PEDIATRIC EMERGENCY MEDICINE ROTATION
STANFORD UNIVERSITY SCHOOL OF MEDICINE
DIVISION OF EMERGENCY MEDICINE
Rotation Director:
Sangeeta Chona, M.D.
E-mail: schona@stanford.edu
Cell: 408-896-3846
Office Location: 701 Welch, Suite C
Administrative Associate:
Kelly Lazkani
Email: klazkani@stanford.edu
Contact for: workshop signups, any change in schedule, CAPE changes, and any rotation issues.
Rotation Liaison: Liz Mannino Avila and Jamie Holland
Introduction
The clerkship provides a comprehensive introduction to Pediatric Emergency Medicine within the Stanford
Emergency Room. The Pediatric Emergency Room is a state of the art technologically advanced department with a
pediatric volume of 15,000/year with a dedicated attending supervision from 10am-2am 7 days a week. Patients up
to the age of 21 are considered “Pediatric.” As there are over 80 EM Faculty that work in the Stanford Emergency
Department, there is a core group of faculty that works in the Pediatric Emergency Department on a routine basis.
Overnight you will be working with the middle hall Attending who may be outside of the regular core group. Due
to this wide variety of Attendings, there is tremendous opportunity to observe and learn alternate practice styles.
This is the essence of Emergency Medicine and the beauty of being given the chance to learn from such a wide
spectrum of practitioners. See our PEM Orientation PowerPoint on the LPCH webpage for a complete explanation
of roles, expectations and details of the department.
Weekly/Monthly Schedule
You will be schedule for shifts during this rotation and these will vary week to week; however, over the
course of the rotation there is a minimum expectation.
All shifts for rotating juniors are 12 hours. Schedules are made in advance by your Chief Residents in cooperation
with Dr. Chona. The Pediatric ED schedule has specific guidelines. Should the need for any schedule changes
arise, please have them approved by your Chief Residents as there are strict parameters which must be met with any
scheduling changes. Interns are only scheduled on Fridays, Saturdays, and Sundays. Intern shifts vary from 5
hours to 12 hours in length and are scheduled by the Pediatric Chief Residents.
See below for a sample weekly schedule.
Rotation Specifics
Orientation
Please review the PEM PowerPoint Orientation prior to starting your rotation. There is very important information
that should be read prior to your first shift. Residents should come prepared to sign in on EPIC and take over
patients at the start of their first shift. Your rotation liaisons will be in touch with you to orient you prior to your
first shift. If you have not heard from them 1 week prior to the start of the rotation, please get in touch with them.
Rounds (Sign out rounds)
At the beginning of each shift, there are “sign out rounds” where all MD’s, the charge nurse, and students gather and
go over the board. Residents that are leaving should be prepared to give a brief summary of their patients to the
oncoming resident with the Attending present in addition to a full assessment and plan. Never sign out unpleasant
procedures (ex. pelvic exam) that were planned at least 30 minutes prior to your shift ending, as this is unfair to the
oncoming resident. All sign outs should be documented on EPIC as “care is signed out to Dr. X at 6pm”. Ideally,
the best sign out rounds consist of a walk through to the patients with an introduction of the new doctor taking over
for you.
Call Schedule
Last updated 6/10 (skc)
There are no call responsibilities as Emergency Medicine is a shift-based specialty. However, if you are ill and
cannot come to a shift, you must contact the Pediatric Chief Residents ASAP so that another resident may be called
in on jeopardy.
Resident Roles, Responsibilities and Expectations
In the Stanford Emergency Department, the Pediatric Emergency Department consists of 9 rooms, 2 of which are
critical care rooms. Residents on service are expected to see all pediatric patients and “run” the Pediatric side of the
Emergency Department along side the attending. Upon arrival you will receive a dedicated phone, to which phone
calls from pediatricians and consultants will be transferred. You must be diligent in answering and taking
appropriate incoming patient calls as well as radiology or lab reports. Documentation is a must of all phone calls of
incoming patients or radiologic/lab results. Prior to your first shift, an EPIC “S” number and password must
be obtained. Do not wait until your first shift to obtain this as you cannot sign in or start seeing patients without the
required login. Residents must be efficient with their patient care responsibilities and sign out on time to avoid any
duty hour violations. Attendings are aware of the shift ending hours and expect you to take the initiative to start the
sign out process.
 Always try to arrive 10-15 minutes early to take over patients, so that the resident signing out will not
have any duty hour violations. You must be ready to provide care at the time your shift starts.
 Introduce yourself to the Pediatric Attending, Peds Resource Nurse as well as the Unit Secretary as a
courtesy at the beginning of your shift.
 As there are a wide variety of Attending styles, it is best to discuss with the attending upon arrival what
their expectations are in regards to seeing patients, how independently they would like you to work as well
as what you should do if feeling overwhelmed.
 Take responsibility for all assigned pediatric patients (even if in middle or front hall). At times, the patient
may be an urgent care adult (see PowerPoint for more details)
 Always be meticulous with “signing on” in EPIC, signing up for patients in EPIC, and documenting all
procedures, consultations, and follow-up. Patient wait times as well as overall encounter times are
monitored
 Be very attentive to contacting all PMD’s of their patients that you see
 See patients independently and ready to present to the attending. Juniors should have a differential and
plan, Interns should attempt to have a differential.
 Formulate a plan with the attending and place orders, consults accordingly
 Follow-up on all orders (labs, radiology, medications) with nurses
 Follow-up on all labs, imaging studies for results and document in EPIC
 Be a team player when the ED is overwhelmed
 Any consults must be done through the Unit Secretary and charted
 Any “Spanish-speaking” patients must be interviewed with an interpreter, both for history, physical,
discussions of plan as well as results and disposition. Documentation must reflect the use of an interpreter
for medical-legal reasons
 Complete chart prior to leaving, taking care to document an interventions/procedures you did.
Workshops/CAPE
A suturing/splinting workshop is offered through our Division and available for sign up. These workshops are
offered once a month on Thursdays. Although not required at this time, both the PEM faculty as well as your
Pediatric Residency Program highly encourage you to take advantage of this opportunity. Please contact Kelly
Lazkani for details.
CAPE is a simulation educational workshop consisting of mock pediatric emergencies. CAPE is offered every other
month. The Pediatric Chief Residents will schedule all juniors in advance. These sessions are REQUIRED of ALL
JUNIORS. Starting the 2010-2011 academic year- you will be required to do an extra ED shift during your ED
rotation if you do not attend your CAPE session.
Issues/Concerns
Contact your Pediatric Chiefs for any concerns. They will try to take care of any issues or involve Dr. Chona.
Feel free to contact Dr. Chona directly (schona@stanford.edu) at any time for any questions, concerns or unresolved
issues with the rotation.
Evaluation and Feedback
Methods for evaluations will consist of:
Last updated 6/10 (skc)




Medhub evaluations will be performed but many residents have found the feedback nonspecific and
have opted to use a paper based system given to the Attending at the end of the shift. These paper
evaluations can be found on the wall in the ED and on the ED section of the peds.stanford.edu
website. It is the resident’s responsibility to solicit feedback and distribute these shifts.
Resident performance will be evaluated using rating scales and narrative comments provided though the
MedHub evaluation system. Specifically, the PEM faculty will receive a Group Evaluation of all rotating
Pediatric Residents after obtaining collective feedback from the EM Faculty.
Residents will also have opportunity to evaluate the rotation using the MedHub evaluation for the
Attendings, the workshops, CAPE, as well as specific ED feedback. Everyone is encouraged to be upfront
on both positive and negative issues. We can only improve the rotation for everyone if honest feedback is
given.
Residents will be asked to evaluate peers as well.
Sample Schedule
Monday
Tuesday/Thursday
11am-11pm Juniors
ED resident
coverage.
9pm – 8am Juniors
Wednesday
Morning Emergency
Medicine
Conferences/ No ED
resident coverage
until 1pm.
Friday
Saturday/Sunday
11am-11pm Juniors
11am-11pm Juniors
Saturday: 10am-10pm Interns
Sunday: 10am-8pm Interns
Start sign out process 30
minutes prior to end of shift to
avoid any duty hour violations
Monthly suturing
and splinting
workshops from
8am to noon on
Thursdays. Sign up
required in order to
attend. Contact Dr.
Chona/Kelly
Lazkani
Wednesday CAPE
sessions every other
month from 1pm to
5pm. Assignments
made by Pediatric
Chiefs. Attendance
is mandatory.
Pediatric Intern shift
5pm-10pm
9pm-8am Juniors
9pm-8am Juniors
9pm-8am Juniors
9pm-8am Juniors
.
*Make sure to arrive 10 minutes prior to the start of every shift to receive proper sign-out.
Last updated 6/10 (skc)
Competency-based Goals and Objectives Pediatric Emergency Medicine
The following goals represent the minimal competencies that should be demonstrated upon completion of the rotation. Through exposure to a variety of clinical scenarios, we
anticipate the breadth and depth of learning will be greater than what is listed here.
Goal 1: Adjust practice style to incorporate the unique demands of an Emergency Department environment including high patient volume, psychosocial factors,
absent continuity and often medical history, and varying acuity.
Resident Objectives:
1. Generate differential diagnosis based
on chief complaint and tailor history and
exam to elucidate diagnosis.
Training Level
All levels
Instructional Strategies
- Obtain focused H&P on
patients
- Present in focused manner
Evaluation
ACGME Competency Goals
 Attending feedback
MK, PC
2. Recognize that patient may wish to
have additional non-acute issues
addressed during the ED visit. Assess
whether this is reasonable based on
demands on the ED at the time. If a nonacute problem that will not be addressed
during the acute visit is identified,
communicate a plan for follow-up.
3. Develop personal style that optimizes
efficiency.
Juniors and above
- Patient care
 Attending feedback
MK, PC, ICS
Juniors and above
- Self-reflection identifying when
/what factors enabled you to
reach a clinical decision
- Increase medical knowledge
through review of texts and
literature.
Test your assessment versus
RN/Attending/other resident
opinion.
-ED follow-up list. Check on
cultures, labs, etc.
 Attending feedback
MK, PC, PBLI
4. Triage patients: assess sick versus
non-sick; admission versus not, within
first few minutes of walking in patient
room.
Juniors and above
 Attending feedback
MK, PC, PBLI
Goal 2: Advance the physician’s skill set such that they are able to assume a higher level of responsibility, enhance leadership and work-flow management skills.
Resident Objectives:
1. See patient’s independently, outside of
one’s comfort zone.
Training Level
Juniors and above
2. At completion of shift, what steps
would have improved efficiency.
All levels
3. Recognize your limitations and
situations in which you need assistance;
All levels
Last updated 6/10 (skc)
Instructional Strategies
Patient care
Don’t defer patient encounters
because of discomfort or lack of
experience.
Estimate the length of time you
will need for a patient encounter;
compare the actual versus your
estimate.
Self-reflection on situations in
asked for help and why
Evaluation
ACGME Competency Goals
 PEM Faculty Formal
MK, PC
evaluations, Attendings
on shifts, senior
resident feedback
 PEM Faculty Formal
evaluations, Attendings
on shifts, senior
resident feedback
 PEM Faculty Formal
evaluations, Attendings
MK, PC, PBLI
MK, PC
ask questions early.
on shifts, senior
resident feedback
 Attendings on shift
MK, PC, ICS
4. Demonstrate initiative by contacting
PMDs and calling consults prior to the
request of the Attending.
5. Assist charge nurse/Attending in
managing patient flow.
6. Develop thoughtful management
plans, independently.
Juniors and above,
learning curve for
interns
Juniors and above
ED orientation PowerPoint,
patient care
Attending modeling
 Attendings on shift
MK, PC
Juniors and above
Improved medical knowledge
Patient care
 PEM Faculty Formal
MK, PC
7. Develop intern by providing teaching,
mentoring, and feedback (at least 2x
during rotation).
8. Improve communication with staff:
Analyze the most effective way to
operate within the ED including factors
such as introductions at the beginning of
a shift, contacting outside PMDs and
working within a multidisciplinary team.
Juniors and above
Direct practice mentoring intern
All levels
Self-reflection
Patient care
evaluations, Attendings
on shifts
 PEM Faculty Formal
evaluations, Attendings
on shifts, Peer feedback
 Self-assessment
MK, PC
PC, ICS
Goal 3. Recognize the role that psychosocial factors play in epidemiology, disease presentation and management in ED patients.
Resident Objectives:
1. Identify how patients without health
insurance are obtaining health care in
our community. Recognize the barriers
to obtaining care.
2. Ask social history questions pertinent
for care including transportation, financial
means, refrigeration for medications, etc.
Training Level
All levels
3. List red flags alerting the physician to
NAT and the appropriate parties to
involve in a work-up as well as physician
role in documentation.
All levels
All levels
Instructional Strategies
Talk with patients about how they
obtain health care/follow-up.
Talk with patients and families,
involve social worker where
appropriate for necessary
support
Cases, attending supervision,
social services support and aid
with CPS involvement
Evaluation
ACGME Competency Goals
 PEM Faculty Formal
MK, PC
evaluations, Attendings
on shifts
 PEM Faculty Formal
MK, PC, ICS
evaluations, Attendings
on shifts
 PEM Faculty Formal
MK, PC
evaluations, Attendings
on shifts
Goal 4. Comfortably and competently manage common respiratory illnesses that present to the ED
Resident Objectives:
1. Generate at least 3 differential
diagnoses for wheezing.
Training Level
All levels
2. Asthma:
- Distinguish a severely ill asthmatic
versus a mild exacerbation.
- Assess which asthmatics require
All levels
Last updated 6/10 (skc)
Instructional Strategies
-Patient care
-Discussion with attending
- Assess asthmatics pre and
post treatment
- Review asthma protocol in
EPIC
Evaluation
ACGME Competency Goals
 PEM Faculty Formal
MK, PC, SBP
evaluations, Attendings
on shifts
 PEM Faculty Formal
evaluations, Attendings
on shifts
MK, PC, SBP
admission.
3. Bronchiolitis
- Appreciate a clinical exam consistent
with bronchiolitis.
- Explain indications for labs and
admissions in bronchiolitis.
- Discuss use/nonuse of steroids and
albuterol in bronchiolitis.
4. Croup
- Assess severity of croup.
- State indications for steroids and
racemic epinephrine.
- Provide counseling on natural course of
illnesss.
- patient management
All levels
-Review Bronchiolitis protocol
-Patient care
-
PEM Faculty
Formal
evaluations,
Attendings on
shifts
MK, PC, SBP
All levels
-Patient care
-
PEM Faculty
Formal
evaluations,
Attendings on
shifts
MK, PC, SBP
Goal 5. Differentiate surgical versus nonsurgical abdominal complaints from history and physical; provide initial work-up plans (R1) and management (R2).
Resident Objectives:
1. State key findings in common
abdominal emergencies (intussception,
appendicitis, volvulus, small bowel
obstruction)
2. State the diagnostic study indicated
for common abdominal emergencies
(intussception, appendicitis, volvulus,
small bowel obstruction)
3. Call consult services and provide
appropriate detail and communicate
appropriate level of urgency.
4. Anticipate next steps in management
of abdominal pain patients; initiate
orders, consults, patient placement.
Training Level
Interns
Instructional Strategies
Patient care, Cases,
Mini lectures
Attending teaching
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
Interns
Initiate abdominal pain work-up
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, SBP
Interns/Juniors
Patient care
Attending teaching
MK, SBP
Juniors and above
Patient care, Cases,
Mini lectures
Attending teaching
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, SBP
MK, PC
Goal 6. Understand work-up and management of fever in various ages
Resident Objectives:
1. State the management plan including
work-up and indications for by age. List
the important clinical and lab evidence
that factors guide decision making.
2. Define indications for and appropriate
choice of antibiotics by age group.
Specify which agents do not have good
CNS penetration.
3. Explain the Indications and
Last updated 6/10 (skc)
Training Level
All levels
Instructional Strategies
Patient care, Cases,
Mini lectures
Attending teaching
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
All levels
Initiate abdominal pain work-up
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, PC
All levels
Perform supervised LP
PEM Faculty Formal
SBP, MK, PC
MK, PC
contraindications for Lumbar Puncture.
evaluations, Attendings on
shifts
Goal 7. Know the common etiologies for seizures. Recognize the red flags in histories that merit further work-up, consultation, and admission.
Resident Objectives:
1. Differentiate simple and complex
febrile seizures.
Training Level
All levels
Instructional Strategies
Cases, mini lectures
Attending teaching
2. Define standard management plan for
child with febrile seizures, post-traumatic
seizures, chronic seizure disorders.
3. Differential Diagnosis of child
presenting with a afebrile seizure
All levels
Cases
Attending teaching
All levels
Cases
Attending teaching
3. State the indications for neurology
consult.
All levels
Attending teaching
4. State indications for admission and
how one would follow-up once
discharged.
5. List the steps in the status epilepticus
algorithm, including drugs and dosages.
All levels
Attending, consultant teaching
All levels
Algorithm
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts, Consultants
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PC
MK, SBP
MK, SBP
MK, SBP
MK, SBP
MK, SBP
MK, SBP
Goal 8. Be able to diagnose and manage patients with altered mental status of varying etiologies.
Resident Objectives:
1. Generate differential diagnosis for
altered mental status in newborn, infant,
toddler, and teen.
2. Recognize the different chemicals
measured in a urine versus blood
toxicology screen and the indications for
each. List the drugs tested for at
Stanford on urine toxicology screen.
3. Locate the poison control phone
number; state the services they provide.
Training Level
All levels
Instructional Strategies
Cases, Mini lectures
All levels
Attending teaching
All levels
ED orientation
Attending teaching
4. Explain why syrup of ipecac is no
longer in use.
All levels
Attending teaching
5. Provide indications, time frame, route
and dose for activated charcoal.
All levels
Attending teaching
Last updated 6/10 (skc)
MK, PC, SBP
MK, PC, SBP
MK
MK, PC, SBP
6. Define the amount of Tylenol required
for toxicity, most useful timeframe for
Tylenol level, physiologic effects and
management of Tylenol overdose.
7. State the physiologic effects of TCA
poisoning and aspirin overdose:
appropriate management and
disposition.
9. Recognize current common drugs of
abuse and describe management for
those who present to the ED.
10. Recognize subset of pediatric
psychiatric patients, suicidal gestures
and existence of Munchhausen’s by
proxy.
All levels
Cases
Attending teaching
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, PC, SBP
All levels
Cases
Attending teaching
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, SBP
All levels
Cases
Attending teaching
MK
All levels
Cases
Attending teaching
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
MK
Goal 9. Know how to diagnose and manage common musculoskeletal injuries in pediatric patients.
Resident Objectives:
1. Define indications for X-ray in an
orthopedic injury.
Training Level
All levels
Instructional Strategies
Stanford ED teaching files
2. Explain the Salter Harris Classification
for fractures and implications of the
different fracture types.
3. Analyze which injuries should be
splinted and select appropriate splint
type, length, and placement.
All levels
Mini lectures
Attending teaching
All levels
Cases
Attending teaching
Splinting workshop
4. Perform maneuvers for reducing
nursemaids elbow. State situations
requiring a radiograph prior to reduction.
5. List 3 orthopedic injuries that suggest
NAT.
All levels
Attending teaching
All levels
Cases
Attending teaching
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, PC
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
ACGME Competency Goals
MK
MK, PC
MK, PC
MK
Goal 10. Be comfortable participating as a member of the trauma and code teams.
Resident Objectives:
1. Perform primary survey and
secondary survey; assess patient and
document findings.
2. Place appropriately sized C-Spine
collar
Training Level
Juniors and above
Juniors and above
Instructional Strategies
CAPE
In conjunction with PEM
attending at traumas in ED
Patient care
3. Order appropriate C-Spine films and
Juniors and above
C-spine X-ray teaching by
Last updated 6/10 (skc)
MK, PC
MK
make basic interpretation.
4. Order appropriate laboratory studies
and consultations. Give clear, concise
presentation to Attending.
Explain the PALS algorithms and
translate into action in clinical and mock
scenarios.
attendings
Juniors and above
In conjunction with PEM
attending at traumas in ED
Juniors
CAPE
-Set-up patient on monitors, hook
up suction, bag and mask.
-Mock Codes
-Execute PALS algorithms
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty, CAPE
session Attendings
MK, PC, SBP
MK, PC, SBP
PBLI, MK
Goal 11. Repair simple lacerations using common techniques. Identify the appropriate repair type based on location and quality of injury.
Resident Objectives:
1. Define the contraindications to closed
wound repair.
Training Level
All levels
Instructional Strategies
Suture workshop, Peds ED,
Patient care
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
MK, PC
2. Explain which suture type to use
based on repair type; state length to
leave suture in. Suture.
3. Analyze which injuries are appropriate
for repair with dermabond. State
limitations of dermabond.
4. State injury types and locations
appropriate for staples. Demonstrate
proper stapling and staple removing
technique; state length of time that
staples should stay in.
5. List indications for specialist repair of
wounds.
All levels
Suture workshop, Peds ED,
Patient care
All levels
Suture workshop, Peds ED,
Patient care
All levels
Suture workshop, Peds ED,
Patient care
All levels
Suture workshop, Peds ED,
Patient care
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, SBP, PC
Resident Objectives:
1. Recognize severity of anaphylaxis
and decide necessity for epinephrine.
Training Level
All levels
Instructional Strategies
Cases
Attending supervision in Peds
ED
Attending supervision
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
2. List medications and doses given in an
anaphylactic event.
All levels
3. List indications for admission
All levels
SBP, PC
MK, PC
MK,PC
Goal 12. Anaphylaxis
Last updated 6/10 (skc)
Attending supervision,
consultants
MK, PC
MK, PC
MK, SBP, PC
4. State to whom you would provide
epinephrine pen at discharge and how to
prescribe this and instruct families on
use.
All levels
Attending supervision
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, SBP, PC
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, PC
Goal 13. Understand head trauma, initiate management, understand common complications.
Resident Objectives:
1. Define most poignant aspects of the
history and physical exam for patients
with chief complaint of head injury.
2. Educate family on concussion and
post-concussive syndrome.
Training Level
All levels
Instructional Strategies
Cases
Attending supervision
All levels
Attending supervision
3. Discuss management of head trauma
including return to play guidelines,
indications for head CT, indications for
and appropriate observation length, and
follow-up.
4. State admission criteria
All levels
Attending supervision
All levels
Cases, Attending teaching
MK, PC
MK, ICS, PC
MK, SBP, PC
Goal 14: Enhance procedural skills unique to ED setting: Procedural Sedation, pain control, minor procedures
Resident Objectives:
1. Perform fluoroscien dye test for
corneal abrasions
Training Level
All levels
Instructional Strategies
Attending/senior instruction and
supervision
2. Perform I&D of Abscess
All levels
3. FB removal (ears, nose)
All levels
4. Understand children experience pain.
Accurately assess pain in children and
infants.
All levels
5.
All levels
Case
Attending/senior instruction and
supervision
Case
Attending/senior instruction and
supervision
Patient care, ask parents, be
cognizant of pain in children.
Communication skills with
children, parents, as well as use
of child life specialist
Frequent re-evaluation,
understanding various pain
scores, communicating with
parents
Attending teaching and
supervision
Pain management, appropriate
medications used, dosing, routes,
in-patient versus outpatient pain
control.
6. Perform procedural sedation making
appropriate drug and dosing selections.
Last updated 6/10 (skc)
All levels, with
attending supervision
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, PC, SBP
PEM Faculty Formal
evaluations, Attendings on
MK, PC, SBP
PBLI, PC, SBP
PBLI, PC, SBP
PBLI, PC, SBP
MK, PC, SBP
shifts
7. State the metabolism, side effects,
dosing, and contraindications for
commonly used medications (Versed,
Ketamine, Fentanyl)
8. Appropriately use local anesthetic.
List contraindications to epinephrine
mixed in local anesthetic.
All levels
Reading, sedation protocols
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, PC, SBP
All levels
Attending teaching, protocols
PEM Faculty Formal
evaluations, Attendings on
shifts
MK, PC, SBP
GOAL 15: Manage dehydration of varying etiologies.
Resident Objectives:
1.Define mild, moderate and severe
dehydration and describe physical exam
findings associated with each.
Training Level
All levels
Instructional Strategies
Attending teaching and
supervision
Evaluation
PEM Faculty Formal
evaluations, Attendings on
shifts
ACGME Competency Goals
MK, PC
2. Define oral rehydration strategy and
patient population in which it is
appropriate and fluid options.
3. Recognize how underlying etiology for
dehydration impacts therapeutic options.
4. Define IVF rehydration strategies
including fluid type, volumes, and rates.
Describe which patients merit an
electrolyte panel.
All levels
Attending Supervision
Direct Patient care
PEM Faculty
MK, PC
All levels
Attending Supervision
Direct Patient care
Attending Supervision
PEM Faculty
MK, PC
PEM Faculty
MK, PC
All levels
PBLI = practice based learning and improvement
ICS = interpersonal and communication skills
P= professionalism
MK= medical knowledge
PC= patient care
SBP = systems based practice
Last updated 6/10 (skc)