Pediatric Emergency Medicine
I. Rationale
The specialty of family practice is vitally interested in all aspects of pediatric health and disease. This
curriculum addresses the care of pediatric emergencies. Pediatric health maintenance will be addressed
in the FPC curriculum, and Ambulatory Peds curriculum. Care of healthy newborn will be addressed in
the FPC curriculum, Nursery curriculum, and OB continuity curriculum. Care of the acutely ill child in
continuity setting is addressed in the FPC and Ambulatory Peds curriculum. Care of the hospitalized
pediatric patient will be covered in the General Peds Wards curriculum. As a family physician, Graduates
must be comfortable and able to deal with a wide variety of pediatric emergencies, be able to diagnose
and treat, recognize situations which require immediate support, require hospitalization, and/or EMS
support/transportation, or require referral.
II. Goals
The purpose of the PEC rotation for Emory Family Medicine residents is to get exposure to and be
involved with the care of children who present with medical emergencies and require high acuity care.
The FPC rotation at the residents’ continuity clinic site provides the residents with ample opportunities to
be involved with lower acuity care.
Medical knowledge/Patient Care
A. Acquire the knowledge base and skills to provide care to infants, children and adolescents,
who present with medical conditions requiring urgent and/or emergent care.
B. Learn appropriate incorporation of health promotion and disease prevention into pediatric
urgent/emergent care delivery.
C. Understand the importance of educating the patient, parent and public about environmental
factors that can adversely affect the physical and mental health, and normal development of
children.
Interpersonal Skills/Communication Skills
A. Demonstrate the ability to communicate effectively with the patient, as well as the patient’s
family and caregivers, to ensure that the diagnosis and the treatment plan are clearly
understood. Develop skills in communicating findings, educating both patients and their
families, discussing sensitive issues and negotiating a plan of action.
B. Develop a therapeutic relationship with both the patient and parent/guardian.
Practice-Based Learning and Improvement
A. The encounter with the patient and the parents will trigger the graduates’ lifelong interest in
maintaining and updating skills and knowledge as essential for delivering safe and high
quality patient care. Residents must be able to investigate and evaluate their patient care
practices, appraise and assimilate scientific evidence, and improve their patient care
practices. Residents must be proactive in obtaining the skills and knowledge needed to
effectively treat childhood medical emergencies and urgencies.
Systems Based Practice
A. Recognize personal practice limitations and understand the role of other health care
providers and resources in providing optimal care to the pediatric patient. Understand the
role of various health care providers and disciplines, and the primary care physician
specifically, in the transition of care from emergency room to ambulatory/primary care to
inpatient care and vice versa.
B. An awareness of the unique vulnerabilities of infants and children that may require special
attention, consultation, referral and/or reporting to child protective services.
Last Updated April 19, 2013
Professionalism, Bioethical Decision Making, Attitudes
The resident should demonstrate attitudes that encompass:
A. Empathic concern for the health of the child in the context of the family.
B. A commitment to carrying out professional duties, in a responsible manner, and adhering to
ethical principles in order to deliver optimal patient care at all times.
III. Objectives
Attitudes
The resident should demonstrate attitudes that encompass:
A. Empathic concern for the health of the child in the context of the family.
B. Be proactive in obtaining the skills and knowledge needed to effectively treat childhood
emergencies.
C. An awareness of social, cultural and environmental factors that impact the health and wellbeing of infants and children, and understand preventable and unpreventable factors which
may contribute to childhood emergencies.
D. The importance of continuity and access to care for prevention of illness.
E. An awareness of the unique vulnerabilities of infants and children that may require special
attention, consultation and/or referral.
Medical Knowledge
A. In the appropriate setting, by the end of the rotation and at time of graduation, the resident
should be able to demonstrate the ability to apply the knowledge of:
1. Child abuse - neglect, emotional, physical
2. Poisoning and ingestions
3. Trauma
a. Head
b. Laceration repair
c. Fractures, sprains, dislocations
4. Loss of consciousness
5. Fever
6. Acute infectious diseases
7. Sepsis
8. Meningitis
9. Dehydration
10. Acid-Base Disorders
11. Drowning/Near - Drowning
12. Anaphylaxis
13. Burns - Stabilization; first, second, and third degree treatment
14. Acute abdomen
15. Airway obstruction and respiratory distress
a. Epiglottitis
b. Croup
c. Foreign body
16. Cardiac Arrhythmias
17. Congestive Heart Failure and Pulmonary Edema
18. Respiratory Arrest
19. Cardiac Arrest
20. Acute Behavioral and Psychological Problems
Last Updated April 19, 2013
a. Depression
b. Suicide attempts
c. Psychoses
21. Diabetic Ketoacidosis
22. Eye injuries
23. Seizures
Procedural skills
A. The resident shall perform and gain competence in the procedures associated with the
diagnosis and treatment of the above-mentioned conditions, including:
1. Indication for and interpretation of xrays – chest, extremities, abdomen, skull, sinus,
neck, head CT and MRI
2. Lumbar puncture and analysis of CSF
2. Phlebotomy including heel stick and venipuncture
3. Umbilical Artery and Vein Catheterization
4. Crisis intervention for acute psychiatric problems
5. Removal of foreign bodies from the eye, ear and nose
6. Nasogastric tube placement
7. Placement of CVP lines
8. Endotracheal intubation
9. Arterial puncture
10. Analysis of ABG's
11. Bladder catheterization
12. Suprapubic catheterization
13. Woundcare/suturing
14. Incision and drainage
15. Treatment of minor closed fractures and sprains
16. Joint aspiration
17. Reduction of Nursemaid’s elbow
18. Peripheral blood smear interpretation
19. Preparation and administration of nebulization treatments for asthma
20. Management of fluid resuscitation
21. Appropriate ordering and interpretation of CBC, serum electrolytes and blood chemistries
22. EKG interpretation
23. Transillumination of the sinuses
24. Transillumination of the scrotum
25. Neonatal Resuscitation
26. PALS training and certification
27. Basic life support
28. Conscious sedation
Learning Activities
Attending Rounds
Research Conference
Multidisciplinary Rounds
Ethics/Comm Conference
Grand Rounds
Specialty Conference
Sub-Specialty
Noon Conference
Conference
Morning Report
X
Faculty Supervision
X
Didactics
X
Procedures
X
1) NPR, PBLS, PALS course during orientation month
Last Updated April 19, 2013
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
2) Receiving and providing shift sign out
Evaluation Methods
X
Attending Evaluation
X
X
Directly Supervised
Procedures
In-Training Exam
Program Director
X
Review
360 ᵒ evaluation
Videotape Review
1) NPR, PBLS, PALS exam
2) Receiving and providing shift sign out
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Patient Care
A. Demonstrate the ability to take an age-appropriate history and perform a physical exam.
B. Synthesize an appropriate diagnosis and treatment plan for common pediatric emergencies.
C. Demonstrate awareness of social, cultural and environmental factors that impact the health
and well-being of infants and children, and understand preventable and unpreventable
factors which may contribute to childhood emergencies.
D. Provides education to patient/parents regarding healthy lifestyles, home, and traffic safety in
children and families as pertinent to the patient’s presentation to the emergency room.
E. Obtain informed consent for procedures, meaning: provide patient/parents with accurate
information regarding indication, benefits and risks of procedures, and discuss potential
alternative treatment options, to aid patient/parent to choose for or against a procedure.
Learning Activities
Attending Rounds
Research Conference
Multidisciplinary Rounds
Ethics/Comm Conference
Grand Rounds
Specialty Conference
Sub-Specialty
Noon Conference
Conference
Morning Report
X
Faculty Supervision
Didactics
X
Procedures
X
Receiving and providing shift sign out
Evaluation Methods
X
Attending Evaluation
X
X
Directly Supervised
Procedures
In-Training Exam
Program Director
Review
360 ᵒ evaluation
Videotape Review
1) NPR, PBLS, PALS exam
2) Receiving and providing shift sign out
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
A. Demonstrate the ability to communicate effectively with the patient, as well as the patient’s
family and caregivers, to ensure that the diagnosis and the treatment plan are clearly
understood.
Last Updated April 19, 2013
B. Develop skills in communicating findings, educating both patients and their families,
discussing sensitive issues and negotiating a plan of action.
C. Develop a therapeutic relationship with both the patient and parent/guardian.
D. Develop positive and functional relationships with colleagues as well as with other disciplines
and support staff, in order to achieve delivery of compassionate and optimal care
Learning Activities
Attending Rounds
Research Conference
Multidisciplinary Rounds
Ethics/Comm Conference
Grand Rounds
Specialty Conference
Sub-Specialty
Noon Conference
Conference
Morning Report
X
Faculty Supervision
Didactics
X
Procedures
X
Receiving and providing shift sign out
Evaluation Methods
X
Attending Evaluation
X
X
Directly Supervised
Procedures
In-Training Exam
Program Director
X
Review
360 ᵒ evaluation
Videotape Review
1) Receiving and providing shift sign out
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Practice Based Learning
A. Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices. Residents must be
proactive in obtaining the skills and knowledge needed to effectively treat childhood
conditions.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
Didactics
NPR, PBLS, PALS course
Evaluation Methods
X
Attending Evaluation
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
X
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Program Director
X
Review
360 ᵒ evaluation
Videotape Review
1) Receiving and providing shift sign out
Last Updated April 19, 2013
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Systems Based Practice
A. Demonstrate awareness of the unique vulnerabilities of infants and children that may require
special attention, consultation and/or referral.
B. Develop and show understanding of the importance of continuity and access to care for
prevention of illness. Facilitate smooth transition of care at time of patient discharge from
the emergency room to either inpatient or primary care follow up.
C. Develop and show understanding of state laws, which affect the delivery of health care to
minors.
D. Communicate verbally and document within the patient’s record clearly and completely both
to facilitate care and meet the documentation billing requirements of both Medicaid and
private health insurance.
Learning Activities
Attending Rounds
Research Conference
Multidisciplinary Rounds
Ethics/Comm Conference
Grand Rounds
Specialty Conference
Sub-Specialty
Noon Conference
Conference
Morning Report
X
Faculty Supervision
Didactics
Procedures
X
1) Receiving and providing shift sign out
2) Consultation with specialist
3) Encounter documentation
Evaluation Methods
X
Attending Evaluation
Program Director
Review
360 ᵒ evaluation
other
Directly Supervised
Procedures
In-Training Exam
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
D. Arrive at the PEC in time, in order to be able to perform and complete assigned duties
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information
about patients.
G. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
H. Appear professionally dressed and well groomed.
I. Complete notes, referrals and other forms of communication and documentation in a timely
fashion.
J. Attend required didactics, conferences.
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K. Respond to pages and clinic messages in a timely fashion.
Learning Activities
Attending Rounds
Research Conference
Multidisciplinary Rounds
Ethics/Comm Conference
Grand Rounds
Specialty Conference
Sub-Specialty
Noon Conference
Conference
Morning Report
X
Faculty Supervision
Didactics
Procedures
X
Receiving and providing shift sign out
Encounter documentation
Evaluation Methods
X
Attending Evaluation
Program Director
Review
360 ᵒ evaluation
other
Directly Supervised
Procedures
In-Training Exam
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
IV. Instructional strategies (see above)
A. On average 4 shifts of 8 to 12 hour per week at Hugh Spaulding PEC, including early, late
and night shifts, under direct supervision of the PEM attending on duty.
B. At least 2 thirds of these shifts need to be spent in the ER rather than in the urgent care, to
ensure sufficient exposure to higher acuity care, and to ensure enough opportunity to obtain
procedural experience.
C. Assessment and management of patients presenting to Hugh Spaulding ED and urgent care,
under direct supervision by PEC attending.
D. Procedures under direct supervision; procedure log.
E. Associated rotations for additional pediatric emergency experience: FPC, nursery, OB
continuity, pediatric wards, outpatient pediatrics
F. NPR, PBLS, PALS courses during orientation month
G. Reading list: see below
V. Evaluation strategies (see above)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Direct observation of patient care by PEM faculty
Review of procedure log by PEM faculty
Ongoing review of resident’s documentation
Direct observation of teamwork ability, communication skills and professionalism
Mid-rotation evaluation by PEM faculty
End of rotation evaluation by PEM faculty
Resident evaluation of rotation and faculty
Topic presentation during the last week of the rotation
Observation by FM faculty in FPC
ITE profiles
Completion of readings and >90% score on open book Monograph quizzes
Last Updated April 19, 2013
VI. Implementation Methods
Contact:
PEC: Deborah Young, MD, FAAP 404-785-6857
Egleston Children’s Hospital
1405 Clifton Road
Atlanta, GA 30322
Chiefs: Joycelyn Grunwell jgrunwe@emory.edu
Lakesha Davison ldaviso@emory.edu
Location:
CHOA, Hughes Spalding
35 Jesse Hill Jr. Drive SE
Atlanta, GA 30303-3032
404-785-9500
Family Practice Center: Half day per week
Call/Vacation: Call will be with the PEC Clinic. Vacation permitted on this rotation
Supervision: Attending faculty will be asked to complete evaluations of performance.
Procedure documentation should be initialed by the supervising physician, whether faculty or senior
resident, and must be done with supervision until proficiency is established by an attending or fellow with
use of the competence form.
Conferences: The resident is expected to attend Pediatric grand rounds.
VII. Suggested Reading List
PEM rotation handbook (provided by rotation)
PALS handbook (provided during orientation)
AAFP Monographs:
#333 Infectious Disease Update (2007)
#338 Childhood Office Emergencies (2007)
#362 GI conditions in children (2009)
#393 Respiratory issues in infants and children (2012)
Textbook of Pediatric Emergency Medicine, 6th ed, edited by G.R. Fleisher, 2010
(Available at Emory Health Library eBooks, link – see below)
Emory Health Library eBooks on Pediatric Emergency Medicine:
http://health.library.emory.edu/search/apachesolr_search/emergency%20medicine?filters=tid%3A3&retai
n-filters=1
Additional E-books at the Emory Library,
http://health.library.emory.edu/collections/etextbooks
search titles as below, and search “pediatric” for additional resources
Nelson Textbook of Pediatrics
http://health.library.emory.edu/search/apachesolr_search/red%20book?filters=tid%3A3&retain-filters=1
Last Updated April 19, 2013
The Harriet Lane Handbook.
http://health.library.emory.edu/search/apachesolr_search/harriet%20lane?filters=tid%3A3&retainfilters=1
Red Book
http://health.library.emory.edu/search/apachesolr_search/red%20book?filters=tid%3A3&retain-filters=1
Last Updated April 19, 2013