Common Inpatient Admissions (Peds)

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Chronic Peds Patients (CPP)

The pediatricians admit CPP patients. These patients have complex, chronic illnesses and are managed by the pediatric group and the pediatric case manager. The pediatricians may ask the family medicine providers to take a CPP patient if they are overloaded. Any CPP patient admitted as a BH/Title 47 patient will be admitted to family medicine and peds can consult on the patient as needed.

Neonatal Fever

Infants under 90 days of age with fever who meet admission criteria per the Fever (Infant 0-90 days) YKHC Clinical Guideline are admitted after an initial work up, on or off antibiotics, as indicated. Use the PEDS Admission power plan plus the admit subphase PED Infant 0-90 Day Old orders that have preselected and other order choices to help with these admissions.

Infants who were pre-treated in the village and/or those patients where a tap was not obtainable in the ER present a challenge for management and treatment. Your options are to try to:

  1. repeating the LP on NW the following day and look at CSF cell count and gram stain OR
  2. watch off antibiotics and re-tap if patient worsens and needs to start antibiotics OR
  3. treat for 10-14 days of IV therapy for possible meningitis

Hyperbilirubinemia

Infants are admitted per our Neonatal Jaundice YKHC Clinical Guideline for phototherapy. At the top of the general peds admission orders there is an additional powerplan labeled PED Phototherapy that has preselected and selectable choices to help with these admissions.

Skin and Soft Tissue Infection

Use the Skin and Soft Tissue Infection YKHC Clinical Guideline to direct care. Admit using pediatric admission order plus the sub powerplan labeled PED Abcess/Cellulitis that has preselected and other choices to help with these admissions. Consider using dilute bleach baths with these patients as well.

Pneumonia / Bronchiolitis

Use the Pneumonia (Pediatric > 3 months) YKHC Clinical Guideline and Bronchiolitis/Wheezing (3-24 months) YKHC Clinical Guideline to direct care plus the additional powerplan labeled PED Respiratory Infection that has preselected and other choices to help with these admissions. Note: if a patient is requiring q 2 nebs, more than 2L O2 or our RTs and nurses are uncomfortable with a patient’s clinical status, it is time to consider transferring the patient.

TB Screening Admission

Kids under 5 years and those that are too young to give a reliable sputum sample are admitted for morning induced sputum collection. Please refer to the Pediatric TB YKHC Clinical Guideline and the Pediatric Induced Sputum Collection Protocol. Use the additional admission sub powerplan labeled PED TB Gastric Aspirate that has preselected and other choices to help with these admissions. Although patients under 5 do not produce droplets large enough to be contagious, regional and lower 48 standard of care is to put anyone on the inpatient unit in a negative flow room.

The aspirates are sent to the state lab for initial screening and you will have to call the afternoon or the morning after the last aspirate is sent to get the results. The final results will take weeks to get back so you will need to speak to a pediatric (Fisher of Chyi) or adult TB (Tyree or Roll) officer to determine therapy and follow up. These admissions will be overnight (minimum).

Stomatitis

Occasionally a patient will fail outpatient treatment/support of bad stomatitis and they will be admitted for pain control and fluid support until they improve enough that they can stay orally hydrated on their own. Use the regular Pediatric Admission powerplan plus the additional sub powerplan labeled Derm Oral that has preselected and other choices to help with these admissions. It is a good idea to put the kids on the magic mouthwash that contains lidocaine (see How to find magic mouthwash), monitor Is & Os and weights and push cold fluids. IV bolus and/or maintenance fluids can used for additional hydration as needed. Motrin and Tylenol are usually all that are needed for additional pain control. We recommend against anything stronger as it is usually not necessary. By the time a patient is admitted it is usually too late to start acyclovir which is considered of limited benefit anyway.

Superinfected eczema

These patients usually have pretty bad skin disease and have failed outpatient therapy. They are admitted for aggressive therapy, support and family teaching. These kids will need bleach baths and possibly IV Clinda or Vanco. Use the regular Pediatric Admission powerplan plus the additional sub powerplan labeled PED Derm Oral that has preselected and other choices to help with these admissions. There are also good discharge handouts that have been customized by peds that can help with home care.

Failure To Thrive (FTT)

These infants and children are generally admitted by peds. Most of these patients are admitted with presumed inadequate calorie support and social issues. Use the regular Pediatric Admission powerplan plus the additional sub powerplan labeled FTT which has preselected and other choices to help with these admissions. If a patient is not gaining after 3-7 days of adequate caloric intake, then an organic FTT work up can be started. If a more comprehensive workup is required, it is better done at ANMC or Providence as most of the labs for this are send outs from here and it takes weeks to get the results.

Brief Resolved Unexplained Events (BRUE)

Generally low risk BRUE events do not need work up and admission, but occasionally these patients are admitted for observation for 12-24 hours, with close monitoring, to reassure parents and caretakers that the event does not repeat and to further evaluate other possible etiologies such as reflux, aspiration, seizure, RSV in a less than 2 month old, meningitis, etc

Seizures

see Pediatric Seizures YKHC Wiki Page for more details

Occasionally seizure patients are admitted for monitoring. (see Seizure Evaluation (Pediatrics) YKHC Clinical Guideline and Seizure Treatment (Pediatrics) YKHC Clinical Guideline). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a Pediatric Seizure Kit for quick access to urgent/emergent anti-seizure medications.

Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered "As Indicated") with refills and a peds discharge handout for seizures.

Patients Requiring Infusions

The Infusion Clinic was designed to provide infusion services for patients 14 years and older. For patients younger than 14 years old, the Outpatient Clinic Pediatrician will occasionally monitor these infusions in the Ambulatory Clinics. Sometimes, the Inpatient Pediatricians will admit patients for infusions. These infusions have included iron infusions and chronic immune suppresents. We are unable to complete some hazardous medication infusions or first time infusions. If it has not been done at YKHC before, discuss with pharmacy director.

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