Pediatric Ward Medical Student Presentations: The Good & The
A complete History and Physical must be obtained with the resident
on the floor and written up for Dr. Miller and the teaching resident.
Presentation of morning rounds must be focused and concise. Specifically:
- Give a one-line introduction with: age, sex, diagnosis(es)
- Brief HPI with chief complaint, length and type of symptoms,
medical interventions (if any)
- ER course: Vital signs, exam in ER, interventions
- Floor course: Exam if different from ER, interventions
- Your plan: Medical management, studies required, etc.
Concise, effective presentations are very difficult to synthesize.
To help you do this, use the intern who is assigned to the patient
to figure out what information is pertinent, and give a trial run
of your presentation to him or her.
You should practice your presentation and time yourself. The goal
is less than two minutes! Remember to include what you feel are
the PERTINENT positives and negatives. Your senior resident will
ask specific focused questions if they require more information.
Again, let me emphasize that we realize this is a difficult task.
If you feel uncomfortable or unsure, talk to one of the seniors
on your team and they can guide you through your specific areas
This is a three year old cute little girl who has been having a
hard time breathing for awhile now. She has a doctor who manages
her asthma with a bunch of different medicines but things weren't
going so well, so she came to the ER with her Mother, sister, and
baby doll, Mrs. Bigglesworth. Apparently, she has been in the hospital
before with this and mom says she misses a lot of her preschool
because of her wheezing. Mom things that she is worse in the spring
but she was a little fuzzy on that point. So today after ballet
class mom saw that Sissy was breathing hard and they decided to
go to the ER after getting Mr. Misty at the DQ on the way, by the
way Sissy got blueberry which worried the ER staff who initially
thought she was cyanotic. Anyway, in the ER she was breathing fast
and working hard so she was given Albuterol nebs and some prednisone
which she vomited twice so she was enrolled in Steve Gordon's asthma
study and given Dexamethasone. She was OK on q2 nebs so she came
to the floor where she is still on q2 but looking a little better.
Here on the floor, she was breathing around 68 breaths per minute
and was having a hard time talking but she looked otherwise well
and in no distress. Her immunizations are all current but mom is
not sure if she should get the new heptavalent pneumovax. Currently,
mom says that she can talk in five word phrases and she easily walks
up and down stairs unassisted. Her exam on the floor is as follows.
HR 118, RR 50, BP 111/68, head circumference 50 cm. Today, I think
we should consider spacing her nebs to q3 hours in preparation for
early morning discharge tomorrow since I know we are in a bed crunch.
This is a three year old moderate-severe asthmatic female who presented
to the ER at 8 pm last night after having an increased work of breathing
for one day that was refractory to Albuterol q3 at home. This is
her fourth hospital admission, no PICU admissions, and no intubations.
Her home regiment includes Albuterol nebs PRN, Flovent 44 mcg with
spacer and mask BID and PO prednisone PRN severe exacerbation. Her
triggers include cats, seasonal allergies and cold weather. Her
mother and brother are also sever asthmatics.
In the ER, her respiratory rate was 68 and her O2 sat 90% on room
air. Her exam revealed diffuse wheezing and pan retractions but
was otherwise unremarkable. She was given IM Dexamethasone as per
Dr. Gordon's protocol; Albuterol with Atrovent times three then
two Albuterol nebs q2. Her respiratory distress improved significantly
and she was admitted to 10 South for further management.
On the floor her respiratory rate was between 35-40, O2 sat greater
than 98% with 1 liter nasal cannula O2, wt=14 kg (59th %). She continues
to have diffuse wheezing but now has only a little nasal flaring.
She continues on Albuterol q2 but appears to be in less distress
Today, I want to continue her nebs at q2, continue her steroid
regimen and get Pulmonary to consult for asthma teaching.