Faap

Introduction

Disorders of the head and neck, including infectious processes and anatomic abnormalities, are some of the most common encountered by pediatric hospitalists. Upper respiratory tract infections (URIs) are the most common reason for acute pediatric medical care. Children under age six years of age average six to eight URIs per year. Acute illness with an infectious process often exacerbates underlying anatomic abnormalities, such as laryngomalacia, tracheomalacia, subglottic stenosis, and others, but these abnormalities alone can require acute intervention and lead to hospitalization. Bacterial infections have the potential to invade other structures or compromise the airway, rapidly resulting in both immediate and long-term sequelae if not appropriately treated. Pediatric hospitalists frequently encounter patients with disorders of the head and neck and should be able to recognize their signs and symptoms and provide evidence-based and efficient care. In particular, pediatric hospitalists must be able to identify impending airway obstruction, provide immediate care, and arrange for the appropriate subsequent level of care.

Pediatric hospitalists should be able to:

• Compare and contrast the head and neck anatomy of children at different chronological ages, including how abnormalities of airflow in different locations may alter the clinical presentation at different ages.
• Discuss the symptoms of various anatomic abnormalities (such as laryngomalacia, tracheomalacia, subglottic stenosis, and others), including the acute infectious processes which may exacerbate their clinical presentation.
• Discuss the pathophysiology, presenting features, and common pathogens associated with bacterial infections of the head and neck (such as otitis media, otitis externa, retropharyngeal abscess, orbital cellulitis, dental infections, mastoiditis, peritonsillar abscess, and others).
• Describe the differential diagnosis of common presenting symptoms of head and neck disorders, such as shortness of breath, stridor, cough, nasal discharge, neck swelling/pain, dysphagia/drooling, facial swelling, and others.
• Describe the features of upper airway obstruction, such as stertor, stridor, tripod positioning, dysphagia, drooling, trismus, and others.
• Discuss alternate diagnoses that may mimic the presentation of acute upper respiratory infection such as allergic reaction, toxic inhalant exposure, and others.
• List the indications for hospital admission, explain the utility of various monitoring options, and review the indications for emergent and non-emergent subspecialist consultation.
• Describe the signs and symptoms of obstructive sleep apnea (OSA) including snoring, respiratory pauses, and hypoxia, and discuss appropriate evaluation, referral, and management.
• Explain the types of studies available to assess the head and neck (including plain radiographs, fluoroscopy, ultrasonography, computed tomography, magnetic resonance imaging, and direct laryngoscopy) and discuss the risks, benefits, and indications for each.
• Discuss the indications, contraindications, and mechanisms of action of pharmacological agents used to treat various disorders of the head and neck, such as antibiotics, nebulized epinephrine, glucocorticoids, proton pump inhibitors, histamine 2 blockers, and others.
• Compare and contrast the benefits and limitations of various modalities of airway stabilization and respiratory support (including heated humidified high flow nasal cannula, non-invasive positive pressure support, and intubation with mechanical ventilation) in patients with varying degrees of upper airway obstruction.
• Discuss the changes in clinical status that indicate need for escalation of care, such as worsening stridor or work of breathing, decreased air entry, cyanosis, altered mental status, and others.
• Describe the patient characteristics that indicate the need for higher level of care and/or transfer to a referral center in cases requiring pediatric-specific services not available at the local facility.
• Describe criteria, including specific measures of clinical stability, that must be met before discharging patients with head and neck disorders, including oxygenation, hydration, and patient/family education.

Pediatric hospitalists should be able to:

• Perform an appropriately focused medical history, attending to symptoms of potential airway obstruction.
• Conduct a thorough physical examination directed by signs and symptoms that may indicate the location, etiology, or severity of the disorder.
• Identify patients with comorbidities or underlying anatomic abnormalities that impact the management plan and order appropriate testing, correctly interpreting results.
• Order appropriate monitoring and correctly interpret monitor data.
• Adhere consistently to infection control practices.
• Identify complications and respond with appropriate actions.
• Perform an evidence-based, cost-effective diagnostic evaluation and treatment plan, avoiding unnecessary testing.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions and escalation of care as appropriate.
• Stabilize the airway and provide appropriate respiratory support for patients with impending or actual airway obstruction or respiratory failure, including head tilt/chin lift, nasal trumpet, and intubation, or arrange for the appropriate personnel to perform the procedure in an effective and efficient manner.
• Engage consultants (such as otolaryngologists, pulmonologists, surgeons, speech and feeding specialists, dentists, and others) efficiently and effectively when needed.

Pediatric hospitalists should be able to:

• Role model and advocate for strict adherence to infection control practices.
• Realize responsibility for effective communication with patients and the family/caregivers regarding the diagnosis, management plan, and follow-up needs.
• Recognize the value of collaboration with the primary care provider, subspecialists, nursing, the hospital staff, and other outpatient providers to ensure coordinated longitudinal care at the time of discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development, implementation, and improvement of cost-effective, safe, evidence-based care within a multidisciplinary team for hospitalized children with head and neck disorders.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers for hospitalized patients with head and neck disorders.

Introduction

Disorders of the head and neck, including infectious processes and anatomic abnormalities, are some of the most common encountered by pediatric hospitalists. Upper respiratory tract infections (URIs) are the most common reason for acute pediatric medical care. Children under age six years of age average six to eight URIs per year. Acute illness with an infectious process often exacerbates underlying anatomic abnormalities, such as laryngomalacia, tracheomalacia, subglottic stenosis, and others, but these abnormalities alone can require acute intervention and lead to hospitalization. Bacterial infections have the potential to invade other structures or compromise the airway, rapidly resulting in both immediate and long-term sequelae if not appropriately treated. Pediatric hospitalists frequently encounter patients with disorders of the head and neck and should be able to recognize their signs and symptoms and provide evidence-based and efficient care. In particular, pediatric hospitalists must be able to identify impending airway obstruction, provide immediate care, and arrange for the appropriate subsequent level of care.

Pediatric hospitalists should be able to:

• Compare and contrast the head and neck anatomy of children at different chronological ages, including how abnormalities of airflow in different locations may alter the clinical presentation at different ages.
• Discuss the symptoms of various anatomic abnormalities (such as laryngomalacia, tracheomalacia, subglottic stenosis, and others), including the acute infectious processes which may exacerbate their clinical presentation.
• Discuss the pathophysiology, presenting features, and common pathogens associated with bacterial infections of the head and neck (such as otitis media, otitis externa, retropharyngeal abscess, orbital cellulitis, dental infections, mastoiditis, peritonsillar abscess, and others).
• Describe the differential diagnosis of common presenting symptoms of head and neck disorders, such as shortness of breath, stridor, cough, nasal discharge, neck swelling/pain, dysphagia/drooling, facial swelling, and others.
• Describe the features of upper airway obstruction, such as stertor, stridor, tripod positioning, dysphagia, drooling, trismus, and others.
• Discuss alternate diagnoses that may mimic the presentation of acute upper respiratory infection such as allergic reaction, toxic inhalant exposure, and others.
• List the indications for hospital admission, explain the utility of various monitoring options, and review the indications for emergent and non-emergent subspecialist consultation.
• Describe the signs and symptoms of obstructive sleep apnea (OSA) including snoring, respiratory pauses, and hypoxia, and discuss appropriate evaluation, referral, and management.
• Explain the types of studies available to assess the head and neck (including plain radiographs, fluoroscopy, ultrasonography, computed tomography, magnetic resonance imaging, and direct laryngoscopy) and discuss the risks, benefits, and indications for each.
• Discuss the indications, contraindications, and mechanisms of action of pharmacological agents used to treat various disorders of the head and neck, such as antibiotics, nebulized epinephrine, glucocorticoids, proton pump inhibitors, histamine 2 blockers, and others.
• Compare and contrast the benefits and limitations of various modalities of airway stabilization and respiratory support (including heated humidified high flow nasal cannula, non-invasive positive pressure support, and intubation with mechanical ventilation) in patients with varying degrees of upper airway obstruction.
• Discuss the changes in clinical status that indicate need for escalation of care, such as worsening stridor or work of breathing, decreased air entry, cyanosis, altered mental status, and others.
• Describe the patient characteristics that indicate the need for higher level of care and/or transfer to a referral center in cases requiring pediatric-specific services not available at the local facility.
• Describe criteria, including specific measures of clinical stability, that must be met before discharging patients with head and neck disorders, including oxygenation, hydration, and patient/family education.

Pediatric hospitalists should be able to:

• Perform an appropriately focused medical history, attending to symptoms of potential airway obstruction.
• Conduct a thorough physical examination directed by signs and symptoms that may indicate the location, etiology, or severity of the disorder.
• Identify patients with comorbidities or underlying anatomic abnormalities that impact the management plan and order appropriate testing, correctly interpreting results.
• Order appropriate monitoring and correctly interpret monitor data.
• Adhere consistently to infection control practices.
• Identify complications and respond with appropriate actions.
• Perform an evidence-based, cost-effective diagnostic evaluation and treatment plan, avoiding unnecessary testing.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions and escalation of care as appropriate.
• Stabilize the airway and provide appropriate respiratory support for patients with impending or actual airway obstruction or respiratory failure, including head tilt/chin lift, nasal trumpet, and intubation, or arrange for the appropriate personnel to perform the procedure in an effective and efficient manner.
• Engage consultants (such as otolaryngologists, pulmonologists, surgeons, speech and feeding specialists, dentists, and others) efficiently and effectively when needed.

Pediatric hospitalists should be able to:

• Role model and advocate for strict adherence to infection control practices.
• Realize responsibility for effective communication with patients and the family/caregivers regarding the diagnosis, management plan, and follow-up needs.
• Recognize the value of collaboration with the primary care provider, subspecialists, nursing, the hospital staff, and other outpatient providers to ensure coordinated longitudinal care at the time of discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development, implementation, and improvement of cost-effective, safe, evidence-based care within a multidisciplinary team for hospitalized children with head and neck disorders.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers for hospitalized patients with head and neck disorders.

Introduction

Disorders of the head and neck, including infectious processes and anatomic abnormalities, are some of the most common encountered by pediatric hospitalists. Upper respiratory tract infections (URIs) are the most common reason for acute pediatric medical care. Children under age six years of age average six to eight URIs per year. Acute illness with an infectious process often exacerbates underlying anatomic abnormalities, such as laryngomalacia, tracheomalacia, subglottic stenosis, and others, but these abnormalities alone can require acute intervention and lead to hospitalization. Bacterial infections have the potential to invade other structures or compromise the airway, rapidly resulting in both immediate and long-term sequelae if not appropriately treated. Pediatric hospitalists frequently encounter patients with disorders of the head and neck and should be able to recognize their signs and symptoms and provide evidence-based and efficient care. In particular, pediatric hospitalists must be able to identify impending airway obstruction, provide immediate care, and arrange for the appropriate subsequent level of care.

Pediatric hospitalists should be able to:

• Compare and contrast the head and neck anatomy of children at different chronological ages, including how abnormalities of airflow in different locations may alter the clinical presentation at different ages.
• Discuss the symptoms of various anatomic abnormalities (such as laryngomalacia, tracheomalacia, subglottic stenosis, and others), including the acute infectious processes which may exacerbate their clinical presentation.
• Discuss the pathophysiology, presenting features, and common pathogens associated with bacterial infections of the head and neck (such as otitis media, otitis externa, retropharyngeal abscess, orbital cellulitis, dental infections, mastoiditis, peritonsillar abscess, and others).
• Describe the differential diagnosis of common presenting symptoms of head and neck disorders, such as shortness of breath, stridor, cough, nasal discharge, neck swelling/pain, dysphagia/drooling, facial swelling, and others.
• Describe the features of upper airway obstruction, such as stertor, stridor, tripod positioning, dysphagia, drooling, trismus, and others.
• Discuss alternate diagnoses that may mimic the presentation of acute upper respiratory infection such as allergic reaction, toxic inhalant exposure, and others.
• List the indications for hospital admission, explain the utility of various monitoring options, and review the indications for emergent and non-emergent subspecialist consultation.
• Describe the signs and symptoms of obstructive sleep apnea (OSA) including snoring, respiratory pauses, and hypoxia, and discuss appropriate evaluation, referral, and management.
• Explain the types of studies available to assess the head and neck (including plain radiographs, fluoroscopy, ultrasonography, computed tomography, magnetic resonance imaging, and direct laryngoscopy) and discuss the risks, benefits, and indications for each.
• Discuss the indications, contraindications, and mechanisms of action of pharmacological agents used to treat various disorders of the head and neck, such as antibiotics, nebulized epinephrine, glucocorticoids, proton pump inhibitors, histamine 2 blockers, and others.
• Compare and contrast the benefits and limitations of various modalities of airway stabilization and respiratory support (including heated humidified high flow nasal cannula, non-invasive positive pressure support, and intubation with mechanical ventilation) in patients with varying degrees of upper airway obstruction.
• Discuss the changes in clinical status that indicate need for escalation of care, such as worsening stridor or work of breathing, decreased air entry, cyanosis, altered mental status, and others.
• Describe the patient characteristics that indicate the need for higher level of care and/or transfer to a referral center in cases requiring pediatric-specific services not available at the local facility.
• Describe criteria, including specific measures of clinical stability, that must be met before discharging patients with head and neck disorders, including oxygenation, hydration, and patient/family education.

Pediatric hospitalists should be able to:

• Perform an appropriately focused medical history, attending to symptoms of potential airway obstruction.
• Conduct a thorough physical examination directed by signs and symptoms that may indicate the location, etiology, or severity of the disorder.
• Identify patients with comorbidities or underlying anatomic abnormalities that impact the management plan and order appropriate testing, correctly interpreting results.
• Order appropriate monitoring and correctly interpret monitor data.
• Adhere consistently to infection control practices.
• Identify complications and respond with appropriate actions.
• Perform an evidence-based, cost-effective diagnostic evaluation and treatment plan, avoiding unnecessary testing.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions and escalation of care as appropriate.
• Stabilize the airway and provide appropriate respiratory support for patients with impending or actual airway obstruction or respiratory failure, including head tilt/chin lift, nasal trumpet, and intubation, or arrange for the appropriate personnel to perform the procedure in an effective and efficient manner.
• Engage consultants (such as otolaryngologists, pulmonologists, surgeons, speech and feeding specialists, dentists, and others) efficiently and effectively when needed.

Pediatric hospitalists should be able to:

• Role model and advocate for strict adherence to infection control practices.
• Realize responsibility for effective communication with patients and the family/caregivers regarding the diagnosis, management plan, and follow-up needs.
• Recognize the value of collaboration with the primary care provider, subspecialists, nursing, the hospital staff, and other outpatient providers to ensure coordinated longitudinal care at the time of discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development, implementation, and improvement of cost-effective, safe, evidence-based care within a multidisciplinary team for hospitalized children with head and neck disorders.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers for hospitalized patients with head and neck disorders.

Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD

This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.

During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.

Some of the challenges discussed in regards to developing an educational structure in community settings included:

1. Logistics

   • Making the case for education
   • Legal framework (i.e. Affiliation agreements, Liability)
   • Finances (i.e. GME funding)
   • Paperwork burden (ex. Licensing, Credentialing)

2. Learning Environment

   • Complementing clinical work with materials
   • Autonomy/Supervision balancing
   • Developing Clinical teachers

The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.

Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.

A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.

Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.

Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD

This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.

During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.

Some of the challenges discussed in regards to developing an educational structure in community settings included:

1. Logistics

   • Making the case for education
   • Legal framework (i.e. Affiliation agreements, Liability)
   • Finances (i.e. GME funding)
   • Paperwork burden (ex. Licensing, Credentialing)

2. Learning Environment

   • Complementing clinical work with materials
   • Autonomy/Supervision balancing
   • Developing Clinical teachers

The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.

Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.

A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.

Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.

Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD

This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.

During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.

Some of the challenges discussed in regards to developing an educational structure in community settings included:

1. Logistics

   • Making the case for education
   • Legal framework (i.e. Affiliation agreements, Liability)
   • Finances (i.e. GME funding)
   • Paperwork burden (ex. Licensing, Credentialing)

2. Learning Environment

   • Complementing clinical work with materials
   • Autonomy/Supervision balancing
   • Developing Clinical teachers

The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.

Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.

A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.

Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.