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Schedule



Day

AM

PM

Monday

General neurology continuity clinic (adult neuro residents)
9 am Peds Neuro clinic (peds neuro residents)

Consults and follow-ups

Tuesday

8 or 8:30 am Peds neuro clinic

Consults and follow-ups

Wednesday

9:30 am patient conference
10:30 am grand rounds

Consults and follow-ups

Thursday

8 or 8:30 am Peds neuro clinic

Consults and follow-ups

Friday

8 am lecture
9 am Peds neuro clinic

Consults and follow-ups

Weekends

8 am (subject to change) - round on inpatients

Schedule time to round on existing consults and new overnight

or AM consults w/ Peds Neuro consult attending

Home Call

Overview

  • Usually the junior resident will be on with a senior resident or a peds-neuro resident.
  • It is not uncommon to be in the hospital until 6 pm or later.
  • The MiChart clinic context is MH PED NEUROLOGY and the clinic schedule is MH PEDNEU NEW PATIENT. Patients will be reassigned to the staffing attending during clinic, and fall off the New Patient schedule.
  • Typically the residents round on the Peds Neurology inpatients with the attending on the weekend. You should be familiar enough with them to answer questions from the peds residents overnight or over the weekend.
  • The Peds neuro clinic is on the 6th floor of the Mott clinic building. Staff room is Pod 1.
  • The Peds Neuro fellow's office is on the 12th floor of the main hospital, down the main hallway, on the right side across from the crash cart. There is a shared key for adult residents on weekends.
  • As residents, we chiefly deal with the consults. The Peds Neuro (PNU) inpatients are cared for by the pediatrics residents on the Gold team, staffed by the on service PNU attending. You should generally be in the loop about the inpatients though, especially over weekends.

Home Call

  • Call is an average of every 3rd night. The third person in the call pool is typically a peds neuro resident who is on elective.
  • It is uncommon to have to come in to see a patient, but you will get frequent phone calls from patients' parents and the ER.
  • Almost all of the pages (consults, and home phone calls, and ER phone calls) should be discussed with the attending before making any decisions, especially when first starting on peds neuro.
  • For each call you receive overnight, you should document the information in a MiChart Telephone Encounter. This should be routed to the on-service attending, and the patient's primary neurologist can be carbon copied on the encounter.
  • The Peds senior should get signout around 8 am from overnight resident. If there are any urgent consults to be seen in the morning, an effort should be made to see them. Otherwise, new consults are typically seen in the early afternoon, and rounds with the attending start afterwards. At the end of the day, sign out to the overnight resident around 5 pm or when it is convenient.
  • Weekends are split between the on-service senior resident and the junior resident(s). On those days, you're responsible for rounding on all the consults that need to be seen, seeing any new consults from overnight or morning, but you don't need to stick around to any certain time. Typically people stay until at least noon, in case there are any new consults that are called in the late morning.

Other Nuts and Bolts

  •  If you are sending a patient from home to our ED, it is courteous to call our ED (936-4230) to give them a heads up about the patient, and what you would like them to do. If the patient is being transferred from an outside ED, it is still courteous to call our ED, but the outside ED also has to call our ED for our ED to accept the transfer.
  • If you are admitting a patient to the floor from the ED to the Peds Neuro service, you should call the admitting senior resident to discuss the plan (Maize senior during day until 4 pm, admitting pediatrics senior-pager 31565 after 4 pm)
  •  If you are consulting on a patient being admitted to the PICU from the ED (e.g. status epilepticus), it would be reasonable to talk about the neuro plan to the PICU resident (pager 33533) or PICU fellow (216-5031 or paging website)
  •  When initiating LTM EEG on a patient, go through the Peds Epi fellow (or on-call epi fellow), and they will call the techs. Make sure with the primary team that the patient is ready for hook-up (all imaging and procedures done)
  • For therapeutic hypothermia in neonates, it is routine to hook up the babies as soon as possible overnight (after any cranial ultrasound or umbilical lines are placed), since seizures often occur early. The techs are often called in from home for this. See the protocol for more details.
  • Ketogenic diet initiation admissions typically occur once a month, on the 1st Sunday of the month. The peds residents typically take care of the this with the Ketogenic dieticians. See helpful documents for more information.
  • Helpful phone numbers are available here
  • Helpful documents, protocols, and handouts are available here


STEPS FOR OBTAINING HYPERACUTE MRI FOR SUSPECTED ACUTE PEDIATRIC STROKE: Also see "CES Flowsheet: Suspected Acute Pediatric Stroke" for more information on pediatric stroke evaluation in the ED.

  1. Ask primary team to place order for “MR Hyperacute Peds Ischemic Stroke” It is available for both the ED and Inpatient context (not available as an outpatient).
  2. The neuro resident should call the MR techs directly when this is ordered to ensure it is obtained quickly and there is no confusion. It is set up to bypass protocoling by radiology resident to be obtained as quickly as possible, so the radiology resident will probably have never heard of it before. Call the tech directly. 
    1. Mott MR technician at 232-6691 until 10 pm
    2. After 10 pm, 936-8876 is the lead tech in main
  3. Review the images as soon as possible. If you are in house, you can accompany the patient to the scanner and read them in real time alongside the technicians. The entire study should take about 10-20 minutes (depending on if perfusion is added). Hopefully bypassing need for anesthesia in most cases.
    1. It includes the following sequences:
      1. axial DWI and ADC
      2. axial FLAIR
      3. axial SWI
      4. MRA CoW – time of flight without need for contrast
    2. There will be an option to add perfusion study if in the 6-24 hour time window if indicated.
  4. If you need help reviewing/interpreting the images, you can call 3-1800 and ask to speak with the “Diagnostic Neuroradiology Staff” on call. Make it clear that it is for possible acute stroke in a potential treatment window.

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Medications

Developmental Milestones & Signs

Useful sites

  • International Child Neurology Association (ICNA) wiki
  • simulconsult
  • genetests.org
  • CNS Neurotransmitters @ medicalneurogenetics.com

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