sift through labs and vitals and develop plans on your patients. Each patient you are following should also be discussed with the resident following the patient with you (they should have also examined the patient as well). You can also feel free to discuss the plan or labs with the fellow or attending if a resident is unavailable.
Students can now write notes that can be incorporated into the medical record. We have a standard PICU note template in EPIC that you will need to use. Please ask the residents or fellows to share the template with you so that you can access it. Then you will share your notes with the resident that is following the patient. The resident will then edit the note and route to the attending for co-signature.
The main objectives of this rotation are for exposure to critically ill pediatric patients, developing an understanding of the complex pathophysiology impacting pediatric patients, and learning how they are managed. Come in with a good attitude, a willingness to ‘get your hands dirty’ and demonstrate that you know the ins and outs of your patients, and you will be fine. One of the most important ways that we can get an assessment of your understanding of the patient and pathophysiology is by assessing your presentations so, please ask for feedback early and often on this! It will serve you well.
Best of luck and, again, welcome to the PICU we are glad to have you as part of the team. Please, if there are questions, don’t hesitate to ask the attending or fellow on service or send me an email.
Stephanie P. Schwartz, MD
Assistant Professor, Department of Pediatrics
Division of Critical Care Medicine
The University of North Carolina at Chapel Hill
417 MacNider Hall, CB #7221
Chapel Hill, NC 27599-7221
Phone: (919) 966-7495
Pager: (919) 216-4768
Goals and Objectives
Overall Educational Goal
The PICU rotation will teach students to care for children with serious medical and surgical problems and to learn the principles to identify and manage children with a critical illness. Students will acquire an understanding of the pathophysiologic basis of common disease processes in the PICU, participate in the resuscitation and care for critically ill children, and understand end of life care for children and their families.
This rotation should allow the student to accomplish most of the following objectives:
Core Competency codes:
PC = Patient Care; MK = Medical Knowledge; PBL = Practice-Based Learning; SBP = System-Based Practice; P = Professionalism; I&CS = Interpersonal and Communication Skills
- Recognize and appropriately respond to acute life threatening events. The student should observe and be able to describe the necessary skills to resuscitate and describe the initial stabilization of the critically ill child. (PC)
- Demonstrate competence in basic airway skills (appropriate implementation of oxygen delivery devices and demonstration of bag-mask ventilation) and placement of peripheral intraosseous and intravenous catheters. Advanced airway skills (intubation) and advanced intravenous access skills (central venous catheter placement and arterial line placement) may be performed if mastery of basic skills achieved. (PC)
- Understand the pathophysiology and treatment of common medical disorders in the PICU: respiratory failure (apnea, bronchiolitis, asthma, ARDS), shock (septic, cardiogenic, hypovolemic), neurologic critical care (status epilepticus, altered mental status, traumatic brain injury, brain death), renal failure, and liver failure (PC, MK)
- Understand the indications, perioperative management and complications of common surgical admissions to the PICU: congenital heart disease, trauma, ENT, orthopedic, neurosurgical and solid organ transplant. (PC, PBL)
- Understand the different monitoring techniques in pediatric critical care: vascular hemodynamics, intracranial devices, blood pressure, arterial saturations, end-tidal CO2, and a variety of common laboratory tests. (PC, PBL)
- Understand pediatric critical care pharmacology: inotropes and vasoactive agents, basic antibiotic therapy, common sedatives and analgesics, drug pharmacokinetics and monitoring of side effects. (MK, PBL)
- Understand techniques for enteral and parenteral nutritional supplementation in the PICU patient. (MK)
- Understand the ethical and legal issues which emerge during the care of critically ill and/or dying children (do not resuscitate orders, withholding and withdrawing life support, right of patients). (MK, SBP)
- Understand the importance of psychosocial issues related to the care of critically ill or dying children. Learn to provide support and deliver difficult information to the family of a critically ill child. (MK, PBL)
- Succinctly present an ICU patient on rounds, formulate a coherent assessment of a patient’s problems and present an appropriate therapeutic/diagnostic plan. Further, effectively communicate this plan to nurses, respiratory therapists, and sub-specialists/ consultants. (PC)
Student performance is observed daily in the PICU and is assessed by the PICU attendings on service. A final online evaluation of the student is based on the goals and objectives outlined above. A mid-rotational verbal assessment should be given to each student by an attending of the division.
LEARNING ACTIVITIES OF THE ROTATION:
Daily work rounds with attendings on service and the PICU team composed of fellows from the divisions of pediatric critical care and pediatric anesthesiology; residents from pediatrics, anesthesiology, and emergency medicine; nurses; respiratory therapists; pharmacists; and social workers.
Weekly lectures given by the attendings and fellows of the division covering essential learning objectives for the rotation. Active participation in conferences pertaining to the patients; parent and family, sub-specialists, social worker, etc.
- Helfaer, M.A. and D.G. Nichols, Rogers’ Handbook of Pediatric Intensive Care. 2008: Lippincott Williams & Wilkins.
- Fuhrman, B.P. and J.J. Zimmerman, Pediatric critical care. 2006: Mosby-Elsevier.
- Park, M.K., Pediatric cardiology for practitioners. 2008: Mosby/Elsevier.
- Marino, P.L. and K.M. Sutin, The ICU book. 2007: Lippincott Williams & Wilkins.
UNC Pediatric Resident Homepage