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There is plenty of variety this week-gingivostomatitis, possible appy, scabies, and a nursemaid’s elbow. I was able to call an Orthopedist on his cell for a consult and follow up with a few patients from previous visits. For the possible appy, I made sure I had an updated contact number to follow the patient’s symptoms, arranged follow up, and provided  a surgery consult referral in case her symptoms worsened. There’s a better workflow between the nurses and myself now that we’re familiar with each other’s expectations and I certainly pitch in and vitalize my patients when triage gets backed up. I also feel more at ease with documentation, accessing records, ordering films, and selecting appropriate referral centers.   Unfortunately, this was a short week for me due to a viral illness (flu season), but I’m feeling much better now and ready to get back to work.

My first week went better than expected. The first few days were a bit rough working with little guidance or orientation but I figured things out soon enough. Once you figure out the system at one site, it’s pretty similar to others, so I didn’t need much orienting afterwards. Surprisingly, the resources weren’t as limited as I had been preparing for. I ordered and reviewed chest radiographs within one shift, selected several different antibiotics from the formulary to treat cellulitis, made a timely referral for a urologic emergency, and there was an otoscope at every site. I saw ~50 patients-plenty of asthma, URIs, cellulitis, and fungal infections. The communication between the nurses and myself varied from site to site. Most of the time, I had to request to keep a steady flow of patients and not assume I needed scheduled breaks. Nurses triage adults and children so getting orders filled in a timely manner, urgent or not, varied day to day. I surprised to see how much autonomy the nurses took in caring for the asthmatics, treating them with duonebs and steroids for 1-1.5hrs before I every laid eyes on them. By the time I listened to the patients, their mild exacerbations had been cleared. The patients and their families seemed grateful to be evaluated by a pediatrician. I spent a lot of time educating patients on inhaler+spacer use, controller vs rescue inhalers, monitoring for dehydration signs, and SIDs precautions. We’ll see how next week goes…