Pediatric Surgery Division at LPCH
The Pediatric Surgery Division at LPCH consists of dedicated healthcare professionals including NP/PAs, attendings, and support staff. They provide comprehensive care to pediatric patients, work closely with other hospital teams, and utilize modern communication tools for effective collaboration.
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Presentation Transcript
Pediatric Surgery LPCH Updated 2.10.2021
Pediatric Surgery Division NP/PA s at LPCH: Raji Koppolu, Katherine Alvarez, Ethan Lew & Jackie Nguyen Inpatient/Outpatient Good Sam NP: Claire Abrajano CPMC NP: Meredith Lahey, Laura Diaz John Muir: Taylor Perry Clinical Research Coordinator: Vicente Marcelo (650) 723-6439 Chief of Division James Dunn, MD Interns - 2/month Chief Resident 3rd yr/2 mos 2021-2023 Fellow, Aaron Cunningham- (516) 509-6516 Surgery Schedulers: Jessica Moran and Brittany Rivera 650-723-6439
Pediatric Surgery Attendings James Dunn Division Chief Matias Bruzoni Fellowship and Surgery Clerkship Director Stephanie Chao Bill Chiu Julie Fuchs Gary Hartman Tom Hui Jeong Hyun- Surgery Clerkship Assistant Director Claudia Mueller Stephen Shew Wendy Su Karl Sylvester James Wall
LPCH Contact numbers Katherine Alvarez, PA-C (650) 407-7934 Ethan Lew, PA-C (650) 441-9072 Jackie Nguyen, PA-C (650) 512-5653 Peds surgery consult pager: 13806 Peds surgery floor pager: 28087 Please download WhatsApp and Voalte onto your phone. Aaron Cunningham will add you to the WhatsApp group. This is the primary way we communicate as a team.
Pediatric Surgery Staff Raquel Alvarez - MA: email for follow up appointments RaAlvarez@stanfordchildrens.org Cheyenne Hubbard MA: email for follow up appointments chubbard@stanfordchildrens.org Jessica Moran: surgery scheduler jemoran@stanfordchildrens.org Brittany Rivera: surgery scheduler brivera@stanfordchildrens.org
Pediatric Teams NICU, PICU- We are a consulting service for these patients, all orders are placed by the primary team. You job is to communicate what orders/test/ recommendations. We do not place orders on patients that are not our primary PCU 300/500 Other units: PCU 200, PCU 220 (CVICU), PCU 320 (CV/PICU), PCU 400, PCU 420 (PICU) PCU 520 Stem cell unit Red: renal and rheumatology, Blue: gen peds, Green: Liver and GI, Purple: cardiology Hospital Tree app and Voalte
How do I reach other teams? From a hospital phone- you can dial 288 to get to the operator. They can page another person/service Most other teams/ providers/nurses are on Voalte and is the best and most common way to communicate Smart page from a computer
Rounds Round with designated rounder with nursing staff and case manager (721-0178) between 8-9 am Family-centered rounds Post op checks Evening rounds/signout
The APP team The APPs divide the list Monday Friday, will divide up the list and assign patients to interns/APPs Each provider is responsible for their patient s daily note, placing orders, coordinating with other teams, order TPN The APPs divide their roles, there should always be at least one APP inpatient and one outpatient
Trauma Trauma 99s Full pediatric surgery team response (residents/fellow and rounder. Critical care surgeon is back up) See flow diagrams for different day and night time response Trauma 97s will be run by ER. Attending/fellow to see patient within two hours of decision to admit. Consult resident to complete Trauma admit note per Trauma Notewriter template We have trauma H&P and tertiary template forms in EPIC Other primary services (neuro and ortho) will call us for tertiary in first 24 hours if admitted to their services
DAYTIME trauma response (M-F 7a-5p) Traumas at 300P age 0-17 years If rounder encumbered or two simultaneous T99, back-up/critical care attg responds Rounder/Fellow responds to ER within 15 minutes TRAUM A 99 T97s should be upgraded to T99 if patient condition dictates to facilitate rapid mobilization of resources For patients requiring admission: Attending/Fellow assessed as urgently as patient condition requires but no later than 2 hours from decision to admit patient PEM Attending directs resuscitation (primary & secondary survey) TRAUM A 97 PEM Attending directs resuscitation (primary & secondary survey) For patients requiring admission: Pediatric Surgery consult resident will perform consult and staff with Pediatric TS TRAUM A Consult
EVENING trauma response (M-F 5p-7a;Weekend/Holidays 24hr) Traumas at 300P age 0-17 years Pediatric TS responds within 30min and assumes care after warm hand- off If multiple T99s are paged or if primary surgeon encumbered, back adult TS will respond to either 500P or 300P as dictated per primary adult TS Adult TS responds to ER within 15 minutes TRAUM A 99 T97s should be upgraded to T99 if patient condition dictates to facilitate rapid mobilization of resources For patients requiring admission: Attending/Fellow assessed as urgently as patient condition requires but no later than 2 hours from decision to admit patient PEM Attending directs resuscitation (primary & secondary survey) TRAUM A 97 PEM Attending directs resuscitation (primary & secondary survey) For patients requiring admission: Pediatric Surgery consult resident will perform consult and staff with Pediatric TS TRAUM A Consult
Trauma All Trauma patients need a tertiary and a social work consult The only person that is allowed to clear a c-collar is general surgery attending and fellow and NSGY attending and fellow. For all patients with concern for child abuse (NAT), pediatric surgery is admitting service for the first 24 hours (neurosurgery may be admitting team as well) Consult SCAN team (2-SCAN) ASAP Ok to transfer to non-surgical team once injuries stabilized
Trauma in the PICU Pediatric Surgery or neurosurgery is the admitting team for all trauma patients in the PICU. Not PICU. We are responsible for going to Trauma rounds every morning at 9 am and communicating to all involved teams the plan of care If requested by PICU, pediatric surgery team will complete discharge summary.
Workup Vascular Access Order in Epic Requesting Service and contact information Diagnosis Current IV Access/Previous lines Recent labs: ANC > 500, (port) Platelets > 50,000, no allergy to contrast Pre op anesthesia review Location of patient Type of Service: Insertion or removal of CVC (SL/DL), pheresis, or port placement or removal and indication Keep port accessed or deaccessed Request for concurrent procedure (BMA, LP ) Risks of pneumothorax, bleeding, infection CXR in PACU
Post op CXR 1-2 vertebral bodies below carina Inferior border of right mainstem bronchus
Gastrostomy Tubes Laparoscopically placed MIC-KEY GT s Obtain really good feeding history PO, NG, NJ? Why? Reflux history, history of aspiration pneumonia Other medical history: cardiac, pulmonary, neuro UGI to identify anatomy (cardiac or neuro patients primarily) ** not a test for reflux! Modified barium swallow or reflux studies depending on history Consider Nissen fundoplication
Consent Not expected to consent for complicated cases Best practice- If you have not done the procedure, the chief should obtain the consent Always ask before proceeding with consent Chief/Fellow will direct you as to what is appropriate All attendings names on consent form and ensure date and time match and blood attestation box checked off Please scan consents into Haiku Epic if possible If patient will remain in house, make a copy, but then place in patient s chart
OR One intern in OR Please check 24 hour update, consent and site mark Post op orders (Same day surgery order set for outpatients, and we have template order sets for admission) Sign out to floor team Assist floor intern in between cases
Notes All floor notes need to be cosigned by rounder All ICU notes need to be cosigned by Critical Care rounder Discharge summary to be co signed by rounder Peds Surgery template notes:
Emergent consults ECMO Any infant with bilious emesis, concern for pneumatosis, free air, incarcerated inguinal hernia Trauma New Tumor, esp with airway risk If unsure, come to OR to discuss
Discharges Anticipate and plan as early as possible, goal is dc before 11 am Home care orders Detailed hospital course General surgery clinic: Monday Morning, Wednesday afternoon, Friday morning Generally, for basic laparoscopic cases, phone call F/U in 2 weeks, no contact sports for 2 weeks, ok to bathe in 48 hours, and all sutures absorbable in 4-6 weeks 650-723-6439; for ALL questions, 24 hours/day Notify for fever, changes in incision
Discharge medications Post op appendicitis go home with Tylenol/Motrin for pain control (No oxycodone unless extenuating circumstances). Perforated appendicitis usually require oral antibiotics for home (duration determined by Attending) Send all dc scripts to LPCH pharmacy, certain formulations are not always readily available at other pharmacies
Special patients Bariatric patients follow a very specific protocol, it s located in the purple binder in the work room. They will go home on multiple prescriptions, please ask the APPs for assistance. They are strict NPO until POD #1. Hydration is important, they remain on mIVF their entire stay Thoracoscopic Nuss for Pectus excavatum: followed by pain team while in house, we are responsible for the dc pain medications. Please see purple binder or ask APP for assistance with this
Order sets General surgery admission set Bariatric post op order set TPN initiation/administration set Blood administration set General surgery post op set Appendicitis admission Same day surgery post op G-tube placement post op Trauma admit orderset Nuss post-op orderset
Ancillary teams Wound care: very helpful in managing all kinds of wounds, they also see all new G-tubes and ostomies Interventional Radiology: we work closely with them Case Manager: helps with dc supplies for new g-tubes, home nursing, etc. Nutrition: Alissa Orcutt is our designated dietician and is on Voalte
