Category:Pediatrics: Difference between revisions

From Guide to YKHC Medical Practices

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==Pediatrician Specific Practice: Description of How Pediatrics is Practiced Differently at YKHC==
YKHC is an unusual and wonderful place to practice medicine and especially pediatrics. Pediatricians at YKHC act as subspecialist extenders for all pediatric specialties that are not available in Bethel and often not in Alaska. There are many unique and interesting challenges (and frustrations) with practicing medicine in a remote region with travel and communication issues that are unique to our area. It is a lot like practicing third world medicine with much better support and infrastructure. The medicine is interesting and spans from primary care to pediatric subspecialty management to critical care with NICU/PICU patient stabilization and transport. Pediatricians at YKHC are primarily responsible for Chronic Peds Patients or complex and chronically ill kids, but we also do a variety of other patient care activities as well.
YKHC is an unusual and wonderful place to practice medicine and especially pediatrics. Pediatricians at YKHC act as subspecialist extenders for all pediatric specialties that are not available in Bethel and often not in Alaska. There are many unique and interesting challenges (and frustrations) with practicing medicine in a remote region with travel and communication issues that are unique to our area. It is a lot like practicing third world medicine with much better support and infrastructure. The medicine is interesting and spans from primary care to pediatric subspecialty management to critical care with NICU/PICU patient stabilization and transport. Pediatricians at YKHC are primarily responsible for Chronic Peds Patients or complex and chronically ill kids, but we also do a variety of other patient care activities as well.


Pediatricians manage approximately 1,200 chronically ill patients of mainly Yup’ik Alaskan descent with significant respiratory, genetic, metabolic, cardiac, endocrine, neuro and infectious disease issues. They act as pediatric subspecialty extenders and consultants for family medicine, emergency medicine and village health aide providers. Pediatricians manage ADHD, fetal alcohol syndrome, cerebral palsy, seizure disorders, congenital heart disease, congenital adrenal hyperplasia, asthma, aspiration syndrome, chronic lung disease, and issues related to prematurity. In clinic, we see complex-care pediatric patients, urgent, acute and well child care patients as well as ER follow up patients. On-call pediatricians need to be able to stabilize, manage, and transport critical care and neonatal emergency patients. Occasionally the pediatrician ‘on-call’ will fly on medevacs to villages for potential preterm or high-risk term infant deliveries. The pediatricians assist and collaborate with pediatric sub-specialists when they visit YKHC. Occasionally pediatricians make visits to village clinics or subregional centers.
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!GENERAL INFORMATION
At YKHC, our pediatric patients get more invasive disease than children in the lower 48. We have therefore adapted standard lower 48 guidelines and created some of our own for more conservative evaluation and treatment of our patients. In most places you would not do as many labs and xrays as we do here, but many times pneumonia, bacteremia and serious infections are missed if we do not check. Kids can be running around the ER with a little cough and no significant lung exam findings and then have a significant pleural effusion on CXR. Or a well-looking 2-month-old with a low grade temp will have 230 WBCs in their CSF. We also have invasive Hflu A infections with either indolent or aggressive presentations. It pays to be very, conservative, vigilant and to watch kids closely before sending them back to a village where they might get worse and not be able to return due to weather.
!SHARED PEDIATRIC RESOURCES
==Description of Pediatrician Services and Practice==
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'''Outpatient''': Outpatient pediatricians work in clinics providing care for routine, acute and complex care pediatric patients. They also provide consultative services to family medicine clinic providers and liaison with sub specialists plus behavioral health, developmental, educational service providers.
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*[[General Introduction to Pediatrics]]
'''Inpatient''': Hospitalist pediatricians work on the inpatient ward and manage hospitalized children with chronic and/or complicated issues. They are also responsible for providing consultation to family practitioners, emergency medicine physicians, midlevels and village health aides; attending all high-risk deliveries and pediatric codes; and providing intensive care while patients are awaiting transport.
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*[[Chronic Pediatric Patient Definition]]
'''ER''': Both hospitalists and outpatient pediatrician ‘on call’ will provide consultative and emergent care to pediatric patients who present to the ED. Duties may involve laceration care, orthopedic care, wound care, care of trauma patients and coordination of care between YKHC and higher level services in Anchorage. There are also scheduled ER shifts where the pediatricians will be taking care of mostly acuity level two and three patients, but may be responsible for critical care stabilization of patients during their shift and can see urgent care patient as well.
*[[INTRA and INTERhospital Transfers|Admissions and Transfers]]
 
*[[Pediatric Consults]]
'''Call''': Call consists of consults, care of hospitalized pediatric patients, medevacs and care/stabilization/transport of pediatric patients in the ER and newborns as required. Some pediatricians do both clinic and hospitalist shifts and all pediatricians share night, emergency room coverage, weekend and holiday call.
*[[Pediatric Care Management|Pediatric Case Management]]
==[[Pediatric Job Duties]]==
*[[Specialty Referrals#Pediatric Specialty Services|Pediatric Specialty Services]]
*[[Newborn Information Access on RAVEN]]
*[[SART|Sexual Abuse Response Team (SART)]]
*[[Pharmacy Things to Know]]
*[[How to remove an allergy banner]]
*[[:Category:YKHC Guidelines|YKHC Clinical Guidelines]]
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!SPECIFIC PEDIATRIC DEPARTMENT INFORMATION
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*[[Outpatient: Detailed Information|Outpatient]] (''detailed introduction to Pediatric Outpatient job'')
**[[Pediatric Outpatient Job Description|Pediatric Outpatient Job Description]]
**[[Preparing For and Navigating Clinic]]
**[[Specific Types of Appointments and Procedural Processes|Outpatient Pediatric Encounters]]
**[[Village Trips|Pediatric Village Trips]]
**[[Bethel Regional High School Clinic]]
**[[Outpatient Clinic Introduction#Medication Refills|Medication Refills]]
*[[Inpatient: Detailed Information|Inpatient]] (''detailed introduction to YKHC Pediatric Hospitalist job'')
**[[Pediatric Hospitalist Job Description|Pediatric Hospitalist Job Description]]
**[[Hospitalist Workflow and Priorities]]
**[[Common Inpatient Admissions (Peds)]]
**[[:Category:Medevacs and Transport#Medevacs for Inpatient Pediatricians|Medevacs for Inpatient Pediatricians]]
**[[Chronic Pediatric RMT]]
**[[Emergency RMT Scenarios and Responses]]
**[[Emergency Stabilization Information]]
**[[ER: Detailed Information|Emergency Department]] (''detailed introduction to Pediatric ED shift'')
**[[OB/Newborn: Detailed Information|OB/Newborn]] (''detailed introduction to Pediatric newborn care'')
***[[:Category:OB & Newborn#NEWBORN SPECIFIC INFORMATION|Newborn Resources on OB & Newborn Main Page]]
***[[:Category:YKHC Guidelines#Neonatal References|Neonatal References/Resources on YKHC Guideline Page]]
**[[OR for Peds]]
**[[Death Protocol]]
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Latest revision as of 18:03, 5 July 2022

YKHC is an unusual and wonderful place to practice medicine and especially pediatrics. Pediatricians at YKHC act as subspecialist extenders for all pediatric specialties that are not available in Bethel and often not in Alaska. There are many unique and interesting challenges (and frustrations) with practicing medicine in a remote region with travel and communication issues that are unique to our area. It is a lot like practicing third world medicine with much better support and infrastructure. The medicine is interesting and spans from primary care to pediatric subspecialty management to critical care with NICU/PICU patient stabilization and transport. Pediatricians at YKHC are primarily responsible for Chronic Peds Patients or complex and chronically ill kids, but we also do a variety of other patient care activities as well.

GENERAL INFORMATION SHARED PEDIATRIC RESOURCES
SPECIFIC PEDIATRIC DEPARTMENT INFORMATION

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