Ethel Maria Kueber, RN CNOR Pediatrics' Team Leader

Pediatrics’ Team members Erickson’s Specials Needs Equipment Special mentions

Team Members: Anesthesia Providers/Surgeons Nurses Surgical Tech’s Ancillary Staff

Pediatric Anesthesia Dr. Melissa McCall Dr. Travis Bond Dr. Steve Sivils Dr. Leif Lunoe Dr. Peter Lunoe Dr. Jan-Ake I. Schultz Dr. Sara Maurer Dr. Lindsey Cobb

Providers Pediatric Surgery Dr. Brent Roaten Dr. Stephen Jolley (Retiring June 2013) Dr. Shawn Safford (Locum-Full Time 6/2014)

Pediatric Urology Dr. Dave Bomalaski Dr. Robert Allen Dr. Andre Godet

Neurosurgery Dr. Estrada Bernard Dr. Marshall Tolbert Dr. Susanne Fix

ENT Dr. Mary Totten Dr. Stephen Schaffer Dr. Brent Rosane Dr. Dwight Ellerbe Dr. Jerome List Dr. Christina Magill (ENT/Plastics) Dr. James Kallman

Pediatric Dental Dr. Brant Darby Dr. Megan Swanzy-Foster Dr. Caitlin Barnes

Plastics Dr. Daniel Suver Eyes Dr. Robert Arnold

Pediatric Team Leaders Ethel Maria Kueber, RN CNOR Team Leader Steve Lopez Surgical Tech Team Leader

RN’s Matthew Reemelin, RN CNOR (scrubs) Kelsey , RN Renate’ Wasnuk-Lewis RN (scrubs) Susan Weaver, RN Vicie Zielinski, RN

Scrubs Stacie Holt, ST Edgar Johnson, ST Staff with experience in additional service lines Linda Ewers, RN Team Lead – ENT, Plastics, Eyes (scrubs) James Lenichek, RN Ron Avellaneda, Tech Team Lead – Team Lead for ENT, Plastics, Eyes

Erikson’s Stages of Development 0-2 Trust vs. Mistrust 2-4 Autonomy vs. Shame & Doubt 4-5 Initiative vs. Guilt 5-12 Industry vs. Inferiority 13-19 Identity vs. Role Confusion

0-2 Trust vs. Mistrust Infant very dependent on parents mostly mother Child’s understanding of the world comes from this relationship Warmth, regularity and affection – Trust Unsure environment and lack of basic needs being provided leads to mistrust Hint’s observe child and parents interactions

2-4 Autonomy vs. Doubt They like to explore the world around them Start to develop interest: music, animals and play Increased muscle coordination and mobility If parents foster antonomy, child will be able to handle more on their own Use these tools to gain child's trust and cooperation, use Child Life

4-5 Initiative vs. Guilt Child is learning to master basic skills (zip, tie, count and speak with ease) Likes to complete own actions (may need to allow them extra time) They may feel guilty over things (they feel guilty about having to have surgery) Give reassurance this isn’t their fault

5-12 Industry vs. Inferiority Become more responsible Like to get things right More likely to share and cooperate Eager to learn Ask them the questions in conjunction with the parents, most of these kids will be able to tell you what their having done

13-19 Identity vs. Role Confusion Concerned with appearance (these are the kids that you let keep underwear, etc.) Transition from childhood to adulthood (hint’s-confusion) The person one has come to be and the person society expects one to become

Anesthesia Provide support during induction of Anesthesia Assist with additional IV lines and epidurals Monitor noise levels during intubation and extubation (laryngospasms)

Anesthesia Intraoperative Almost all pediatric codes are due to respiratory origin (80%) Why Funneled shaped larynx-narrowest part of the pediatric airway is cricoid cartilage Larger tongues Angled Vocal Cords Take very little to extubate patient/move with caution, always ask before you move

Intra op warming devices K-thermal warming device Bair hugger French Fry Lights (know how to use) Increase Room temp Don’t let prep fluids pool

Specials Considerations Chart

What is normal

Normal

Mongolian Spots Congenital Dermal melanocytosis Benign, Flat birthmark Most often seen in Asians, South-East Asians, Polynesians, Naïve American, East Africans and Turkish Disappears around age 3-5, almost always by puberty

Mongolian Spot con’t

Mongolian Spot con’t

Port Wine Stain Superficial and deep capillaries in the skin Reddish to Purplish in color Present at birth May be part of a syndrome: Sturge-Weber/Klippel- Trenaunay-Weber Syndrome Wide range of Tx’s

Port Wine Stain’s

Port Wine Stain con’t

DELAYS AND SYNDROMES

DOWNS

DOWNS SYNDROME Also known as Trisomy 21 Cased by presence of all or part of a third copy of chromosome 21 Most common chromosome abnormality in humans Associated with delay in cognitive ability and physical growth Low IQ’s Umbilical Hernia Congenital Heart Disease Macroglossia And many more

Autism and Asperger’s

Autism Neural Development Characterized by Social Interaction and Communication Restricted and Repetitive behavior Sx apparent before age of three May have birth defects Prevalence is 1-2 per 1000 people worldwide CDC reports 20 per 1000 in the United State Sx start before age two (gradually) Causes: Strong Genetic Basis

Asperger Difficulties in social interactions Restricted and Repetitive Behaviors Clumsy Speech and Language Cause is unknown

Usual suspects

Even this is included……

Looking at our future they will be our caregivers

Equipment We need our tools

PSOA Laparoscopic Cart

PSOA OPEN CART

NICU TO GO Cart Special thanks to Laura and Dani Go Team

MISC CART (Look this Cart Over)

Pediatric Cast Cart

SUTURE CART

DR. Bomalaski’s Urology Cart

DENTAL CART’S

Special Needs/Issues Transporting Pediatric patients Sedated Patients Policy on carrying patient Thanks From the Pediatric Team