Thursday, January 8, 2015

Monday December 22, 2014

This was my first 24 hour call day.  The call schedule here was q5.  This was a learning experience for sure, as the on-call person covers the Pediatric wards, NICU, PICU, does admissions, and attends Cesarian sections to do infant resuscitations.  While I did have current NRP and PALS certifications, my only real experience with either of these in residency was with mannequins.  I must have reviewed the PALS and NRP algorithms in my head 50 times that day.

From 9am - 3pm, I was in the clinic.  It was very busy.  We see an average of 15-20 patients each during a clinic day.  A lot of viral syndromes, crazy strep/staph skin infections, genuinely sick kids.  The clinic here does no primary care, as the well child checks are all done at the department of health.

I was surprised to find that American Samoa also has one of the highest incidence of Rheumatic fever in the world, so a lot of kids coming in for screening and their bicillin shots.  Despite what I learned in medical school (strep throat leads to rheumatic heard disease, and strep skin infections lead to glomerulonephritis), most of the physicians believe that the high incidence of Rheumatic Fever/Heart disease is due to a very virulent strep skin infection.

That evening, I had three admissions, plus a lot of phone calls from the ED with questions about management, drug doses, etc.  It was also very refreshing to be in a place where the ER physicians do not admit the patients - I think HCMC has to be one of the only places where ER physicians admit and the team actually taking care of the patient cannot refuse the admission.  Of course, with this being my first on-call, I played it safe and admitted most of the kids.  After all, many of these kids come from well over an hour away, and their parents may not bring them back if the doctor tells them their kids are "fine".

My admissions included a two week old with a fever, concern for sepsis.  Dr. Marrone came in and taught me how to do a lumbar puncture on a baby.  There was also a kid with a bad pneumonia, and a little girl with seizures. I also had a straightforward "emergent" cesarian section that I attended as the NICU pediatrician.  The baby required some active resuscitation with PPV, but APGARS were 8 at 5 mins, and the baby did fine.

All in all, it was a very busy call.  I got maybe an hour of sleep, but the learning experience was worth it. The three kids I admitted became "my patients", and I would round on them every day before clinic, write the orders, and discharge them home.  It was awesome having the autonomy, but also a little out of my comfort zone - since up to this point, most of the medical decisions in residency are micromanaged by attendings (especially when it comes to kids).

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