Thursday, March 5, 2015

Paeds 101 - For First Posters

How time flies...I'm already in my third month of pediatric rotation. Some said, I'm the happy houseman because I'm a first-poster - still very energetic, enthusiastic and smiles a lot. Well, truth is, the reason I renamed the blog was simply because I don't want to be a grumpy houseman along the way. I am aware that this journey might, one day, consume whatever is left in me. It serves as a reminder of what kind of houseman I want to be.

I have only two core advice for first posters in pediatric.

1. Never hesitate to ask question, but be careful of who you're asking. 

I really don't mind if people think I'm stupid for asking too many questions. Better than making any mistake that might jeopardize a child's safety. But, along the way, I have learnt to be a bit selective in addressing my questions. After a while you will recognize reliable and trust-worthy senior to refer to when in need. Usually this seniors are a bit more strict / garang but they will lead you to the right path. When someone tell you "Chillax la... don't worry... never mind one...." always seek a second opinion on the matter.

2. The Nurses is master of the master - if you don't know what to do, call for their help!

The nurses in pediatric are very skillful. They have post-basic or at least have been there longer than any of your senior houseman. Some of my nurses have been there since my specialist was a houseman, imagine! When you don't know what to do, you can also ask them , "Kak, selalunya... kalau macam ni, kita kena buat macam mana?" They sure know.. When they say something, take it into consideration because they definitely know better than you. Don't get offended when they correct you, they just want to save you from being scolded later.

So that's the fundamentals of survival. Let's move on to the more technical aspect.

Special Care Nursery - My favorite place to be :-)

Neonatal jaundice
  • How to clerk a NNJ case? Using a NNJ clerking sheet
  • Know when to start, off and continue photo
  • NNJ standard plan : Encourage BF, start/continue photo, Repeat LSB
  • Know when to repeat LSB, coming morning? 4 hours later? 6 hours later?
  • Know that heel prick SB (serum bilirubin) is not as accurate. Some might consider it as rubbish. I usually ask the mommies, ambil darah cucuk kaki atau ambil di tangan
  • Learn to use the the LSB photo chart 
obviously NNJ is your core business in NNJ. Other topics you should master includes

  1. Risk of MAS, MAS
  2. Risk of sepsis, Neonatal sepsis
  3. Hypoglycemia
  4. Prematurity - their problems, and screening that are necessary 
General Pediatric

Is not my forte. Basically you have to know how to clerk a pediatric case, don't forget the nutritional, vaccination, birth and developmental history. I used to use a list / template on my tagging days so I wouldn't miss  a thing. Common cases you will see:

  1. Dengue, dengue and dengue!!! 
  2. Febrile fit
  3. Afebrile fit
  4. Bronchiolitis
  5. AEBA
  6. Acute tonsilitis/pharyngitis with poor oral intake
  7. AGE
  8. AGN & Nephrotic syndrome 
Remember that for first poster, you will have end-of-tagging assessment. To pass this, I highly recommend the Ampang HO guide notes. You must be able to manage dengue shock, hypoglycemia, status epilepticus, life threatening asthma and master the fluid requirement and type of fluid we use in pediatric,

Going through previous admission clerking done by your senior colleague is a good way to learn. Read through the management as well, you will see the pattern. 

A senior once told me, the difference between a good, thinking houseman and a so-so houseman, is when you present your case and say "My plan is to bla bla bla bla..." Don't just wait for your MO plan, if your plan is wrong  you might kena marah, but at least you tried kan.

Attitude-wise.. I just would love to share how I deal with being scolded. Okay I made a mistake and deserved to be corrected - regardless how it was done. Then I move on and not repeat the same mistake la. Don't think too much about it, "MO must think I'm stupid" is not the kind of thinking you should have. At least don't let that paralyze you. If anybody wants to think I'm stupid, they have the right to do so, but I won't let what they think of me to define me. I'm a work in progress kan. Yang penting LEARN from your mistake and DO NOT REPEAT them.

Last but not least. You have to believe that everything is in HIS hand. It is easy to fall into the belief that your fate is now in another human's hand - given the assessment, multisource feedback form and what not... But, you have to get this right - nothing in this life happens without HIS permission. Everything is specifically designed to mould you into a better human being.

Please share your nasihat here as well :-)