För att få tillgodoräkna utbytesstudier som SVK till KI skall en loggbok föras, det är en detaljerad beskrivning av kursen, vad jag gjort och vad jag lärt mig. Eftersom den skulle vara underskriven av handledare skrevs den på engelska. Nedan följer i stort sett mina "logg books" för de två kurser jag gick.
Elective 1: PED 7539: Neonatal Medicine Externship, at University of Minnesota, Amplatz Children’s Hospital, 3 weeks, 11/11-29/11
Hours: Monday-Friday 06.30-17.00 (Thanksgiving holiday Nov 28-29th). On call once/week, Fri Nov 15th, Thu Nov 21th, Mon Nov 25th. Hours on call were 07.00 until 11.00 following dag.
The NICU – Neonatal Intensive Care
Unite works in two teams.
The Maroon team for 15-18 of the
sickest babies (HFV, ECMO, <30 weeks, CHD, complex anomalies) with 1
attending, 1 fellow, 2 residents and 1 NNP (Nurse practionner, mainly doing the
same work tasks as the residences).
On the Gold team there were 25-30 of lower
acuity babies with short term mechanical ventilation, >30 wks, feeder/growers,
straightforward anomalies with 1 attending, 1 fellow 2 residents and 1 NNP
working.
I was at the Maroon team and there were
mostly around 18 babies admitted. I daily participated and listened to rounds
of all the Maroon children. Some babies I followed more in detail and those I
also examined every day. I have listened to different heart murmurs due to CHD
(Congenital Heart Diseases), seen different congenital clinical features, like
DiGeorges syndrome and Down’s syndrome. One child had a work up for suspect
biliar atresia and another was diagnosed with duodenal obstruction and had an operation
a several days later. Last week a baby was born with a mass (cyst) in the lung
and another very premature child developed NEC.
A fewer patients I assessed and
presented at rounds. The rounds were very well structured and for each child
you went through gestational age, birth weight, growth, special events, fluids,
electrolytes, nutrition, respiratory, cardiovascular, infectious diseases,
hematology, gastroenterology/jaundice, neuro, endocrine and renal status.
Parents were invited to participate during rounds and if they were they had a
shorter summary at the end.
Besides following the work for the
admitted children I also followed most calls for Delivery team at the labor
department. It varied from only one call a day to 4-5 calls a day, both
caesarian sections and normal vaginal deliveries.
What
I have;
Seen:
Many newborns, premature babies, intubation and administration of surfactant (x
3), extubation (x2), access of umbilical artery and vein catheters (x2-3), CPAP
and other respiratory management of newborns (daily), surgery closing of PDA
(x1), in whole care of babies at NICU.
Participated:
Daily rounds including radiology rounds work up, delivery team and initial care
of newborn with or suspected respiratory distress, education in certain topics
about 3 days/week for example Management of respiratory choices and settings, HIE
- Hypoxic-ischemic encephalopathy, History of incubators. One afternoon I also
participated a NICU simulation.
Performed:
Presented 1-2 patients at daily rounds, calculated fluid balances (daily),
written orders for TPN (daily from w2), pulled out umbilical artery catheters
(x2), ventilated newborn baby (x1). Informed and/or updated parents on their
children.
Kommentar om kursen
Kursen var ett av mina förstahandsval. Jag lärde mig enormt mycket under kursen, både om det amerikanska systemet, hierarkin i sjukvården och om neonatologi. Det som var mycket uppenbart var att de uppställda internationella guidlines som finns tillämpas såväl i Sverige som i USA.
Elective 2: PED 7538 Pediatric Gastroenterology and Nutrition, at
University of Minnesota, Amplatz Children’s Hospital, 3 weeks, 2/12 - 20/12
Hours: Monday-Friday 07.30-16.00.
The Pediatric Gastroenterology and
Nutrition (GI) is one of a several teams that share an inpatient unit. The other
pediatric teams where Nephrology, Hemathology/Oncology General Pediatric and
also children with Surgical issues. The unit has 24 beds in total, all rooms are
individual and with a separate bed/sofa for the parents.
In the Pediatric GI team there were one
attending, one senior resident and two interns (first year residents). In
addition to me there were another final year student. There where 3-5 children
admitted in general. The patients where admitted due to for example; biliary
atresia, post operative peritonitis and gastrocutaneaus fistula in patient previously
treated for B-cell ALL, work up for Inflammatory Bowel Disease (IBD), Irritable
Bowel Syndrome (IBS), Constipation without or without underlying sickness like
Cystic fibrosis (CF), Rhabdomyolysis in patient with Long-chain 3-hydroxyacyl
CoA dehydrogenase deficiency (LCHAD).
The mornings started with a report of
events during nights, and before rounds at 8.30, all children had been assesed
by a resident with an updated physical exam and a plan for at least the day.
After rounds there were time for consultants and to update notes, discharges
and so on.
Most of the days there were some
teaching, sometimes in the mornings and sometimes at lunchtimes for ground
rounds. The teaching could either be a specific case, or a certain topic like
Hyperbilirubinemia, Celiac disease, Gastro esophageal reflux. I also
participated in three Medical Mock Code, a simulation training at the
Children´s Emergency department. I also followed a few children on a gastro-
and colonoscopy. In one female teenager the colon turned out to be very
inflamed and the she was diagnosed with IBD. During the first week one child
was admitted with a several diagnosis and the mother had some significant signs
of Munchausen syndrome.
For about three days I attended Clinic
with an attending in Pediatric Gastroenterology. I saw patients with suspected
Wilson´s disease and work up for liver failure, Constipation, IBS, Failure to
thrive, Gagging etc.
What
I have;
Seen
and participated: All children admitted to the
Pediatric GI with daily rounds in patients mentioned above.
Performed:
Presented in general one patient at daily rounds suggested plans, made a daily
physical exam, wrote daily notes for this patient. Some newly admitted patients
I also wrote History and Plan for. I informed and/or updated the children and
parents.
Kommentarer om kursen
Bra kurs. Den senior resident som var min huvudsakliga handledare de första 2 veckorna var fantastisk, resident som handledde mig under sista veckan var inte lika intresserad av att undervisa. Likaså varierade intresset från överläkarna (attendings) att undervisa. Första veckan hade vi i teamet en "mini" föreläsning varje dag som var superbra. Roligt att variera kurserna från mer intensivvård till mer ordinärt avdelningsarbete.
Amplatz barnsjukhus var ganska nybyggt och fräscht.
Jag hade inga problem att få kurserna tillgodoräknade av KI efter hemkomsten.