Orientation: Procedural Elective

Welcome to the the procedure elective. The basics of this elective is start to become comfortable doing procedures on children. As with everything, the basics are essential. The first step is really just learning how children respond to painful things. Starting with peripheral IVs, you learn that its so important for you to be comfortable (not hunched over in the dark, use lighting), the child to be as comfortable and immobile as possible (distraction), helpers are key (to hold, distract), and how each child is different. There are plenty of opportunities to begin to experience these essential skills.

This elective consists of many locations including the IV team at St. Agnes, the PEDS ED at St. Agnes, the LP clinic, PEDS ONC procedures, and you can even go with the IV team at Hopkins.

For the PEDS at St. Agnes, you can work with any doctor. All our doctors especially love working with residents so be sure to try and work with us, however your schedule and best time for you should be most considered. You can work whenever works best for your home and work schedule. Afternoon and evenings do tend to have the most volume and procedures.

If there are no current procedures, you may see other patients as the docs may appreciate this. Its up to you. There are plenty of interesting patients. For documentation, some docs are cool with you documenting on the pink sheets, but some would rather document themselves.

Here are some things to work on in down-time:
1. Watch many NEJM procedural videos www.nejm.org/multimedia/medical-videos including LP, IV placement, suturing, Bag mask, intubation, I+D, splinting.

2. Check out the Hawaii pediatrics Radiology Page: Specifically look at the pediatric elbow links and how to read a peds elbow. http://www.hawaii.edu/medicine/pediatrics/pemxray/pemxray.html

3. Spend some time with the ortho techs in the PEDS ED at St. Agnes. Go with them to see adults too- the KNOW how to splint, assess, and care for ortho injuries. Also spend time with the phlebotomist if they will allow you to. We can also go with the IV team.

4. Read about paronychias, fish hook injuries, digit blocks, Ottawa ankle rules, examing the shoulder. Check out UTDOL for these.

5. Go through the Zitelli chapter on dermatology, ortho, and ID. Dont read the whole thing, just look at the pictures.

6. Read about Rapid sequence Intubation on UTDOL.

7. Also, if you want IV placement experience, there may be opportunities at the Harriet Lane, Hopkins PEDS ED, or the IV techs as Hopkins. I learned from them too! Residents have done a ton of IV stuff out front in the main ED, just ask me about that. Also you can call the IV team at 2715. Brian is really nice and likes to have residents go around with him putting IVs in throughout the hospital, etc.

8. The procedural sedation course is good. Goto www.hopkinsinterative.org. It takes like 7 hours but is worth it.

9. This site is particularly awesome www.lacerationrepair.com definitely watch a couple of the videos. So is this one https://www.youtube.com/watch?v=7-aBEcnftmU&t=21s.

LP tricks:

https://www.youtube.com/watch?v=TVPtC2SIY8o

https://www.hippoed.com/peds/rap/episode/welcometothe/increasingyour