Taking care of pediatric patients in the ED can be intimidating, especially as a new learner. Unfortunately, pediatric patients are not just mini-adults and there are some important things to consider when assessing a pediatric patient. In this episode, Patricia is joined by pediatric emergency medicine physicians Yaron Ivan and Delia Gold, to discuss tips and tricks for medical students as they learn to evaluate and care for pediatric patients in the ED.
History Pearls:
- Ask the family if the patient has been smiling and if they have been acting normally. This helps assess the patient’s recent neurological function since it can be difficult for a child to participate in a full neuro exam.
- Ask about intake and output.
- Ask what the parent is worried about.
- When asking about nausea, consider asking what their favorite food is and then ask if you had that favorite food in front of them right now, would they eat it?
- For preteens and teens, separate the parents and patients to give patients the opportunity to be honest without fear of getting in trouble.
- When you staff the patient with a resident, fellow, or attending, be honest if you didn’t ask about something.
Physical Exam Pearls:
- Observation is key
- Physical exams on newborns and crying children can be difficult, but remember that there are many things you can learn about the patient just by looking at them.
- Your physical exam starts at the door with an overall impression, work of breathing, etc.
- In preteens and teens, you can use observation to assess maturity level which can be helpful when it comes to asking questions and explaining the plan.
- It’s ok not to examine from head to toe
- Often in adult medicine, we are taught to do our physical exams from head to toe, but in pediatric patients, it is better to listen to their lungs first when they are calm and quiet prior to looking in their ears or doing a more invasive test that will upset them.
Take-home points:
- Observation is key.
- Know the maturity level of the patient.
- Separate parents and patients to gain an honest history.
- It’s ok to do your physical exam “out of order”.
- Be honest when presenting the patient to the resident, fellow, or attending.
Post by Patricia Capone, DO PGY3
About Our Guests:
Yaron Ivan, MD
Pediatric EM Physician at Sunrise Children’s Hospital in Las Vegas, Nevada
Delia Gold, MD
Pediatric EM Physician at Nationwide Children’s Hospital in Columbus, Ohio
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