Pediatric Surgery HOUSESTAFF MANUAL UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Last revised: January 2013 In Pediatric Surgery, always remember: “Call Early, Call Often” “Children are NOT little adults” “You don’t know what you don’t know” “Bilious vomiting is a surgical emergency until proven otherwise” “A baby has no language but a cry” “Primum non nocere” “Before anything else, do no harm” “But also, do some GOOD” “To cure sometimes, to CARE always” 476-2538 - 24/7/365 Prayer of the Newborn Undergoing Surgery: Let them keep me warm, Let them keep my airway clear, Let them maintain my blood volume, And please LORD, let them get me right the first time. Introduction This manual is intended to serve as an orientation to the Pediatric Surgical Service at Parnassus. We see and treat a wide breadth of problems on this service. Management of pediatric surgical patients requires constant attention to detail with little margin for error. The tempo of disease processes in children can be quite rapid. Be careful when ordering medications and intravenous solutions— dosages for pediatric patients are based on mg/kg. There are always plenty of resources available, particularly if the care of children is new to you. For any problem that arises, always err on the side of too much communication rather than too little communication with the attending. You may not know what you don’t know when it comes to the care of children. Remember, children are NOT little adults! FTC/Pediatric Surgery Office The FTC/Pediatric Surgery Office is located at 400 Parnassus, 1st floor, Room A-123 (next to the clinical lab). Our office staff and nurses are located in this area. There may be times when you are paged by the Nurse Practitioner to see a patient here. There is one exam room with limited supplies. This area is only used for drop-in or urgent patients. Sometimes the attending surgeon may also schedule a patient to be seen here during non-clinic hours. Important Phone Numbers All numbers are area code 415 unless stated otherwise. 24/7 PedSurg Attending: 476-2538 Pediatric Surgery Michael Harrison, MD Cell: 235-5812 Ranch: 707-847-3430 Home: 665-0297 Office: 476-4086 Lan Vu Cell: 283-8837 Pager: 443-2897 Office: 476-0447 Hanmin Lee Cell: 235-7702 Pager: 443-8700 Home: 285-1323 Office: 502-7392 Doug Miniati Cell: 816-6025 Pager: 443-1929 Home: 564-6615 Office: 476-3642 Shin Hirose Cell: 519-2417 Pager: 443-2443 Office: 476-0447 MacKenzie Cell: 238-6934 Pager: 443-9930 Office: 476-2479 Maura O'Day Cell: 508-272-7066 Pager: 443-4088 Office: 476-3641 Barbara Bratton Cell: 699-0716 Pager: 443-1565 Home: 452-2804 Office: 476-9717 Jody Farrell Cell: 650-218-6147 Pager: 443-3402 Home: 650-692-8147 Office: 476-0445 Appt Scheduler, Olga Martin Office: 502-6740 Fax: 476-2929 OR Scheduler, Brian Forman Office: 476-8080 Office: 476-2539 Surgery Assistant Office: 476-8580 Important UCSF Numbers General Academic Offices HSW 1601 476-4086 ACC Fax 353-2279 ACC Front desk Pediatric Surgery 353-2586 ACC Pediatric Primary Care 353-2287 ACC Pediatric Urgent Care 353-2025 ACC Team Room 353-2852 1-877-UC-CHILD Access Center/Pediatric admissions 1-877-822-4453 353 1611 Chaplain Services 443-2773/353-1941 Child Life Services 353-1203 Teresa McDonald(outpt) 443-4159 Consult Pagers Adolescent Medicine 443-1469 Cardiology 443-4547 Child Life 443-4914 CT Surgery Fellow 443-7834/443-0338 Dentistry 443-2243 Dermatology 443-7792 Derm Fellow 443-6221 Discharge Coordinators ICN: Irma China 353-1825 ICN: Amanda O’Byrne 353-1824 Pedi: Anne-Marie Philpott 353-8410 Pedi: Anne-Marie Pager 443-1519 Endocrine/Diabetes 443-9086 Feeding Therapy: Nora Chun-Uba 443-4081 Miriam Crennan 443-8981 Helen Sang 443-0668 Genetics 443-8075 GI-Academic office 476-5892 Hematology/Oncology 443-6966 Infectious Disease Fellow 443-2384 Neurology 443-9204 Neurosurgery 443-4323 443-9654 Ophthalmology After hours 443-9652 Orthopedic Surgery 443-5621 Otolaryngology 443-8724 PICC line RN: Anna Liang 443-7492/3-1143 Plastic Surgery 443-7307 6-7231 Psychiatry After hours 476-8905 Pulmonary 443-0631 Renal Academic office 476-2423 Rheumatology/Immunology Academic office 476-2491 Sedation team 443-1121 Urology Academic office 353-2200 Urology Fellow Pager 443-0372 CPMC Radiology dictation line 1-866-803-3838 Directions to campus 476-2999 Emergency Room-Main number 353-1238 Pedi Urgent Care in ER 353-1818 Family House 476-8321 Family Resource Coordinator 353-2016 Fetal Treatment Office 476-0445 Interpreter 353-2690 ATT (UCSF ID# 295007) 1-800-874-9426 Lab services 353-1667 Blood gas lab 15 353-1755 Blood gas lab PICU 353-1195 Chemistry 353-1501 Hematology 353-1747 FNA Service 443-1845 Microbiology 353-1268 Pathology 353-1613 Blood Bank 353-1313 Medical Records Chart request 353-2473 Nutrition Lisa Boice (ICN) 443-9460 Carrie MacFarland (Peds) 443-2299 Pain Service 443-6100 Pathology Hot Seat 353-1296 Grace Kim 443-2763 Pharmacy TPN 353-4710 On call pharmacist 443-1779 IV Adds 353-1216 Main 353-1028 Pediatric ORs Room 21 353-8521 Room 22 353-8522 PACU 353-1965 Surgical Waiting Room 353-1626 Pedi OR Scheduling 353-1591 Pediatric Surgery Office 476-2538 Pediatric Surgery Social workers Caroline Casey (pager) 443-3988 Eunice Flores-Uselman (pager) 443-8663 Sharon Nomberg LIFE Clinic (pager) 443-9603 Pediatric Urgent Care Phlebotomy: Tatyana Mendes 443-0451 PreOp Fax 353-1303 Prepare Clinic 353-1150 Radiology CT 353-1189 CT body 353-1354 Fluoro 353-8585 Reading room 353-1384 On call reading room 353-9027 Interventional 353-8694 IR scheduling 353-1300 IR on call Fellow 443-9417 Nuclear Med 353-1521 US Moffitt 353-1963 Moffitt Reading room 353-1353 US ACC 353-2572 ACC Reading room 353-2038 Radiology Scheduling 353-2573 Registration 353-1724,1037 Surgery Center 353-2384 ER Main 353-1238 Urgent Care Pedi (in ER) 353-1818 6 Long 353-1921 6 Long Doctors Room 353-1047,1053,1054,1064 443-MDUC 6 Long Senior Peds Resident 6 PCRC 353-8744 6 PICU 353-1352 6 North 353-1005 7 Long 353-1631 7 Long Doctors Room 353-1159,1161,1162 7 North 353-9140 7 BMT 353-1616 7 PICU 353-1955 14 Long 353-1321 15 ICN 353-1565 15 East Doctors Room 353-1525,1527 15 West Doctors Room 353-1450,1451,1453 15 WBN 353-1978 15 L&D 353-1787 353-1611 Surgery Scheduling (ask Brian) Transfers See Pediatric Access Center) 1-877-UC-CHILD Pediatric bed control 353-1937 Resident Responsibilities Please meet with Dr. Hirose 3 times during your rotation (start, middle, end) The residents on the Pediatric Surgery team are responsible for the following activities: Patient List Please confirm the patient lists on APEX daily: short list and active list. Keep inactive surgical patients on short list until discharge. Do not sign off on surgical patients without consulting with attending. Hours Resident work hours must be logged on a weekly basis. Hours will be reviewed at Wednesday am conference. No full weekend call is permitted. Submit schedule to Dr. Hirose before starting. Rounds Patient rounds and notes should be completed prior to AM cases starting in the OR. Attending walk rounds will be done on a daily basis. Page the surgical nurse (443-4088) to “15” at the beginning of daily rounds. Please notify the attending surgeon of all significant changes in patient condition, regardless of the time of day. Admissions Promptly inform attending surgeon of any new admissions & consults. The majority of outside referrals are received directly by the attending surgeon, via the answering service (476-2538), or by the hospitalist service. If you receive a call directly from an outside pediatrician/hospital, please take their name, hospital and contact number and promptly report to attending. Do not accept any patients to the pediatric surgical service without approval of the attending surgeon. All accepted inter-facility intensive care transports are to be referred to the fellow of the neonatal ICU (3-1565) or the pediatric ICU (3-1352), as appropriate, for coordination of admission. A neonatal transport is considered for any patient under 30 days of age. Emergent admissions to the pediatric acute care floor should be coordinated with the pediatric transfer center (1-877-UC CHILD). Attending Physician The schedule for the attending physician changes weekly and may also include different night/weekend coverage. Please check with the office or attending on service regarding the on call schedule. Attendings: Phone Calls Call attending directly or positively ascertain attending has been notified upon the following situations: Death (even if expected) Cardiac arrest Respiratory failure either requiring intubation or significantly increased O2 demands. Severe respiratory distress Airway issues Transfer to ICU or higher level of care Concern that patient needs a procedure or operation A new need for acute dialysis Bleeding requiring transfusion Hypotension/hemodynamic instability Symptomatic and severe hypertension Significant new arrhythmia Suspected MI Suspected PE New onset severe chest pain New onset severe abdominal pain Abrupt deterioration in neurologic exam or profound decreased mental status Significant change in neurovascular exam of extremity Patient or family wishes to speak to the attending Patient wishes to be discharged AMA Plus Any other significant change in clinical status of patient that is of major concern Any new admission The arrival of a patient accepted in transfer from another institution Consultations Perform consultations requested by other services including the Pediatric and Neonatal ICUs. The consultation template must include the name of the requesting attending physician (even if a resident requests the consult).