Seattle Children's - ER

Seattle, Washington - PEDS 665 P

Schedule and Goal of Medical Student Call in the Seattle Children’s ER

Goal:

  • To provide students with additional exposure to acute pediatrics illnesses

Objectives:

  • Observe the initial triage and assessment of pediatric patients presenting to the emergency room.
  • Observe a variety of illnesses managed in the pediatric emergency room.
  • Take a medical history for a pediatric patient with a common ED complaint.
  • Contrast the approach to patients in the ED and outpatient setting.

Before you start

All students will review the ED Med Student Slide Presentation prior to their first shift. You will receive this presentation as a part of your clerkship orientation materials.

Shift times (specific shift instructions and locations can be found below):

  • AM Shifts: 7:00-11:30
  • PM Shifts: 3:00-7:30

Suggested readings to complement your experience:

  1. CLIPP cases 12, 16, 19, 24 and 25
  2. Write down the diagnosis or major symptoms for each patient you see in the ED (or interesting cases that you hear about). Read a short discussion about that topic in a textbook either during (if there is time) or after your shift.
  3. Recommended textbooks
    1. “Pediatric Emergency Medicine – A comprehensive study guide” by Strange et al. This book has brief, but thorough discussions.
    2. “Textbook of Pediatric Emergency Medicine” by Ludwig and Fleisher. This textbook has a discussion of symptoms and pediatric emergencies by organ system.

For questions or concerns regarding the ED rotation please contact:

Sherilyn Smith, MD
Co-Director, Medical Student Programs
987-2008
sherilyn.smith@seattlechildrens.org
Bekah Burns
Attending Physician, Emergency Department
987-3882
rebekah.burns@seattlechildrens.org

Detailed Schedule of Activities in the ER

“Front” Shift

  1. Enter the ED through the ED Staff Entrance. Ask the Admissions Services Coordinator (ACS) located at the central desk to point you in the direction of the charge nurse or an attending.
  2. You will be introduced to the lobby RN and observe the initial assignment of the emergency severity index (ESI) and rapid visual assessment (RVA). You will then escort the patient to their room with the Medication Intake Coordinators (MICs, for level 3-5) or with the intake RN (levels 1-2).
  3. You will stay in the room while the MIC and intake nurse ask initial questions and performs the initial evaluation.
  4. If an early initiation (EI) provider is available, stay in the room and observe their initial assessment and plan.
  5. When initial settling of patient is completed by nurse, MIC and EI provider, return to the lobby to start the process over with the next available patient. If the team residents or medical students begin their evaluation, return to the lobby.
  6. Complete the ED “Front Shift” self-evaluation form and return it to the Medical Student Office.
Specific skillsMinimum achievement
Basic evaluation of the acutely ill patient
  • Demonstrate the "ABC" assessment as a means for identifying who requires immediate medical attention and intervention
  • Recognize that vital signs and other clinical clues to acute illness are different for children as compared to adults, and will vary for children of different ages
  • Develop a framework to identify a child who needs acute, urgent, or emergent care
  • Inspect airway
    • Look and listen
    • Auscultate lungs
    • Correctly articulate patency of airway
  • Inspect for chest movement
  • Recognize signs of respiratory distress (retractions, cyanosis, apnea, tachypnea)
  • Assess circulation
    • Feel for a pulse
    • Assess capillary refill
    • Assess heart rate
  • Recognize signs of circulatory compromise (tachycardia, bradycardia, weak pulse, prolonged capillary refill)
  • Note mental status as a marker of overall illness (calm, fussy, inconsolable, agitated, somnolent, obtunded)
  • Note general appearance as a marker of overall illness (alert, floppy, weak cry, etc.)

“Back” Shift (EAST or WEST)

  1. Enter the ED through the ED Staff Entrance. Check your schedule to confirm whether you are assigned to ED East or ED West. Ask the Admissions Services Coordinator (ACS) located at the central desk to point you in the direction of the East or West attending(s).
  2. Find the attending(s) and introduce yourself.
  3. At the beginning of the shift, partner up with a resident and observe patient care from start to finish (including history/exam, ordering tests, doing procedures, writing prescriptions, and discharging/admitting).
  4. After shadowing for one or more patients with an ED provider, identify 1-2 patients that are appropriate for you to do the initial evaluation for (triage levels 3-5). Preferably choose a patient that is presenting with one of the common ED complaints below. Ideally, the patient should NOT be transferred from another hospital.
  5. Find a resident to see the patient with you.
  6. Introduce yourself as a medical student on the ED team. Perform the initial history and physical with the resident in the room. The resident will also perform an exam. Afterwards discuss the patient with the resident to help come up with an assessment and plan.
  7. Present the patient to the ED attending with the resident present and work with the resident to complete patient care.
  8. Hand the ED “Back Shift” evaluation form to the attending prior to leaving the ED. Evaluations should be returned to the Medical Student Office, OC.7.830.
Specific skillsMinimum achievement
Specific topics in pediatric acute care
  • Obtain history relevant to a pediatric patient with an urgent medical problem, with special recognition of variations in presentation for different age groups
  • Identify need for acute, urgent, or emergent care for certain specific pediatric issues:
    • Asthma/respiratory distress
    • Dehydration/volume depletion
  • Make a rapid assessment of the patient’s clinical status
  • Obtain assistance as indicated
  • Obtain focused history with further details as necessary or appropriate

Common pediatric ED complaints

  • Abdominal pain
  • Vomit and diarrhea
  • Fever
  • Cough
  • Musculoskeletal complaint

Other goals while on a “Back” Shift

  • Observe residents, fellows and attendings greeting ambulances
  • Observe procedures including sutures, I and D, splints
  • Observe resuscitations
  • Observe the interactions various roles of an interprofessional medical team and its members

Note: Please look at the ED tracking board and if there are any specific patients or processes you would like to see, let the team know.