Mother & Baby Department
Actually Paeds is my 5th department, but after completing medical, which is my 2nd, i decided to do peads first. Why? Because after a "tiring & no life" department, i needed some rest to recover physically and mentally. In my hospital, paeds is a chill posting, the head of department, specialists and medical officers are damn nice to you, as long as you don't create trouble and do your job properly (of course!).
My advice is always plan and prepare for whats coming. We're not a fortune-teller.... but we're not a damn gambler either. With better preparation and planning, success is easier to achieve !!
First of all, paeds posting is divided into :-
- Nursery : aka special care nursery (SCN) or whatever they wanna call it. Basically you're going to deal with neonates. We all learn how to differentiate neonates and children in medschool don't we?
- Ward : From a baby of 1 month old and up to 12 years old, is your future patient here.
For example : they gave me ward first, and then nursery. So i did tagging 1 week and spend 2 months in paeds ward... then.... did tagging another 1 week and spend another 2 months in nursery.
So if you realize, the total tagging period is still 2 weeks and the total allocated time in paeds department is still 4 months, like other posting. But i did not have to do tagging for 2 weeks continuously, less tiring !!
*** Disclaimer : Beware of Parents, especially Mother, as they can be very protective, avoid doing procedure like blood taking and branulla (IV line) insertion in front of them.
The next thing you want to avoid is having parents complaint about you, saying you poke their child many times for blood-taking or branulla. Remember that some parents are not as educated as you are, their emotion can easily surpasses their logic thinking. The worst case during my HO time, the so-clever mother, complaint to the Minister using SMS !! Since its near the election, the minister gave a phone call to the Pengarah Hospital !! Then, the whole department is like being shot with a machine gun by the Pengarah.. lol
While some complaints are relevant, some are not !!
This is hospital, happy-health-go-lucky people don't get admitted here !!
Baby = Small Hand = Small Vein = Difficult
Very Sick Baby = Difficult x 99
** remember, sepsis causes peripheral vasoconstriction, causing even harder to get peripheral line access !!!
- if you;re not sure, ask for help, not for trouble
Houseman Job in Ward
- Usual stuff : Clerking, present cases, blood taking, & set Branulla..
- Specific stuff : You need to plot the growth chart (google image to see it). If the child is under-weight or over-weight, remember to ask the mother regarding the child's nutrition status (what they eat, how frequent, blaa..blaa..blaa). If the child is under-weight, consider chronic infection? immuno-compromissed? Get the history from the parents. Might need to do screening (Hep B, Hep C, HIV test) for the parents and the child as well. Don't forget to ask the development progress, 6 months old can do what? 1 year old can say what? Start crawling/walking/running/talking??
- Physical Exam : Always check the throat (main cause of fever/poor oral intake), peripheral circulation (capillary refill time, warm/cold periphery). Always look for the danger sign, as you are the 1st doctor to attend the patient, child can deteriorate super fast, if you sense any danger, straight away inform your Medical Officer.
Houseman Job in Nursery
- Usual stuff : Clerking, present case, blood taking & set Branulla
- Specific stuff : Learn how to calculate the feeding. Neonatal jaundice, what level of total bilirubin need phototherapy? Neonatal Resuscitation is a MUST as you will be working closely with your O&G colleague, in a difficult/complicated delivery, they save the mother, you save the child. Also you need to know, the criteria of admission to nursery. APGAR score. (Will write a post of all these separately)
# My experience in Nursery
- That day, the weather was nice, there's a rainbow and the birds are singing. I just started my duty, and was informed by O&G team that they are pushing a mother to the operation theater for an Emergency Lower Segment Cesarean Section (LSCS) for suspicious CTG (remember my O&G post?) and suspected chorioamnionitis. So me, a nurse and my MO went there with resuscitation kit and we prepare for the baby.
- The Anesthetic team, gave the mother general anesthesia, because of failed spinal anesthesia.
- Baby was born vigorous, APGAR score full, no resuscitation given. My MO checked the baby and then he said, "ok, discharge to mother lah, baby all ok right, i go out first okay.."
- 1 minute later, when i was writing the discharge ordered by my MO in the mother's file, the baby suddenly stopped crying, became bluish (pale blue in colour) and limp !!
- The nurse started to panic, but thank God, i have my Neonatal Resus Skill like at the back of my hand, when you understand the resus flow and know exactly how to react, you won't panic.
- So i gave the baby Positive Pressure Ventilation (PPV) for 1 minute and ordered the nurse to give a shot of IM naloxone to the baby. The next minute, the baby became pink again and started to cry with good muscle tone, although i was ready to do chest compression, if necessary. Praise to Almighty God !!
- Can you imagine what will happen to the baby if i am not well equipped, knowledge and equipment wise?? My medical officer (MO) already left at that time. Lucky him to have me (hehe).
During my medschool, I never know what Neonatal Resuscitation is, let alone performing it. But I learn it during tagging time in Paeds with all my heart..
If an average medicine student who knows nothing about resuscitation during medschool, can save a baby's life..
You sure can too, medicine is a lifelong learning process !!!
