History and Physicals:
Journal Article Summary:
There are currently different recommendations regarding when to place tympanostomy-tubes for children with recurrent acute otitis media. This study set out to determine the efficacy of tympanostomy tube placement vs medical management in children with recurrent AOM defined as at least 3 episodes within 6 months or 4 episodes within 1 year. The primary outcome was measured by the number of episodes of AOM per child per year during a 2-year period. The population included children age 6 to 35 months of age.
The rate of episodes of AOM per child per year was 1.48 in the tympanostomy tube group and 1.56 In the medical-management group managed with antimicrobials. In regards to secondary outcomes, there was no evidence of increased microbial resistance in the medical management group despite the greater use of antibiotics. In conclusion, results found that the rate of episodes of AOM during the 2 year period was not significantly lower with tympanostomy-tube placement than with medical management of antimicrobials.
Site Visit Summary:
My first case presentation was about a teenage male with a history of hematuria. I chose this case because it had a wide differential of causes. The patient and accompanying parent were not good historians and there was no medical records available which challenged me to think of how to narrow the differential. My site evaluator guided me on how to correctly write in a chart when family history was not obtained and for what reason.
The second case was a classic presentation of varicella (Chicken Pox) in an unvaccinated young child. This case challenged me to think about possible complications/sequela of this virus and how to address them. One of the reasons I chose to present this scenario was to remember not to assume a child is fully vaccinated and overlook viruses like this.
The third and last case was presented on a newborn cesarean delivery in a baby with transient tachypnea of newborn. Due to the unique situation of being newly born, much of the way I wrote this history and physical differed from how I would address an older child H&P such as the ROS, known allergies, medical history, etc. I chose this case because it was a good exercise on how to write up a newborn history and physical with the aspects that are unique to it. My site evaluator provided feedback on different interventions that can be used for TTN and expected findings.
Typhon Case Logs:
During my Pediatric rotation at Queens Hospital Center, I was faced with many different types of patients in many different settings. I spent three weeks in the Pediatric Emergency room which had a psychiatry component, one week in the NICU including newborn deliveries, and the last week in the outpatient clinic which included primary care, cardiology, pulmonary, neurology, genetics, and other subspecialities. The wide breadth of experiences gave me a comprehensive pediatric experience.
In the ER, I learned how to place a different type of IV than the one I had previously learned. I also did my first splinting on an ankle joint and wrist joint. Additionally, I was able to assist on an incision and drainage of a cyst on the chest wall. In the NICU I learned about isolettes, how to complete a newborn physical exam, and how to use a NeoPuff. In my last week at the outpatient clinic, I learned how to do different maneuvers for a cardiac echocardiogram.
One of the most challenging parts for me was learning the different milestones and aspects of a physical exam for different age groups. This differs from adult medicine in that a newborn has different reflexes and capabilities than a toddler which is even more different than a teenager. The second biggest challenge was learning how to calculate weight-based dosages which is how medication dosages are prescribed in pediatrics. In general, learning different drug dosages is something I want to continue to work on in future rotations.
At first, I found pediatric patients to be a challenge due to their age-related abilities to cooperate. However, the nurses quickly taught me effective strategies on how to distract and calm down children at different ages to allow us to perform the necessary exam components and procedures for them.
At the beginning of this rotation, I was sure that Pediatrics would be the one area of medicine I did not want to work in because I was intimidated by differences from adult medicine. However, I quickly learned that I like these differences and work well with children. Several parents and providers complimented me on my ability to connect with the kids and accomplish the medically necessary tasks to care for them. After one week in I began seriously considering wanting to work in Pediatrics upon graduation.