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Day in the Life of a Pediatrics PG3 Resident

Day in the life of a third year resident on-call…

6:00 am

Wake up, shower, and pack my overnight bag.

6:45

Leave for work.

7:00

Arrive to the PICU for sign out.  The unit holds ten patients and there are already 8 on the list so it could be a long day.

7:30

Take a look at the overnight flow sheets and examine my patients.

7:45

Head down to morning conference where today we are starting a new series on medical errors.  Have my bagel and tea and prepare myself for the day.

9:00

Back up to the PICU after conference when I get a page that there is a 10 yo asthmatic on the floor who is quickly worsening.  He came in overnight from an outside hospital and now has increased work of breathing despite continuous nebulizers and now has an oxygen requirement.  Discuss case with Steve, our attending, and bring our asthmatic over to the PICU for futher tx.

10:00

Start rounds with Steve. We have a crew of interesting patients today including a 2 mo infant with panhypopituitarism, a 4 wk old ex-premie with apnea, and a 12 yo female with head trauma from a motor vehicle accident.

11:30

Finished with rounds and now it’s time to make sure all orders are in for the day.

noon

Despite our list of patients, the PICU is calm and Steve gives a lecture on ICP which will turn out to come in handy later this evening.

12:30 pm

Lunch. Always very important to eat whenever the opportunity arises because you never know what a day in the PICU may bring!

2:00

My asthmatic is doing much better on IV steroids and an increased dose of albuterol.  I should be able to start to wean his oxygen soon.

3:00

Post-op procedure patient arrives.  A 3 mo old infant with Beckwith-Wiedeman syndrome, hypoglycemia and hyperbilirubinemia who went to the OR for a liver biopsy to look for the etiology of her increasing bilirubin.  Infant did very well in surgery, so hopefully she and I will have a quiet night together.

5:00

Our 12 yo female with head trauma who is intubated has some vital sign changes after being moved in bed, including an increasing blood pressure, decreasing pulse and respiratory changes, indicative of increasing intracranial pressure.  Steve and I go to the bedside where we hyperventilate the patient and give a dose of mannitol and her vitals begin to normalize again. Based on these new clinical changes, Steve would like to repeat her head CT tonight.

6:00

Just as we’re getting our 12 yo female settled back down, Endocrine comes by to discuss our 2 mo old with panhypopituitarism. We’ve been managing his diabetes insipidus with a vasopressin drip and they would like to try to wean his drip tonight so that we can transition him over to oral medications soon.  And while they’re here they also would like me to keep an eye on the blood sugars for our Beckwith-Wiedeman baby.  

8:00

After working with pharmacy, our new vasopressin drip arrives for our wean and now we’re in for a fun night of following sodium levels.

11:00

The PICU is quiet, so we decide to take advantage of this opportunity and take our 12 yo head trauma patient down to CT for a repeat scan.  Luckily I have a great group of nurses and staff with me so we make a relatively uneventful trip to CT and back while I stare at her vitals, hoping not to see the changes we observed earlier.

midnight

The sodium level on my panhypopituitarism baby is 139 and urine output is good. Excellent!

1:00 am Blood sugar on my infant with Beckwith-Wiedeman is a little elevated at 127, so I adjust her IV fluids and will recheck in a couple of hours.
3:00 Sodium level is starting to creep up to 144 on our panhypopituitarism baby but still within normal range and urine output still good.  While I’m up we check a repeat sugar on my Beckwith-Wiedeman, hypoglycemic infant which is 113. Great!  We’re heading in the right direction.
6:00 Brush my teeth and touch base with all the nurses before change of shift and before my fellow collegues come in to relieve me.
7:00 Fellow PICU residents arrive for sign-out.  My call day is now officially over!
7:45 Down to morning conference and intake.  Boy am I ready for breakfast!
9:30 Round with Steve and discuss overnight events.
11:00 Finish up any notes and orders and sign out to the on call resident.
11:45 Call my husband to let him know that I arrived home safely after my night on call and crawl into my bed for a much anticipated afternoon of sleep!