Blog from March, 2012

COG 3.30.12

The Enhanced Online Version available on Pediatrics XL:  

CHIEF-O-GRAM

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In this chief-o-gram you will find:

- PREP Question of the Week

- Clinical Shout Out!

- Pharmacy Tip of the Week: Vancomycin Monitoring

- Interns – Please return your Pink Baby Badges

- Intern Class Dinner!

- March Madness Update

- Happy Birthdays

- In Other News…

- Your Jeopardy and Clinical Chiefs 

- PREP Question Answer

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PREP Question of the Week:

You are examining a healthy 4-year-old boy who has complained of intermittent left anterior thigh pain over the past 1 to 2 months. In the past week, his parents have begun to notice that he is limping slightly on that side. He has had no fever, malaise, other complaints of pain, or change in appetite or activity. He is taking no medications. Physical examination reveals an afebrile child who has no redness, warmth, or swelling over his legs or feet and no point tenderness over his spine, pelvis, thigh, lower leg, feet, or abdomen. He does exhibit decreased internal rotation at the left hip. His peripheral white blood cell count is 9.6x103/mcL (9.6x109/L), erythrocyte sedimentation rate is 8 mm/hr, and C-reactive protein is 0.4 mg/dL. Radiographic evaluation of the hips shows flattening and sclerosis of the femoral head on the left. 
A. Observation at home and follow-up evaluation in 1 week

B. Orthopedics consultation

C. Parental antibiotics for 2 to 4 weeks

D. Physical therapy referral

E. Rheumatology consultation.

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Clinical Shout Outs! 

  • Impressive work by Bev Young and Hilary Seeley for managing a very sick (and mysterious) Red-team patient this week, even while parents refused transfer to PICU.
  • Seth Williams and Ellen Laves get an extra THANK YOU for helping to cover SFGH on their UCW outpatient time and staying happy and positive while doing it!
  • Amy Williams’ primary care project was featured in this short video.  Also she featured.  Check it out! http://www.ucsf.edu/news/teaching-tolerance-one-goal-time?utm_source=March+2012+Faculty&utm_campaign=Pulse+Mar+2012+Faculty&utm_medium=email
  • And a special thanks to Holly Martin for saving Mimi Choi’s bike from being thrown away by the SFN authorities. (Apparently bikes are dirty and therefore not allowed in the clean utility areas…live and learn Mimi!)

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Pharmacy Tip of the (Every-Other) Week: Vancomycin Monitoring

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Interns -- Return your Pink Baby Badges

For those of interns that have done the well-baby rotation at Parnassus, you may remember being issued a pink card that allowed you to transport the newborns around the 15th floor without a SWAT team attacking you for stealing babies. The nursery has run out of these cards due to lack of people returning them, leaving the current interns at risk of physical attack. Please return these to the newborn nursery clerk as soon as possible.

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Intern Class Dinner!!!

Reminder to Interns! Your class dinner with be at Paxti’s Inner Sunset from 6-9pm on Tuesday, 4/3. Eat, drink, and be merry! Also please remember we can’t cover alcohol and those of you on night shift please be back by 9pm to relieve your coverage.  R2s and R3s you too will have dinner with your class…keep an eye out for when and where…

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March Madness Update

It's ALMOST over!    The semi-finals are Saturday and on Monday night, the NCAA will crown it's new national champion and we will be rewarding our First Place and Last Place Winners with $20 to Trader Joe's each!

It is an exciting race for first place!!  Kristen Wendorf narrowing beat out Maura Madou for the current lead!  Both with 43 of 60 correct picks but Kristen with 93 points (157 possible points), and Maura with 86 points (102 possible points).  Representing our intern class.  Jim Anderson is close behind with 81 points (145 possible points).   Ryan Padrez and Kate Gregg are right behind him in 4th and 5th place respectively.

And while Jess Schumer is in 6th place and Taylor Clark is in 8th place, both have 141 and 135 possible points respectively so they shouldn't be overlooked!

Not to be overlooked are those who are gunning for last place:  Mimi Choi firmly has that locked up with 34 points out of a max possible of 34 points.

It's almost over...take a look at our bracket and see who has the best shot of taking home 1st place!

http://tournament.fantasysports.yahoo.com/t1/group/4528

Group ID: 4528 (No password)

...And stay tuned for the announcement of our winner by Tuesday morning!

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Happy Birthday to: NOBODY!

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 In Other News:

-       Shockingly Natalie Portman’s son is as beautiful as she is… http://www.usmagazine.com/celebrity-moms/news/aww-see-how-big-natalie-portmans-son-aleph-10-months-has-gotten-2012293

-       Lindsay Lohan’s probation has official ended…for now. http://www.usmagazine.com/celebrity-news/news/lindsay-lohans-formal-probation-ends-2012293

-       Andy is thinking about the Alamo as his next apartment:
 
Amazing video of the week!! In honor of Saunders, but not to be taken as encouragement:

http://www.youtube.com/watch?v=0MzUwVG8VXA

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Your Chiefs are:

3/31-4/1 Saunders is your Jeopardy and Clinical Chief

4/2-4/6 Leslie is your Clinical Chief and Suni is Jeopardy Chief

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Julie, Leslie, Suni and Saunders!

Chief Residents
UCSF Department of Pediatrics
ucsfpedschiefs@gmail.com

 

 

PREP Question Answer

Answer B – Orthopedics Consultation

Legg-Calvé-Perthes disease is one of the common causes of hip pain and limp in children 3 to 10 years of age, occurring more frequently in boys (80%) than girls (20%). Often, the initial interruption in vascular supply is asymptomatic, with limp or pain developing during collapse of the femoral head or revascularization. On physical examination, the child appears well and is afebrile. The most constant findings are limited abduction and internal rotation of the hip, as described for the boy in the vignette. The findings are most prominent at the extremes of the range of motion, with less pain in midrange motion.

Legg-Calvé-Perthes disease is diagnosed using bilateral hip or frog leg and lateral radiographs. Earliest findings include joint space widening due to narrowing of the proximal femoral epiphysis and sclerosis of the femoral epiphysis. The next phase is fragmentation in which lateral films may show a crescent sign resulting from a subchondral fracture. Subsequently, films may show reossification and eventual healing. Some authors believe that magnetic resonance imaging is more sensitive in detecting early disease. Laboratory findings are normal and are only useful for evaluation of other entities in the differential diagnosis.

Appropriate treatment of Legg-Calvé-Perthes disease is controversial and depends on patient age and extent of necrosis. Consultation with an orthopedic specialist is vital as soon as the diagnosis is made. The prognosis is best when the child is younger than 6 years at presentation or there is less than 50% necrosis of the femoral head. For these patients, physical therapy and close monitoring may be sufficient to maintain the femoral head in appropriate position in the acetabulum, but orthopedics consultation must precede such therapy. Orthoses that hold the hip in abduction have been used for patients who have more severe disease, but not all studies have shown benefit with this treatment, and some authors recommend abandoning this modality. A variety of surgical approaches is available, but operative intervention usually is reserved for children who have the most severe involvement. In a recent study, osteotomy resulted in a significantly better outcome than orthosis or physical therapy for children older than 6 years of age who had more than 50% femoral head necrosis.

Observation with close follow-up is appropriate for a limping child who has transient synovitis, but radiographs for such a patient would appear normal or show only a small hip effusion. Surgical evacuation of the hip effusion and a prolonged course of antibiotics are required for a septic hip and osteomyelitis. However, a child who has that diagnosis would be febrile, have severe pain, and have radiographs showing a hip effusion. If a rheumatologic condition such as juvenile idiopathic arthritis is suspected, a rheumatology consultation is appropriate, but flattening and sclerosis of the femoral head would not be seen on radiography.

--
Chief Residents
UCSF Department of Pediatrics

Wiki Classes - April 2012

Need help using the wiki? Sign up for a free wiki class offered by the library this month:

If you have any questions about these classes, please contact the Wiki Administrators.

< Back to Dashboard
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COG 3.23.12

The Enhanced Online Version available on Pediatrics XL:  

CHIEF-O-GRAM 3.23.12

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In this chief-o-gram you will find:

- PREP Question of the Week: on hiatus

- Clinical Shout Outs!

- Meal Cards at SFGH

- March Madness Update!

- Please don’t eat/drink in patient care areas:(

- Happy Birthdays

- In Other News…

- Your Jeopardy and Clinical Chiefs 

- PREP Question Answer

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PREP Question of the Week: on hiatus

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Clinical Shout Outs! 

Orange Team domination! BOTH Emily Barsky and Karina Vivar had champagne taps this week!

Stanley Vance was awarded the Career Development Award in Adolescent Medicine at the Society for Adolescent Medicine conference last week! Woot Woot!

To Alex Channing for coming down to Zone 4 and helping out the peds team for A LONG TIME while she was SFX!

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Meal Cards at SFGH

·  All pediatric residents (not medical students or Sub-I’s) will be issued a card to use for the academic year, they will get food allowances during the dates they rotate at SFGH. They will be issued on 3/29/12 and you can pick them up from Christina Castillo from 3/29-4/4, and after that Alicia will be distributing them.

·  Residents with SFGH Continuity Clinic will NOT be allotted meal $ unless rotating at SFGH

·  Pick up cards through Alicia Velasquez or Christina Castillo in 6D37 from M-F 8:30-4:30.

·   SFGH is not making any changes to the meal allowances- the daily amount remains as stipulated in the City’s MOU with CIR-SEIU.

·   The card is a tracking tool to ensure accountability for individual use and overall spending by Food Services.

·   All items must be rung through the cash registers and paid for either with a meal allowance card, or with cash if the total amount exceeds the available allowance.

·   Once the allowance cards are issued, ID badges and/or the existing paper meal tickets will no longer entitle any member of the housestaff to meals.

·   Any problems or issues with the cards should be handled and logged by the on-duty SFGH Food and Nutrition Services supervisor.

·    If a card is lost or otherwise not present and the resident is on the schedule to work, the resident can obtain a temporary meal card from the SFGH Dean’s Office at 2A2.  The temporary card is good for one day and must be returned to the Dean’s Office. There is a $15 lost/stolen card replacement fee – Checks should be written to SFGH.

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March Madness Update!

In the beginning of the week, Aris “Oatmeal” lost hold of his lead and dropped to 8th place after Texas was taken out of the tournament, putting Maura in 1st place after the Round of 32s with 50 points.  Coming in a close second isKristen Wendorf *with 49 points and *Allison Moorman is in third place with 48 points.  *Mimi Choi *continues to sit steadily in last place with 34 points. 

The regional semi-finals have started so it's still anyone's game!

It’s coming down the wire, and  what you really want to pay attention to is the total possible points available now that teams have been eliminated…

Follow us:  http://tournament.fantasysports.yahoo.com/t1/group/4528

Group ID: 4528 (No password)
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Please don’t eat/drink in patient care areas:(

Just a reminder - there is no eating/drinking in patient care areas, which includes the nurses' station and the hallways on the Parnassus ward. Please remind your teams that this includes rounds. There's hard evidence! See below:

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Happy Birthday to:

3/24: Mimi Choi

3/27: Jess Schumer

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 In Other News:

What a hottie wedding!….Justin and Jessica’s nuptial plans:

http://www.usmagazine.com/celebrity-news/news/jessica-biel-and-justin-timberlakes-wedding-plans-all-the-details-2012233

Snooki is pregnant with Jionni’s baby!!! I hope CPS has been alerted in advance….

Amazing video of the week!!

Oldie but SO true….http://www.youtube.com/watch?v=u-yLGIH7W9Y

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Your Chiefs are:

3/23-25: Leslie (Clinical and Jeopardy chief)

3/23-3/30: Leslie Clinical chief, Julie Jeopardy chief

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Julie, Leslie, Suni and Saunders!

Chief Residents
UCSF Department of Pediatrics
ucsfpedschiefs@gmail.com

 

COG 3.16.12

CHIEF-O-GRAM 3.16.12

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In this chief-o-gram you will find:

- PREP Question of the Week

- Clinical Shout Out!

- Pharmacy Tip of the Week: no existe

- March Madness!

- The Match!

- The Wacky Tabacky

- Happy Birthdays

- In Other News…

- Your Jeopardy and Clinical Chiefs 

- PREP Question Answer

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PREP Question of the Week:

A mother in your pediatric practice recently delivered a 28 weeks' gestation infant who is in the neonatal intensive care unit. The woman exclusively breastfed her previous child, who was born at 36 weeks' gestation. She is concerned that something is wrong with her milk for this infant because it is being combined with human milk fortifier before being given to her infant. You reassure her by explaining that fortification helps to meet the additional needs of her preterm infant.

Of the following, the MOST important role of such fortification is to:

A. augment the immunologic properties of human milk

 B. boost the carbohydrate content of human milk

 C. decrease the osmolality of human milk

 D. enhance the absorption of iron from human milk

 E. increase the protein content of human milk

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Clinical Shout Out! 

Ellen Laves for running a kick-bootie mock code on 6 Long!! Ellen, if my plastic baby stops breathing, I hope you are there to save the day.

Alison Nair and Asmin Tulpule for totally handling EVERYTHING in a 25-week resuscitation at SFGH last week.  I was standing there, but didn’t do anything!  They don’t need us!

Holly Martin for being selected to present at the Global Health and Innovation Conference in April at Yale!

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Pharmacy Tip of the Week: on hiatus

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March Madness Bracket Update:

Let the games begin!  We're off to an exciting start.  We have 20 residents in the tournament!

Leading the pack is Aris Oates in first place correctly predicting the winners 15 of 16 games.   Close behind him are fellow R2s: Maura Madou and Kristen Wendorf with 14 of 16 picks correct.

Currently tied for last place our our lovely R3s:  Jessica Schumer, Mimi Choi, and Holly Martin with 10 of 16 picks correct.

You want to be first or last because both will win $20 to Trader Joe's!  We are only half-way through the first round so first place and last place are still for grabs!  Stay tuned for next week for updates!

Follow our tournament:  http://tournament.fantasysports.yahoo.com/t1/group/4528
Group ID: 4528 (No password)

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The Match!  We did awesome!  Congrats, interns – your relief is on the way!  Stay tuned for emails from the PTB (powers-that-be) with the list and contact info.

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UCSF official stand on what my mom calls “the wacky tabacky”

You may have seen a few media reports questioning UCSF Medical Center’s policy on patients using medical marijuana in the hospital. I want to take this opportunity to clarify our position.
For some patients with serious medical conditions, medical marijuana is an effective way to alleviate symptoms such as pain or nausea that are not relieved through other standard therapies, and we support its use. However, within the hospital setting, that use must be consistent with hospital policies developed to protect the health of all of our patients and employees, and within current legal guidelines. We do prescribe Marinol, a pill that is an approved synthetic form of the drug, as appropriate.
UCSF Medical Center is a smoke-free hospital, and this includes medical marijuana. Even vaporized forms of medical marijuana can be damaging to others and present a safety risk in the hospital environment, as they are delivered by non-FDA approved devices that produce very high heat. Vapor and odor can impact other patients and hospital employees. Thousands of patients come to our hospital trusting we will provide the safest environment for their care, and we cannot make exceptions that could negatively affect their health.
In addition, marijuana is an illegal drug under federal regulations.  Allowing a patient to use medical marijuana in this setting would place our physicians and hospital at risk, which we will not do.
We are not unique in our position on medical marijuana. Hospitals throughout the Bay Area have similar policies.  We will continue to do everything we can to both help our patients manage their pain, and keep our hospital a safe place for our staff and patients.

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Happy Birthday to:

Larry Shiow 3/16 (Hoy!!!)

Peter Simon 3/21 (Be nice to him. He gets to be on DOTS for his B-day)

Matt Zinter 3/21

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 In Other News:

George Clooney arrested!! (He looks dreamy in handcuffs…) http://www.usmagazine.com/celebrity-news/news/george-clooney-arrested-2012163

Happy St. Patrick’s Day (celebrate with disturbing cakes) http://www.sfgate.com/cgi-bin/object/article?f=/g/a/2012/03/15/stpatricks_cake_wrecks.DTL&object=%2Fc%2Fpictures%2F2012%2F03%2F14%2Fba-031412_stpatr_SFC0107621680.jpg

Amazing video of the week!! (Thank you Mimi!!!)

http://youtu.be/EGvhKlKnERA

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Your Chiefs are:

3/16-3/18: Saunders (Clinical and Gastro coverage chief)

3/19-3/23: Saunders (Clinical chief)

3/19-3/23: Suni (Gastro coverage chief)

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Julie, Leslie, Suni and Saunders!

Chief Residents
UCSF Department of Pediatrics
ucsfpedschiefs@gmail.com

 

 PREP Question Answer

E. increase the protein content of human milk

The protein content of human milk must be increased to meet the requirements of a preterm infant. The estimated protein requirement for a preterm infant is 3.0 to 4.0 g/kg per day compared to 1.5 to 2.0 g/kg per day for the term infant. The requirement for the preterm infant does not include additional allowances for catch-up growth that are due to losses of lean body weight prior to the infant surpassing birthweight. If these allowances are included, the recommended protein content increases to 3.4 to 4.2 g/kg per day.

Milk supplied by the preterm infant's mother is the preferred enteral feeding. Although milk produced by a mother who delivers prematurely may have increased protein content compared to term milk, the protein content declines in the first weeks of lactation to that of term milk. Human milk fortifier supplies additional protein, which has been shown to increase concentrations of blood urea nitrogen and weight gain in the enterally feeding preterm infant.

Human milk fortifier does not augment the immunologic properties of human milk. Human milk contains secretory immunoglobulin A as well as other factors such as lactoferrin and lysozyme that confer immunologic protection upon the infant. The carbohydrate content of preterm human milk may be slightly lower than term human milk, but it is well tolerated in spite of the intestinal lactase functioning at 30% of the level of a term infant. The iron content of human milk is lower than that of iron-fortified formula, but nearly 50% is absorbed. Human milk fortifier does not significantly increase the carbohydrate content or enhance the absorption of iron. Of note, the addition of human milk fortifier does increase the osmolality of enteral human milk feedings.

--
Chief Residents
UCSF Department of Pediatrics

Overview

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Instructions

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1. On the page where you want to display the attachment list, click the Edit button
2. Go to the Insert menu and select Other Macros
3. Type 'attachments' in the search box and then click the Attachments macro
4. Change any desired parameters and then click the Insert button
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6. The list of attached files now appears on your page
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COG 3.9.12

The Enhanced Online Version available on Pediatrics XL:  

CHIEF-O-GRAM

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In this chief-o-gram you will find:

- PREP Question of the Week

- Clinical Shout Out!

- Pharmacy Tip of the Week: Methotrexate Drug Interactions

- 4th Annual PlaySafe Cardiac Physicals Event – May 19th!

- CICU post-op tutorial

- Updates on TPN

- Happy Birthdays

- In Other News…

- Your Jeopardy and Clinical Chiefs 

- PREP Question Answer

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PREP Question of the Week:

A previously healthy, 3½-year-old girl presents following 2 days of diarrhea, vomiting, and a low-grade fever. Her symptoms began shortly after the family dined at a local fast-food restaurant. She has had four to six watery-mucoid stools per day. Her parents are very concerned because they have begun to see some blood in her stool. On physical examination, the alert, somewhat irritable child has a temperature of 38.6°C, heart rate of 100 beats/min, and respiratory rate of 16 breaths/min. Her oral mucous membranes are dry, and capillary refill is 2 seconds. Her abdomen is diffusely tender and without distention. Initial laboratory results include:

Hemoglobin, 11.5 g/dL (115 g/L)

White blood cells, 14.5x103/mcL (14.5x109/L)

Sodium, 136 mEq/L (136 mmol/L)

Potassium, 4.5 mEq/L (4.5 mmol/L)

Bicarbonate, 18 mEq/L (18 mmol/L)

Of the following, the MOST appropriate treatment for this child is

Of the following, the MOST appropriate treatment for this child is:

  1. glucose-electrolyte solution
  2. cholestyramine
  3. loperamide
  4. metronidazole
  5. trimethoprim-sulfamethoxazole

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Clinical Shout Out! 

A double shout out (from 2 different people) to Lisa Patel who “facilitated an expedient w/u of a 10mo with osteomyelitis on a weekend, including MRI with anesthesia, IV abx, initiation of home care plan, all with a challenging family AND while coordinating great pain relief plan in a teenager with chronic abdominal pain by strategically using our 24/7/365 IP3 service!"

Way to go Stan Vance for his recent publication in Pediatrics on Children and Adolescents With Gender Identity Disorder.  Check it out   http://pediatrics.aappublications.org/content/129/3/418.abstract

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Pharmacy Tip of (Every Other) Week:   Methotrexate Drug Interactions

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4th Annual PlaySafe Cardiac Physicals Event – May 19th!

The 4thAnnual PlaySafe Cardiac Physicals Event is coming up on May 19th, and we need volunteers!!
Similar to past years, we will be providing medical, orthopaedic, and cardiac screening to PlaySafe and San Francisco High School student athletes. Most of you have assisted with this event in the past, and we would really appreciate your continued support! Last year, with your help, we were able to provide 350 student athletes with a sports physical and cardiac screening. This year we are aiming for 500-600 student athletes.  Save the date – May 19th!

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CICU Post-Op Tutorial

Matt Zinter (with edits from Sandrijn) put together a great post-op tutorial for kids coming back to the CICU after cardiac repair.  Check it out here!  It is also posted on the wiki on PICU/CICU page.  Thanks Matt!

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Updates on TPN

There are some revisions to the purple TPN card.  The new ones have been ordered and hope to be here soon – but if you are interested, here they are!

Also, Because of the new APEX Pharmacy system, modified TPN orders must be handled in a specific way.  If a second TPN order is completed for the day (due to modifications), the new order must be scanned to the TPN pharmacy, then placed in the chart, and the patient's nurse must be informed so that it is clear the first TPN order is no longer valid.

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Happy Birthday to:

Aris Oates  - 3/15

Larry Shiow  - 3/16

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The BEST video of the week!!

http://www.nbc.com/saturday-night-live/video/disney-housewives/1388796

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Your Chiefs are:

3/9-3/11 Julie is Clinical and Jeopardy Chief

3/12-3/16 Leslie is Clinical and Andy is Jeopardy

3/16-3/18 Andy is Clinical and Jeopardy

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Julie, Leslie, Suni and Saunders!

Chief Residents
UCSF Department of Pediatrics
ucsfpedschiefs@gmail.com

 

 

PREP Question Answer

Answer: A (glucose electrolyte solution)

The clinical findings of fever, diarrhea (often with mucus and blood), and leukocytosis appearing soon after dining at a restaurant described for the girl in the vignette are typical for gastroenteritis caused by nontyphoidal Salmonella (NTS). Such findings generally appear within 72 hours and as rapidly as 6 hours following exposure. NTS is the most common organism implicated in foodborne gastroenteritis in the United States. S enteritidis (serogroup D), S typhimurium (B), and S newport (C2) are the most common NTS species, accounting for approximately 50% of the culture-confirmed isolates. The principal reservoirs for NTS are poultry, livestock, reptiles, and household pets (especially turtles). Foods of animal origin comprise the most common modes of transmission, especially poultry, dairy products, beef, and eggs. Ingestion of contaminated water and contact with infected animals (reptiles are a common source) represent other infecting vehicles. As with many foodborne illnesses, transmission also may occur via the fecal-oral route.

In most cases, infection causes a relatively mild, self-limited illness. However, in young infants (<6 months of age), the elderly, and debilitated and immunocompromised individuals, infection with NTS may be associated with a wide spectrum of serious complications, including bacteremia, enterocolitis, and other localized invasive infections such as meningitis and osteomyelitis. Therapy for the previously healthy toddler in the vignette should focus on maintaining fluid homeostasis with a glucose-electrolyte solution provided either orally or intravenously, depending upon the child's hydration status and oral tolerance.

Antibiotics are not indicated for uncomplicated cases of NTS gastroenteritis because they do not shorten the duration of illness and may prolong the period of fecal bacterial excretion. Antibiotics should be reserved for patients who have severe NTS disease or who are at a high risk for invasive disease. For example, treatment with antimicrobial agents are indicated for all infants younger than 3 months of age and for infants younger than 12 months of age who have temperatures exceeding 39.0°C pending blood culture results. Others for whom antibiotic treatment may be recommended include those who have hemoglobinopathies (especially sickle cell disease), human immunodeficiency virus infection and other immunocompromised states, neoplastic diseases, and chronic gastrointestinal illnesses.

In suspected bacterial enterocolitis, antidiarrheal agents such as loperamide may inhibit gastrointestinal motility, leading to third space fluid accumulation; mask symptoms, and prolong the duration of illness. Cholestyramine is a bile acid-binding resin that may be efficacious in certain enterotoxigenic diarrheas (eg, as an adjunctive, toxin-binding therapy for Clostridium difficile enterocolitis), but it has no role in the management of NTS infection.

--
Chief Residents
UCSF Department of Pediatrics

COG 3.2.12

The Enhanced Online Version available on Pediatrics XL:  

CHIEF-O-GRAM 3.2.12

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In this chief-o-gram you will find:

- PREP Question of the Week

- Clinical Shout Out!

- Happy Birthdays

- In Other News…

- Your Jeopardy and Clinical Chiefs 

- PREP Question Answer

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PREP Question of the Week:

A mother brings her 3-year-old boy to the emergency department because of increased sleepiness. She explains that his activity has decreased over the day, and when she tried to awaken him from his nap 1 hour ago, she could not arouse him. He has had no fever or other signs of illness and no findings of note on his past history. His 6-month-old sister has a seizure disorder, and his maternal grandmother has diabetes. On physical examination, the child moans to sternal rub. His temperature is 36.5°C, heart rate is 72 beats/min, respiratory rate is 20 breaths/min, and blood pressure is 60/30 mm Hg. You administer oxygen by a nonrebreather mask and obtain a bedside glucose determination, which is 120 mg/dL (6.7 mmol/L).

Of the following, the MOST appropriate next step in this child's treatment is to

A. administer activated charcoal

B.  administer atropine

C.  infuse 20 mL/kg of 0.9% saline

D. initiate external rewarming

E. obtain a urine toxicology screen

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Clinical Shout Out! 

Nancy Chen, Megan Gould, and Michelle Kaplinski whose rapid resuscitation and astute clinic recognition diagnosed a 3 day old baby with volvulus at SFGH in time to save the gut!! TIME IS BOWEL PEOPLE! Nice work ladies.

Robin Horak who actually looked at a scheduled AM chest x-ray and noticed that an intubated patient in the PICU with a critical airway wasn't actually intubated anymore... in time to fix the situation.

Kendell German and Laura DiNardo for dealing with an insanely high number of babies in WB!!!

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UCSF Pathway to Discovery in Health and Society

The UCSF Pathway to Discovery in Health and Society is open to all interested GME learners.  There is a required one week course (Oct 8-12) and then independent learning and project requirements.  Anda Kuo is happy to discuss this with anyone who is interested.  More information is on Page 4 of the linked  document: http://www.medschool.ucsf.edu/pathways/GMEPathwaysBrochure2011_12Final.pdf

Please note, however, that this document is for the current academic year and is outdated.  You can ignore the stated application deadline of Feb 1 but anyone interested should identify themselves as soon as possible. Email AKuo@sfghpeds.ucsf.edu

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Is Your Pager Working?

The pager people have made a number of updates to the system to help improve the service. They are wondering how things are going and would like to hear about any issues. Please let Cathy Ratti know so that she can report back.

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Happy Birthday to:

No birthdays…

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 In Other News:

Apparently you can buy a house from IKEA now. That is just weird. http://newsfeed.time.com/2012/03/02/forget-bookcases-now-you-can-buy-an-entire-house-from-ikea/?hpt=hp_c2#ixzz1nxoUrHzJ

Ever wonder what Jay-Z would look like with Bieber hair? Look no further, your prayers have been answered! Saunders loves this…or maybe he said that he could see me getting dumber just by looking at it? Either way, here you go:

http://www.usmagazine.com/celebrity-beauty/pictures/stars-with-justin-biebers-hair-2012212/20960

Amazing video of the week!!

Awesome hip hop dance: http://youtu.be/TLtSfYX8tJk

Ellen Degeneres doing SAME hip hop dance: http://youtu.be/WJ5bbPOa53Q

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Your Chiefs are:

3/2-3/4:  Julie (Clinical and Jeopardy)

3/5-3/9: Julie (Jeopardy)

3/5-3/9: Saunders (Clinical)

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Julie, Leslie, Suni and Saunders!

Chief Residents
UCSF Department of Pediatrics
ucsfpedschiefs@gmail.com

 

 

PREP Question Answer

C.  infuse 20 mL/kg of 0.9% saline

The boy described in the vignette most likely has taken his sister's anticonvulsant medication and is exhibiting signs and symptoms consistent with a barbiturate overdose, including coma, bradycardia, and hypotension. Although an overdose of oral hypoglycemic agents may cause similar symptoms, they would be due to hypoglycemia, which is not present in this patient. Treatment of a barbiturate overdose is largely supportive and involves restoration of vital functions and decontamination. The initial approach should focus on ensuring adequate oxygenation and ventilation with supplemental oxygen and assisted ventilation and correcting hypotension with fluid boluses and vasoactive pressor agents. The boy requires an initial saline bolus to correct hypotension. Decontamination with activated charcoal should follow once resuscitative measures are underway, although in a patient who has altered mental status, care must be taken to ensure a protected airway prior to activated charcoal administration. Passive external rewarming with warm blankets may be initiated and a urine toxicology screen may be obtained as the patient is being stabilized. Atropine is not indicated because the bradycardia in this setting is not vagally mediated.

Although the overall incidence of barbiturate overdose has decreased as safer anticonvulsants and sleep aids have been introduced, the illicit use and abuse of barbiturates has seen a resurgence among adolescents. This is of particular concern because these medications are highly addictive and produce tolerance within a narrow therapeutic range. As a result, teens who become addicted require increasingly higher doses that can extend into the lethal dose range.

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Chief Residents
UCSF Department of Pediatrics

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