Pediatrics

Objectives: Pediatric Rotation

October 30, 2009

I just finished my first week on the pediatric ward at VGH. I admit it is a totally different world and I no longer can work up patients as quickly as I did in internal medicine and geriatrics. My first patient had multiple complicated disease states such as seizures, hypertension, GERD and short bowel syndrome. I’ve had to do a lot of reading because we did not get a lot of exposure to pediatrics during school.

The H1N1 flu is also a bit of a concern on the ward. There has been a few patients who have been admitted with flu-like symptoms and any patient who is influenza A positive gets put on Tamiflu. To get H1N1 confirmation, we have been sending the samples to Vancouver (BCCDC) and this usually takes ~ 1 week. However, starting Monday the labs in Victoria should be able to run the tests.

I’m faciliating a journal club on Tuesday so I will post a copy of my handout after it is done!

November 3, 2009

Today I lead a journal club on the use of lansoprazole vs placebo in the treatment of symptomatic GERD in infants. Interestly enough, the study showed that there was no difference in “crying episodes” post feedings. Apparently, it is common practice to prescribe PPIs in infants who have regurgitation/crying/fussiness even though there is no evidence of benefit! Here is a copy of my one page summary: Pediatrics Journal Club Handout

November 6, 2009

This week I got to spend a morning in the CF clinic. The clinic is staffed with a multi-disciplinary team (doctor, pharmacist, dietitian, nurse, physiotherapist) and I got to follow a patient all  morning.  Unfortunately, this patient had to be admitted due to an exacerbation secondary to influenza so now I am following him as an inpatient. There aren’t a lot of “DRPs” per se with this patient  because he is so closely followed in the clinic but I am learning a lot about CF medications.

I am also getting to know the nurses, residents and MSIs very well. They are asking questions and I am getting more comfortable making my recommendations.   I hope to find an interesting patient to use for my case presentation over the next few days and I need to work on developping better monitoring plans (as per my midpoint evaluation with Greg).

November 21, 2009

Last day on Pediatrics today! The rotation seemed to fly by. I really enjoyed working with the team of residents, MSIs and nurses.  I had a lot of questions dosing and choice of drug therapy and it was nice to give my input. I ended up looking up most of the questions because I didn’t know a lot of answers. Here are a few things I took away from the rotation:

1) A lot of therapies are initiated without any real evidence. Unfortunately, there aren’t a lot of well done RCTs in the pediatric population so we have to work with what we have. An example is giving PPIs for pediatric GERD.

2) Getting children to take meds can be a challenge. I had multiple encounters where I had to convince patients to take their liquid antibiotics. Cefuroxime suspension is very bitter and most children don’t like it. The taste of it is also difficult to mask in yogurt or apple sauce.

3) Meticulously checking all doses! Normally I am able to look at a drug regimen (in adults) and know whether it’s an “appropriate” dose or not but with pediatrics you have to checking all doses based on mg/kg dosing. 

I also presented a case on a contreversial topic: the use of prophylactic antibiotics in children. I had a hard time putting it together and worked really hard to make it interesting for the audience. Afterward, I got some great feedback so the hard work paid off I guess! Here is a copy of my slides: pedscasepresentation