In this Issue....

August 19, 2008
Pediatric Intubation Course
Hematology In-Service
Unassigned Newborn Coverage
Fall Pediatric Conference
Calendar of Neonatal and Pediatric Educational Events, 2008
Clinical Corner
Welcome to Linda Schmidt, M.D., Child and Adolescent Psychiatrist
Providence Portland Child and Adolescent Psychatric Units

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Pediatric Intubation Course

In accordance with our commitment to provide excellent care for challenging pediatric patients, we presented a one-day pediatric airway management course. Cynthia Cristofani, M.D., pediatric hospitalist, Dan Hull, M.D., emergency department physician, and Greg Nadol, M.D., pediatric anesthesiologist, served as faculty for the course. Pediatric hospitalists and emergency physicians from Providence St. Vincent Medical Center participated. Essential topics including patient evaluation, use of rapid sequence medications, techniques for intubation, and alternate approaches, such as use of a GlideScope, were covered in didactic sessions and hands-on practical stations.

Course evaluations were uniformly positive, and most participants registered to augment their training with hands-on experience in the operating room under anesthesiology guidance.

The anticipated results from this training are that Providence St. Vincent Medical Center physicians will be able to respond more effectively to children with acute respiratory crises and that the provision of enhanced pediatric sedation services will be made easier in the future.

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Hematology In-Service

Pediatric in-service training at Providence St. Vincent Medical Center in May was presented by Greg Thomas, M.D., of the Oregon Health & Science University hematology department. Two topics that routinely challenge non-hematologists, anemia and clotting disorders, were reviewed. The presentation was stimulating and practical in its review of underlying pathophysiology as well as appropriate clinical work-up and management of children with bleeding or anemia. For those who missed this valuable session, Dr. Thomas graciously agreed to share his slides, which are available below.

Click here to link to the slides from Dr. Thomas' presentation.

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Unassigned Newborn Coverage

Providence pediatric hospitalists began covering unassigned newborns in July as a service to community pediatricians. Pediatricians who wish to continue seeing unassigned newborns at Providence St. Vincent may do so.

Pediatric hospitalists will work with Newborn Services and the Postpartum Care Center to facilitate inpatient and follow-up care in a timely, convenient and safe manner. We are excited to offer this service to pediatricians. Informational and agreement letters were sent out in June. For more information, please contact Dr. Matt Gadbaw.


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Fall Pediatric Conference

Our 2nd annual fall conference offers an outstanding program. We are pleased to announce that the Oregon Pediatric Society has chosen to collaborate with us in this presentation. The partnership allows us to present an expanded program that includes several national-expert faculty members, including David Rosen, M.D., of the University of Michigan, Colleen Kraft, M.D., of Virginia Commonwealth University, and Raffi Tachdjian, M.D., of UCLA. We are also delighted that former Governor John Kitzhaber, M.D., will address the group as a keynote speaker on the first day.

The conference will be held Wednesday afternoon, Oct. 1, and all day on Oct. 2 at Providence St. Vincent Medical Center in Portland.

Accreditation

Providence Portland Medical Center designates this educational activity for a maximum of 10 hours of AMA PRA Category 1 credits.™ Physicians should only claim credit commensurate with the extent of their participation in the activity.

Providence St. Vincent Medical Center Department of Nursing is a provider approved by the California Board of Registered Nursing (Provider #CEP8693). Nurses will receive 2.75 hours for Oct. 1 and 6.25 hours for Oct. 2.

Conference speakers and topics are:

Oct. 1, 2008 (plenary sessions)
Pediatric Care for the 21st Century
John Kitzhaber, M.D.
Former Governor, State of Oregon

Community Pediatrics and Transformation of Pediatric Care
Colleen Kraft, M.D.
Richmond, Va.

Facilitated discussion

Oct. 2, 2008 (plenary sessions)
The Challenge of Eating Disorders
David Rosen, M.D.
Ann Arbor, Mich.

Methamphetamine and its Effect on Children in Oregon
Jack Stump, M.D.
Vancouver, Wash.

Pediatric Pain Management
Raffi Tachdjian M.D., M.P.H.
Los Angeles

Breakout sessions (participants may select two of the four)
Developmental Sexuality: How and What to do in the Office Setting
Mike Wilmington, M.D.
Vancouver, Wash.

An Approach to the Depressed Child
Linda Schmidt, M.D.
Portland, Ore.

Practical Management of Eating Disorders Patients in Your Practice
David Rosen, M.D.
Ann Arbor, Mich.

Coping with Pediatric Surgical Diseases
Barry Newman, M.D.
Portland, Ore.

The Oregon Pediatric Society will host a luncheon meeting for members on Oct. 1, prior to the opening of the conference. All participants are invited to a reception at the end of the first day of the conference. Lunch and snacks also will be provided on Oct. 2.

Save-the-date cards have been mailed to targeted conference attendees. Practitioners who did not receive the mailer should contact
Dr. Cynthia Cristofani. A detailed program brochure containing a registration form will be mailed soon. We look forward to seeing you at the conference!

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Calendar of Educational Events, 2008

Click here for calendar

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Clinical Corner

HPI: A 3-month-old Hispanic male infant presents to the emergency department with two days of worsening respiratory distress. His mother states that he has developed nasal congestion and cough, beginning approximately two weeks prior. He has a 3-year-old brother with similar symptoms. Two days prior he was seen in urgent care, where he was diagnosed with an upper respiratory infection (URI) and started on azithromycin and albuterol. A chest X-ray reportedly showed signs consistent with early pneumonia. After he was started on the medications, his breathing rate increased and he appeared to be breathing harder. He had one episode of "mucousy," nonbloody emesis. He has been breast- and bottle-feeding normally without a change in urine output.

Birth history: Full-term, vaginal delivery, no complications

Past medical history: Jaundice treated with inpatient phototherapy for one day, and outpatient therapy for one week.

Social history: 3 year-old brother ill with URI symptoms. No tobacco or other concerning environmental exposures are present.

Family history: none significant.

ROS: only significant for development of a fine, macular rash that has developed on his chest over the last 24 hours. His brother has a similar rash.

Physical Examination:
Vital signs: Temperature 36.4, HR 156, BP not measured, RR 64, O2 sats 88% room air
HEENT: anicteric sclera, L tympanic membrane erythematous and opacified, AFOS
Lungs: moderate subcostal retractions and tracheal tugging; diffuse, loud coarse breath sounds with bilateral inspiratory and expiratory wheezes.
CV: RRR, 2/6 systolic murmur, femoral and distal pulses 2+, no LE edema, cap refill two seconds
Abdomen: soft, nontender, liver at costal margin, no splenomegaly, no masses
Skin: fine blanching maculopapular rash on upper chest and in his groin, no erythema, no petechiae, no pustules.

Lab data: WBC 19.5 (55% neutrophils, 3% bands, 40% lymphs), HGB/hct 13.4/39.5, plt 551, rapid RSV negative, UA unremarkable. Chest X-ray showed hazy airspace opacities in both lungs without associated consolidation, perihilar densities on lateral view suspicious for early pneumonia; high lung volumes suggestive of peribronchial inflammation; widening of vascular pedicle, likely reactive lymphadenopathy or thymic activation.

ED course: He was given three albuterol nebs with mild improvement, but remained hypoxic. He was admitted to the pediatric ward for ongoing treatment and observation.

A diagnostic test was performed which revealed the diagnosis.

Click here for the diagnosis and case discussion

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Welcome to Linda Schmidt, M.D., Child and Adolescent Psychiatrist

We are pleased to announce that Linda Schmidt, M.D., has joined the staff of Providence St. Vincent Medical Center. Dr. Schmidt is board certified in child and adolescent psychiatry and has special expertise with eating disorders as well as consultation to hospitalized general pediatric patients. She will work with Jason Stone, M.D., and the team at Providence St. Vincent Eating Disorder Treatment Program, supporting the busy partial hospital/intensive outpatient program for teenagers. In addition, Dr. Schmidt will provide psychiatric consultation to the pediatric inpatient unit at Providence St. Vincent and to pediatric patients in the emergency department.

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Providence Portland Child and Adolescent Psychatric Units

Eugene Borkan, M.D.
Regional Medical Director
Child and Adolescent Behavioral Health

For 24 years, the child and adolescent inpatient psychiatric units at Providence Portland Medical Center have been serving children and adolescents in mental health crisis. The inpatient programs include the 10-bed child unit, treating kids ages 4 to 12, and the 15-bed adolescent unit, treating youth from ages 13 to 17. The child unit is the only dedicated acute psychiatric inpatient unit for children in Oregon.

Children in acute crisis are referred by pediatricians, family practitioners, nurse practitioners, emergency departments, mental health providers, schools and community agencies. We receive referrals from throughout Oregon and the Northwest.

Our staff includes four board-certified child and adolescent psychiatrists, psychiatric nurses, clinical social work case managers, family therapists and experienced mental health therapists.

The objective of care is rapid evaluation, diagnosis, stabilization and dispositional placement to a less restrictive clinical environment. The focus is child-centered, family-inclusive and evidence-based.

The length of stay averages eight days. The vast majority of kids return to their homes with a strong discharge plan, emphasizing the strengths of the patient, family and community. About 1-in-5 patients are transferred to a lesser level of care, such as residential treatment or substance abuse services. We work very closely with referring physicians and community providers.
 

Referral for acute inpatient psychiatric care can be made by contacting Access Triage,
503-574-9235 or 1-800-716-5235. I welcome calls from providers who have questions.
I can be reached at 503-215-6840

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