The fellow should develop the skills and knowledge necessary for
management of critical airways in children. The fellow should become familiar
and comfortable with Bag-valve mask techniques, intubations, and Laryngeal
Mask Airways. The fellow should also become familiar with all medications
and equipment for airway management. This will not only include the use of
inhalation agents, but paralytics, sedatives and reversal agents. The fellow
will learn indications and contraindications of different types of intubations
(endotracheal, nasotracheal, oral airways, etc). The fellow will also become
familiar with rapid sequence intubation and management of the difficult airway.
The rotation should be completed early in the first year in order to assure
that the fellow is comfortable and familiar with airway management.
Pediatric Intensive Care (PICU) The rotation through the PICU should allow the fellow to learn to manage
critically ill and injured children following initial emergency department
stabilization. The fellow should become familiar with advanced life-saving
procedures such as placement of central lines, cardioversion, BiPAP and other
critical care techniques. The fellow should also become familiar with the use
and management of advanced care medication, drips and pressors. The fellow
should become an integral part of the PICU team and function with the responsibilities
as would be expected of a junior fellow in critical care. While only one month
is required by the ABP/ACGME, we require that fellows do a minimum of two months
in the PICU during their training. The importance to the emergency physician
of knowledge and comfort with advance care procedures and medications is vital.
While rotating through the PICU, the call schedule will be dictated by the
PICU attending. No emergency department responsibilities are expected during
this rotation.
Trauma During this rotation the fellow will be an integral part of
the trauma team at Grady Memorial Hospital. Under the direction of
the trauma service, the fellow will learn to manage both adult and
pediatric critically injured patients. Fellows should learn to manage
blunt and penetrating injuries, as well as other related traumatic
injuries (burns, for example). The fellow should develop the technical
and cognitive skills necessary for the stabilization and critical
initial management of injured patients. The fellows should gain first
hand experience in Advanced Trauma Life Support and related techniques.
The fellow should complete the basic ATLS course prior to this rotation.
The call schedule will be decided by the trauma service and there
will be no other emergency department requirements during this month.
Orthopedics During this rotation the fellow should become comfortable with
basic and advanced splinting techniques and the emergency department
management of common pediatric orthopedic conditions. The fellow should
become familiar with special procedures such as arthocentesis. The
fellow should also become comfortable with initial management and stabilization
of orthopedic conditions. They should also learn to recognize conditions
that can be initially treated in the emergency department by the ER
physician (with stabilization and referral to an orthopedic specialist)
and those conditions requiring immediate orthopedic consultation. The
fellow will not be responsible for call on the orthopedic service during
this month and will have limited clinical responsibilities in the pediatric
emergency center.
Toxicology The fellow will learn the cognitive skills necessary to
critically manage both adult and pediatric toxic exposures (intentional
and unintentional). The fellow will become familiar with the poison
center and the
extensive resources available (poison index, etc), and participate in poison
center rounds, inpatient consultations and telephone advice services. The
fellow should become familiar with common toxidromes, toxicology screens
(their clinical utility) and the work-up and management of common exposures.
The fellow will not be required to take call during this rotation and will
have limited responsibilities in the pediatric emergency center during this
month.
Adult Emergency Medicine The fellow will become familiar with the management
of critically ill and injured adult patients. This
will allow the fellow the opportunity
to manage emergencies in patients outside of the pediatric range. The
fellow should become familiar with the recognition of common adult
emergency medicine concerns including myocardial infarction and DVT’s.
The pediatric emergency medicine physician will often practice freestanding
pediatric centers and may be called upon when emergencies occur in
family members of pediatric patients throughout the hospital. Adult
patients might also present inadvertently to pediatric emergency centers.
It therefore becomes vital for the pediatric emergency medicine fellow
to become familiar with common adult concerns, initial management and
stabilization. The fellow will be an integral part of the resident
team of physicians and will take on the responsibilities as might be
expected of a senior level emergency department resident. The adult
emergency medicine training program will determine call, and the fellow
will not be responsible for pediatric emergency department call during
this rotation. Two months are required. Additional months may be chosen
as part of elective time.
Pediatric Emergency Medicine The fellow will be an integral part of the
pediatric emergency department team. During the
dedicated pediatric
ED months, the fellow
will be responsible for 35 clinical hours per week during their first
year, 30 during the second and 25 during the third year. This will
occur in conjunction with a pediatric emergency department attending.
The level and degree of responsibility will gradually increase as
the fellow’s knowledge and comfort with the
care of ill and injured children progresses throughout
the training. Initially, fellows will
gain comfort with the care of individual patients and will gradually
progress to overall management of the emergency center. Progress
will be monitored and discussed with fellows throughout
their training.
The ultimate goal is to incorporate all the training experiences
in order to become comfortable and competent in
the care of acutely ill
and injured children.
Gyn/Adolescent Medicine During this month the fellow will have the
opportunity to be involved with the evaluation
and management
of common disorders of adolescents.
These include sexually transmitted diseases as well as issues related
to sexual assault. The rotation is conducted at the Adolescent clinic
at Hughes-Spalding Children’s Hospital under the direction
of Dr Mary Sawyer.
Emergency Medical Services (EMS) During this rotation with a large urban
EMS provider, the fellow learns about EMS systems
and operations, CQI/QA, pre-hospital rules
and regulations, base station practices, and
issues concerning on-line and off-line medical
control. Fellows staff EMS units as in integral
part of the pre-hospital care team dealing
with both adult and pediatric patients. The
fellow develops an appreciation for using technical
and cognitive
skills in an unprotected, and at times, hostile environment. There is an option
to participate with the EMS helicopter service. Fellows are scheduled for a
variety of shifts to gain experience at different times of the day. The EMS
Director decides the schedule. The fellows will take limited call in the pediatric
emergency center during this rotation.
Elective and research months are to be chosen
at the discretion of each fellow. This time
should be used to enhance the training experience
and to focus on
areas of emergency medicine, which the fellow has particular interest in or
feels he/she needs exposure to. These areas should be discussed and planned
in conjunction with the fellowship directors and the fellow’s mentor.
Opportunities can be chosen within the Children’s Healthcare and Emory
systems (egs; Plastic Surgery, Ophthalmology, Radiology, Pediatric Surgery,
Oral Surgery, Allergy & Immunology, Cardiology, Dermatology, Genetics,
Endocrinology, Gastroenterology, Hematology/Oncology, Infectious Disease, Neurology,
Psychiatry, Pulmonary, Nephrology, Sports Medicine, and Sexual/Physical Abuse).
It will also be possible to pursue electives at other institutions. During
elective months it is expected that the fellow work on their area of research,
as clinical time designated to the pediatric emergency center will be limited
to a total of 48 hours.
