Differences

This shows you the differences between two versions of the page.

--- resident:children_s [2020/06/25 10:17] – [Cleft Palate Repair Surgery] melissa
+++ resident:children_s [2026/02/20 11:28] (current) – [Children's PAs] jordan_p
@@ Line 1: / Line 1: @@
-=====Children’s Day-to-Day=====
+=====Children's Hospital =====
+Connect to TCH family network for link to work.
+Haiku Setup Link:\\
+https://haikusetup.childrenscolorado.org
-**Children's Faculty**\\
+==== Children's Faculty ====
 [[resident:brooke_french|Dr. Brooke French]]\\
 [[resident:david_khechoyan|Dr. David Khechoyan]]\\
-[[resident:leahthan_domeshek|Dr. Leahthan Domeshek]]\\
+[[resident:jason_yu|Dr. Jason Yu]]\\
+[[resident:Phuong_Nguyen|Dr. Phuong Nguyen]]\\
+[[resident:Timothy_Irwin|Dr. Timothy Irwin]]\\
+\\
+[[https://docs.google.com/spreadsheets/d/15l3skvSUPxqvK8jMCr3UDJxt15PaH9_B0FAXyPeE0Zc/edit?usp=sharing|Attending-Specific OR and Post-op Preferences]]
-Important phone numbers:\\
-Peggy Walsh: 713-320-9063\\
-Maureen Andrews: 303-929-7929\\
-Amy Circle: 970-310-7745\\
-OR charge: 64890\\
-ED: 76888\\
-One call: 73999\\
-How to see who's on call: either call One Call or go to children's webpage, click on quick links, then amcom.
+===== Children's PAs ====
+Amber Matzol: 612-229-6907\\
+Maggie Webster: 303-681-8224\\
+Lindsay Dyer-Kindy: 720-937-7964\\
+Mel Mabee: +1 (817) 917-1704\\
-Important rooms: There's a surgeons lounge on the 1st floor right when you walk in from the parking garage with food and drinks. There's a faculty respite room in the hallway leading up to the outpatient building on the 1st floor that has comfortable seats and 6 computers/phones and a printer.
+==== Schedulers =====
+Dr. Irwin: Melinda Bond\\
+Dr. French: Joanne Agenar\\
+Dr. Khechoyan: Daniela Ramirez\\
+Dr. Yu: Daniela Ramirez\\
+Amber: Joane Agenar\\
+Mel Mabee: Melinda Bond\\
+Lindsay: Daniela Ramirez\\
+Maggie: Marquise Sanford\\
+Brooke (RN): Marquise Sanford\\
+ER f/u: message "Plastics Scheduler" pool for APP follow up\\
+F/u visits > 1month: message "SIC Schedulers" then select "pool"
+==== Welcome to Children's ====
-Expectations:
+This page contains a wealth of information about University of Colorado Children's Hospital. The rotation includes high volume pediatric plastic surgery and craniofacial surgery. Please see this[[Mason_Welcome| Welcome Packet]] that includes introductory information, weekday and weekend workflow, resident responsibilities, Day Call, The List and Transition of Care and Children's Specific Conferences including Oral Boards. You are encouraged to read this prior to starting your rotation.
-OR takes precedence over clinic. However, if you are not in cases, you are expected to attend clinic. If simultaneous cases, I would cover cases in order of seniority (Dr. French's cases covered first, then Khechoyan, then Domeshek). Of course, if one of the more junior attendings is doing a really cool case, I'd talk to French about covering those instead.
-Consenting:
+This page contains other informal tips and tricks from prior residents.
-Children's is all electronic consents. In order to make a consent, you click on the pre-op consult tab in Epic and then click consents. To make a consent - you click on procedure #1 (or 2 or 3 if it's a combo case) consent (or something like that) and fill in the correct information in the boxes on the right. .momsname or .dadsname in the first box and then whatever parent (or patient) is signing for the kid. This has to be accurate and only have one parent's name, they will hold a case indefinitely if this is done incorrectly. You can add extra procedures and whatnot in those boxes on the side. And then fill in your name as the person obtaining the consent. Often the procedure and stuff will already pre-populate. If you're consulted for a spine closure or something, you'll have to type in all the stuff yourself.
-After you did all that, you can either have the parents sign on the computer, or on the patient's ipad. To log into the ipad you put in the patient's DOB (mmddyy).
-Click submit after you and the patient have signed the consent. The attending can sign the consent when they're back in the OR.
-Rounding: I ended up seeing everyone myself in the morning and writing everyone's notes. In the past, it sounds like the fellows have left the notes to Peggy and Maureen, but ever since that meeting we had a couple of months ago, it's clear that the attendings don't like that.
+**Important phone numbers**:\\
-- After rounding - I would text both the attending covering the patient and Peggy for general plastics kids or Maureen for the craniofacial cleft kids.
+Maureen Andrews: 303-929-7929\\
+OR charge: 64890\\
+OR Desk: 76492\\
+ED: 76888\\
+OneCall: 73999\\
+Yellow Team: 79247\\
+IT: 74357\\
+Phone stems: 720-777-XXXX. 720-752-XXXX. Numbers that start with 6 are all internal (usually nurse PCD). The only way to call back from outside is to call OneCall and ask them to connect you.\\
+Main OR numbers:\\
+OR 1 - 73416\\
+OR 2 - 73420\\
+OR 3 - 73421\\
+OR 4 - 73424\\
+OR 5 - 74324\\
+OR 6 - 74325\\
+OR 7 - 74326\\
+OR 8 - 74327\\
+OR 9 - 74328\\
+OR 10 - 74329\\
+OR 11 - 73762\\
+OR 12 - 73780\\
+OR 14 - 73774\\
+OR 15 - 64836\\
-Craniofacial kids:
+**On call**: either call OneCall or go to the Children's home page, click on Quick Links, then Amcom (must be at the hospital or remotely using the CHC Desktop).
-●	Maureen is an awesome resource. She ends up seeing everyone herself too, and will write her own little note. She'll also check in with people postop. I would text her whenever we finished a craniofacial or cleft case so she would know how it went. She provides teaching to all the families while in house, and is their main point of contact after they get discharged. If she's ever not there, you can get the teaching handouts for patients on discharge on the children's webpage - resources - patient hand outs.
-●	If you put in distractors, French usually likes to teach the parents pretty quickly on how to turn the distractors themselves. However, for the first day or two, you and Maureen are responsible for distractions. Typically, I'd let her do the morning distraction with the parents and I did the PM distraction.
-●	All of the craniofacial kids are neurosurgery primaries postop. They are responsible for drains and everything. The only thing we are responsible managing are distractions.
-●	Consents - these cases are always booked under the neurosurgery attendings. The neuro fellows are usually slammed in the mornings, so I would be the one doing the consents there. All the kids need a regular procedural consent as well as a transfusion consent. The plastics attendings are typically not on the consents. We've established this is okay because they're co-surgeons on the same procedure. If they were doing different procedures, plastics would need their own consent.
-Cleft cases:
+**Lounge space** (ONLY Independents have access): There's a surgeons lounge on the 2nd floor with food and drinks.
-●	Maureen helps to manage these too.
-●	They typically stay in house only one night. If you type in "plastics" in the post op order sets, there're pre-populated ordersets for each type of cleft case.
-●	For Dr. Khechoyan - if they are a syndromic kid who is getting a palate repair, they go to the PICU postop (French's kids all typically go to the floor). Khechoyan will also do a tongue stitch and sometimes a nasal trumpet sutured in that you have to remove the next morning. This is super fun.
-Orthognathic cases:
+**OR Lockers**: There is a designated PRS locker in the Men's and Women's locker rooms.\\
-●	Khechoyan has a big postop pathway, see separate document.
+^ ^ Locker # ^ Code ^
+| Men's | 68 | 00000 |
+| Woman's | 94 & 160 | |
-Clinic:
+**Expectations**:
-●	The clinics are on the second floor of the outpatient side of the hospital. Hallway B tends to be where all the general plastics patients are, there's a work room in the back hall that we share with gyn and ID. Multi-D clinics are behind these. Sometimes you're in the clinics at one end of the hallway, sometimes you're in clinics on the other end of the hallway.
+OR takes precedence over clinic. However, if you are not in cases, you are expected to attend clinic. If simultaneous cases, cover cases in order of seniority (Dr. French's cases covered first, then Khechoyan). Of course, if one of the more junior attendings is doing a really cool case, talk to French about covering those instead. Please look ahead and coordinate coverage as needed. Some cases require extra hands (ABG, breast reduction, etc).
-●	There are several multidisciplinary clinics that we attend: craniofacial, cleft, brachial plexus, vascular malformations. These are kind of weird clinics where you just stand in the background and observe. I didn't pre-see patients or write notes in these clinics. They're educational, but you don't do much. side note: Khechoyan showing up to his multi-d clinics, at least for me, has been hit or miss. If he wasn't there, I wouldn't stay.
-●	Plastics clinic- you're expected to see the patients yourself and then staff them like we usually do. We also write the notes, like we usually do.
-●	Amy Circle is the go-to person for outpatient plastics stuff. She'll also help you with wound care stuff on the floor if you ask her.
-●	Sometimes you'll get called by Amy to help with the odd clinic patient (usually for tissue expander fills, steroid injections, vac changes, etc.)
-Consults:
+**Rounding**: You will see all the necessary patients yourself and update the attendings. Maureen will also see the Cleft/Craniofacial patients, but this should not replace your rounding.
-●	We are now first call for all consults (face, gen plastics, wound). If you're slammed, Peggy is happy to help with these too. I've asked her to take care of wound care consults in the past, since she's the one who does the outpatient wound care anyway.
-●	Wound care consults: you'll sometimes get weird consults from wound care to establish care prior to a patient's discharge. Typically I just go see them then say continue whatever wound care recs the inpatient wound team has recommended and then set them up to see Amy and Peggy as an outpatient. It's totally reasonable to have Peggy see these too, since she'll be the one seeing them as an outpatient.
-Admitting complex patients to medicine:
+**Supplies**:
-This is a new thing for me. If there's a complex medical patient coming in (read: Maxwell Harmon) or if you want to have a patient stay overnight from the ED (I've done this for lip hematomas and stuff that we may or may not operate on), you can have medicine admit them. They usually don't put up much of a fight. You call the One Call people and then select admissions/transfers and they'll connect you to the admitting attending and senior resident to discuss the admission.
+  * The code for the supply rooms on the floor is 13579#. These are not super well stocked and may not have what you're looking for.
+  * Most dressings can be found in the burn procedure room in 6 South (the middle unit on 6, rms 625-649). Door code: 13579#. Cabinet code: 3167.
+  * The code for the clinic cart that lives in Hallway B is 1225. Plastics-specific supplies are in the cabinets above the desks in the work room. There is a big supply room with lots of different dressing stuff in the blue side of the MDC.
+  * Wound vac sponges are in OR pod 2 ~between OR 14 and 10. The cast/splint cart lives in the far hallway outside of OR 14/15. The burn cart lives across from the dictation room.
-=====Bone Graft Splint and Hygiene Instructions=====
+====Consenting====
+Children's is all electronic consents. In order to make a consent, you click on the Pre-op Consult tab in Epic and then click Consents. To make a consent - you click on New Surgical Informed Consent (or Panel 2 or Panel 3 if it's a combo case) and fill in the correct information in the boxes on the right. .MOMSNAME or .DADSNAME in the first box and then whatever parent (or patient) is signing for the kid. This MUST be accurate and only have one parent's name spelled correctly. They will hold the case if this is done incorrectly. You can add extra procedures and whatnot in Additional Procedure Information. Fill in your name as Provider Performing Consent. Often the procedure etc will already pre-populate. If you're consulted for a spine closure, etc, you'll have to type in all the stuff yourself. \\
+-After the form is filled out, the parent can sign on the computer's signature pad or on the patient's iPad. To log into the iPad you put in the patient's DOB (MMDDYY). The consent must be closed (close the patient's chart) to access the consent on the iPad.
+Click submit after you and the patient have signed the consent. The attending can sign the consent when they're back in the OR. \\
+__Caveats__: \\
+-If the patient is over 18 and otherwise legally able to consent for themselves, THEY must sign the consent and not a parent. Parent should sign if they are the legal guardian of an otherwise >18 year old patient (delayed, etc).\\
+-Transfusion consents are separate than the surgical sent. There is another box to click for the transfusion consent (fill out as above).
-  * **1 week before surgery:**
-  - Peridex rinses 4x per day
-  - Wear splint as much as possible. Practice eating with it so it is comfortable after surgery
-  * **First five days after surgery:**
+====Craniofacial patients====
-  - Continue Peridex rinses 4x per day
+  * Maureen is an awesome resource. She will seeing everyone herself too, and will write her own note. She'll also check in with people postop. Text her and the attending after any craniofacial or cleft case so she knows how it went. She provides teaching to all the families while in house, and is their main point of contact after they get discharged. If she's ever not there, you can get the teaching handouts for patients on discharge on the Children's home page - Resources - Patient Handouts.
-  - Do not remove splint for the first five days after surgery. No exceptions.
+  * If you put in cranial distractors, Dr. French usually likes to teach the parents pretty quickly on how to turn the distractors themselves. However, for the first day or two, you and Maureen are responsible for distractions. Coordinate with her on who will do the AM versus PM turns.
-  - Lower teeth may be brushed normally
+  * All of the craniofacial patients are neurosurgery primaries post-op. They are responsible for drains and everything. The only thing we are responsible managing are distractions.
+  * Consents - these cases are always booked under the neurosurgery attendings. The fellows are usually slammed in the mornings, so you are responsible for the consents. All the kids need a regular procedural consent as well as a transfusion consent. The plastics attendings are typically not on the consents-- Include under Additional Procedure Information: "Co-surgeon: Dr. Brooke French, MD" as appropriate.
+  * Postop wound care: Do not apply Vaseline or any other ointment after the 48 hours of antibiotic ointment. Start hair washing/incision site washing. If at the incision site check, there is a lot of crusting, we may have parents apply ointment 30-60 minutes before washing the site but that will be case by case.
-  *** After 5 days post-op:**
-  - Continue Peridex rinses 4x per day
-  - Continue full time splint wear, including during meals
-  - Splint may be removed for oral hygiene:
-  * Continue brushing lower teeth normally
-  * Upper back teeth may be brushed normally with caution around stitches
-  * Clean teeth near surgical site carefully with gauze or a wet cotton swab
-=====Alveolar Bone Graft Surgery=====
-Before the Surgery:
+====Cleft cases====
-  * Your child’s surgeon will talk to you about the best surgery for the bone graft.
+  * Maureen helps to manage these patients pre- and post-operatively as well. \\
-  * Please don’t give your child any ibuprofen products (Motrin®, Advil®) for 10-14 days before the surgery.
+  * There are multiple applicable ordersets (Plastics IP Alveolar Bone Graft Admission; Plastics IP Cleft Lip Repair Admission; Plastics Cleft Palate Admission)\\
-  * 2-3 weeks before the surgery, we’ll schedule you with the craniofacial orthodontist for any presurgical x-rays that your child needs and to take an impression to make a bone graft splint for your child to wear after surgery. If you don’t have an appointment, please call 720-777- 3749. We will also schedule a Maxillary CBCT scan to assess alveolar bone graft take.
+  * These cases are admitted to the hospitalist service Pink Team post-operatively. Since they are non-surgical and rotate every week, they need a lot of hand-holding. Call them after the OR to sign out the patient to them (number above). Be VERY explicit about all instructions, nursing care, diet, pain meds, antibiotics, etc. \\
-  * The orthodontist office will call to schedule this visit. Should you not hear from their office, please call 720-777-3749 to schedule your appointment.
+  * For Dr. Khechoyan - all primary palate repairs go to PICU postop for airway monitoring (French's patients typically go to the floor). Khechoyan will also do a tongue stitch and sometimes a nasal trumpet sutured in that you have to remove the next morning. Sometimes Mo is able to remove these when she does her rounds. Coordinate with her as needed.\\
-  * One week before the surgery we’ll schedule your child to see the craniofacial orthodontist to have the bone graft splint fitted to their mouth. Please have you child wear the splint as much as possible and practice eating with the splint so it is comfortable after surgery.
+  * Cleft Marking videos: \\
-  * One week before the surgery we’ll prescribe a medicated mouth rinse called Chlorhexidine (Peridex) for your child. They should begin oral rinses at that time. Rinse with 10 ml (two teaspoons full) after all meals and at bedtime.
-  * A Surgery Scheduler will call you a few days before surgery to let you know when your child can no longer have anything to eat or drink, what time to arrive, and the scheduled time of surgery.
-  * If your child is sick anytime during the week before surgery, please call the nurses in the Cleft Lip and Palate Program, to make sure the surgery doesn’t need to be rescheduled. The nurses are available Monday through Friday for any concerns/questions you might have before the surgery.
-After the Surgery:
-  * Your child will be watched closely in the Post Anesthesia Recovery Unit (PACU) for 1-2 hours after surgery. As soon as your child is awake, the PACU nurse will call you to join them.
-  * Your child will usually stay in the hospital for 1-2 nights. Parents/guardians can stay in the room with their child.
-  * Each room is a private room with its own bathroom. Parents/guardians should remember to bring their own clothes to sleep in as well as toiletries.
-  * We recommend that you find childcare for siblings while your child is in the hospital.
-Types of Bone Graft Procedures:
+Cleft and Craniofacial patients:
-  * Bone Morphogenic Protein (BMP): If BMP was used to fill the cleft, the upper lip and cheek can be very swollen for the first 2-3 days after the surgery. The swelling can last up to a week after surgery. This is normal. Keeping your child’s head raised and putting an ice pack on the face may help with the swelling.
+Once done in the OR, text Mo any updates
-  * Iliac Crest Donor Site: If bone from the hip was used to fill cleft, the upper lip and cheek can be very swollen for the first 2-3 days after surgery. The swelling can last up to a week after surgery. This is normal. Keeping your child’s head raised and putting an ice pack on the face may help with the swelling.
+Mo rounds and manages these patients along with you, so please keep her in the loop on all things pertaining to these patients. For craniofacial kids, Plastics is "primary" (ie manages the drain, dressings, etc - Pink is still the real primary team) and Neurosurg is secondary.
-  - For the first 2 days after surgery, your child should only have a sponge bath to keep the donor site (hip) dressing clean and dry. After the first 2 days, the dressing on the hip can be taken off. Please leave the Steri-strips on and let them to fall off on their own.
+====Orthognathic cases====
-  - It’s normal to have a bruise at the donor site. It should go away in 10 to 14 days. Your child may use an icepack to help with pain if needed.
+Khechoyan has a big postop pathway, see separate document.
-Mouth Care:
+====Clinic====
-  - Don’t let your child drink through a straw.
+  * The clinics are on the second floor of the outpatient side of the hospital. PRS patients are usually in Hallway B. The work room is all the way in the back near hallway G.
-  - Continue using the Peridex mouth rinses as prescribed, rinsing 4 times a day.
+  *   * There are several Multidisciplinary clinics that we attend: Craniofacial, cleft, brachial plexus, vascular malformations. You are mostly observing and writing notes (for some MDC clinics, Dr. Khechoyan will do his own notes).
-  - Do not remove the mouth splint for the first 5 days after surgery—NO EXCEPTIONS.
+  * Plastic Surgery clinic: You are expected to see the patients yourself and then staff as usual. Notes are your responsibility.
-  - Your child can brush their lower teeth as usual. Don’t brush the upper teeth.
+  * Brooke Jacobson is the go-to person for outpatient Plastics stuff. She'll also help you with wound care stuff on the floor if you ask her.
-  - After 5 days from surgery:
+  * Sometimes you will be called by Brooke to help with the odd clinic patient (usually for tissue expander fills, steroid injections, vac changes, etc.).
-  * Continue with Peridex mouth rinses 4 times a day. The mouth rinses will continue for 4 weeks after the surgery.
-  * Continue full time splint wear, including during meals.
-  * Only remove splint for oral hygiene (performed or supervised by parents, when possible).
-  * Continue brushing lower teeth normally.
-  * e. Clean teeth near the surgical site carefully with gauze or a wet cotton swab. Rinse with water after cleaning.
-  * Brush splint with a toothbrush and warm water to remove food and plaque before putting it back in the mouth.
-Feeding after Alveolar Bone Graft Surgery: Your child will have an IV (tube in a vein) to give them fluids and medicines, while they are in the hospital.
+====Consults====
+  * You are first call for all consults (Face on even days, gen plastics, wound).
+  * NEW cleft lip/palate consults: Sometimes if the baby has a prenatal diagnosis, they have seen Mo to get information and to be plugged into the MDC system. I would let Mo know the baby has been born. The consult should go to the attending on call (or whoever is next) between French, Khechoyan, and Nguyen. The primary team should consult OT for feeding. Mo can coordinate NAM/lip taping/follow-up with Dr. Lowe as needed.
+  * If Khechoyan is on call, staff EVERYTHING with him in real time, even if it is very simple or in the middle of the night.
-  *  1-3 days after surgery, your child should go back to drinking the same amount of liquids as they were drinking before the surgery.
+**ED Laceration Repairs**
-  * For _____ weeks, your child will be on a pourable liquid or blenderized diet. A pourable liquid diet includes anything you can put in a blender and add enough liquid to make it a pourable consistency. We suggest you add liquids that are high in calories such as cream, whole milk, regular chicken/beef stock.
+  * Ask the ED to obtain supplies/local/baci ointment for you. Baci is not freely available in supply rooms and has to be ordered. The ED has a poor selection of sutures. Go to OR Pod 1 (between ORs 4 and 8) to select sutures as well as instruments. There are a few sets specifically set aside for ED lac repairs (they will be labeled as such. This is also where you can find individual peel packed instruments if you don't want the whole set.
-  * After _____ weeks, your child can start eating a soft diet. A soft diet includes foods that aren’t crunchy, hard or sharp and can be eaten with little biting or chewing. Examples are baby food, soft, over-cooked pasta, scrambled eggs, soft cooked veggies, and ground or finely chopped meats. Avoid spicy foods, foods with seeds, crunch or hard foods, chewy or sticky foods such as caramel, taffy or gum.
+  * For ED facial lacerations, be mindful of absorbable versus non-absorbable sutures based on patient age and location of laceration. Discuss with attending if you are unsure.
-Safety: It’s very important to protect the gum line/incisions while they are healing. The stitches will dissolve on their own. It will take about six weeks for the surgical site to heal completely. Your child needs to take care not to injure the surgical area. Your child should only do quiet activity for at least 3-4 weeks. No contact sports for 4-6 weeks.
+**Coordination of Follow-up visits:**
+  * Most ED follow-ups are seen by the PAs. To schedule, send an EPIC Staff Message to Marquise and Joanne (and CC the APPs). Include any relevant scheduling needs (ie, ‘s/p xxx procedure w/xxx MD, needs clinic follow up in 7-10 days’). If Dr. Khechoyan is on call, please clarify when staffing with him whether he wants them scheduled with a PA or with him.
+  * If a patient will require sedation in the Procedure Center for suture removal, this can be scheduled without needing to come to clinic first. Nowadays, the the APPs prefer to schedule this themselves. Communicate this scheduling need to the APPs in your EPIC Staff Message (see above). If a patient does not require sedation for suture removal, can schedule as a regular clinic visit.
+  * Please include the appropriate [[children_s#Schedulers]] if you need to arrange follow-up with a specific attending.
-//Author: Cleft Lip and Palate| Approved by Patient Education Committee | Valid through 2021 The information presented is intended for educational purposes only. It is not intended to take the place of your personal doctor’s advice and is not intended to diagnose, treat, cure or prevent any disease. The information should not be used in place of a visit, call or consultation or advice of your doctor or other health care provider.
+=====Admitting Patients=====
-Children’s Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. • ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-720-777-1234• CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-720-777-1234.//
+  * Most plastics "primary" patients, including combo craniosynostosis cases with NSGY, are admitted to the Pink team. For elective cases, you can check if Pink is aware of them by going to Status Board > Team: Pink Med/Surg. To reach out to the Pink provider/attending, go to On-Call Finder > Medical Pink.
+  * Isolated facial traumas that need to be admitted (ie facial fracture we'll operate on tomorrow, etc) are admitted to Pediatric Surgery.
+  * If the patient needs to be admitted to the PICU and you don't know which team is taking them, reach out to PICU White (see On-Call Finder).
+  * PICU patients will downgrade to either Pink (most patients) or Pediatric Surgery (trauma patients).
+  * If there's a complex medical patient coming in or if you want to have a patient stay overnight from the ED (ie lip hematomas etc that we may or may not operate on), they will be admitted to Pink or Pediatric Surgery depending on the context.
-Medicines after Surgery: Your child will usually go home on acetaminophen (Tylenol®) as well as a narcotic pain medicine like oxycodone. Depending on your child’s surgeon, your child may be able to use ibuprofen (Motrin®, Advil®). If your child is prescribed ibuprofen, you may be able to give your child both acetaminophen and ibuprofen, alternating the doses. Your child will also go home with Peridex to be used for 4 weeks after surgery and possibly an oral antibiotic for 1-2 weeks after surgery.
+=====Prescriptions=====
+   * __Liquid oxycodone is the one med that impacts our kids as it is hard to find outside of CHCO.  Attaching the work around in case you think this is work sharing with the rest of the team.  If not—feel free to discard and no reply back to me is needed.  Happy Friday!  M
-Call with Any Questions/Concerns, or if your child:
+*From CHCO Pharmacy team:
-  * Has an injury to either surgical site-mouth or hip.
-  * Has redness, swelling or drainage or a foul odor from the mouth.
-  * Is bleeding a lot from the nose or mouth.
-  * Has a fever above 101.5°F for more than 24 hours that Tylenol or ibuprofen (don’t take the temperature by mouth) can’t bring down.
-  * Shows signs of being dehydrated: low urine output, lethargy, decrease in your child’s activity level, a child who is hard to wake up, can't make tears, or a dry mouth.
-  * Shows signs of a reaction to the medicines: throwing up, diarrhea or a rash.
-For Any Concerns/Questions, Please Call:
+*15310 E Colfax Ave (M-F 9a.m. - 9p.m., Sat. 9a.m. - 6p.m., Sun. 10a.m. - 6p.m.)
-  * The Cleft Nurse at 720-777-5364 Monday through Friday 8-4:30pm.
+*Yes – 380 mL oxycodone liquid in stock (don’t typically use that much and could get quickly if ordered for the weekend)
-  * Your surgeon’s office.
+*10501 E Colfax Ave (M-F 9a.m. - 9p.m., Sat. 9a.m. - 6p.m., Sun. 10a.m. - 6p.m.)
-  * To reach the ENT office after hours, please call 720-777-8501.
+*No – NO oxycodone liquid in stock
-  * To reach the plastic surgery office after hours please call 720-777-1234 and ask to speak with the plastic surgeon on call.
+*10601 E Alameda Ave (M-Sat. 9a.m. - 6p.m.)
+*Yes – 257 mL oxycodone liquid (wouldn’t be able to get any in stock until Tuesday)
+*12051 E Mississippi Ave (M-F 9a.m. - 9p.m., Sat. 9a.m. - 6p.m., Sun. 10a.m. - 6p.m.)
+*Yes – 63 mL oxycodone liquid in stock
-Follow-Up after Surgery:
+*The last alternative is to use the Afterhours dispense of critical medications policy.  In this policy, critical medications can be dispensed for discharge by the inpatient pharmacy.  However, some rules apply:
-Your child needs to be seen for a follow-up appointment 1-2 weeks after surgery with your surgeon or Advance Practice Provider for a quick post-operative check. They will also need to be scheduled for a follow up 4-6 weeks after surgery with your surgeon. Your child needs to be seen by the Craniofacial Orthodontist in 2-4 weeks after surgery. Please call the orthodontist office at 720-777-3749 to schedule the follow up. To schedule a post-op appointment in 4-6 weeks with your child’s surgeon please call: \\
+*Only use if absolutely necessary on critical meds that can’t be obtained at another pharmacy
-  * Plastics Office 720-777-6409 options #1
+*All meds have to have a specific dispense quantity as noted below
-  * ENT Office 720-777-8501
+*For non-narcotics like decadron, can dispense up to 72 hour supply
+*For Schedule IV drugs like Valium, can only be up to 24 hours
-For all other questions, please call the Cleft Clinic at 720-777-2572.
+*Schedule II drugs like oxycodone CANNOT be dispensed this way at all
-=====Cleft Palate Repair Surgery=====
-Before the Surgery:
-  * Your child's surgeon will talk with about you the best surgical approach for the repair. Depending on your surgeon's preference, your child may be scheduled for a pre-operative visit.
+*For 24 hour options:
-  * You should shift your child from the bottle and to a Sippy cup before the Cleft Palate Repair.  Cups should be free flowing with no valves, and should have little to no spout.
-Good cups to use are:
+*19028 Lincoln Ave Parker, 80134
+*4001 E. 120th Ave Thornton, 80233
-  * Avent Natural Drinking Cup
+=====Patient Handouts=====
-  * Gerber Hard Spout
+The language in these is geared toward parents, but includes lots of good information about care. These are helpful to refer to when parents call in about what they're supposed to do.\\
-  * Playtex Coolstin
+  * Cleft Lip Surgery: {{ :resident:cleft_cleftlipsurgery_eng.pdf |}}\\
+  * Lip taping before unilateral cleft lip repair: {{ :resident:cleft_liptapingbeforeunilateraloronesidedcleftliprepair_eng.pdf |}}\\
+  * Lip taping before bilateral cleft lip repair: {{ :resident:cleft_bilateralcleftlipandpalateliptaping_eng.pdf |}}\\
+  * Feeding a baby with cleft lip/palate: {{ :resident:cleft_feeding_your_baby_with_a_cleft_lip_or_palate_eng.pdf |}}\\
+  * Cleft palate handout: {{ :resident:cleft_palate_handout.pdf |}}\\
+  * Cleft lip and nose revision: {{ :resident:cleft_cleftlipnoserevoldchild_eng.pdf |}}\\
+  * Mouth care instructions for ABG: {{ :resident:cleft_mouthcareinstructionsforalveolarbonegraftsurgery_eng.pdf |}}
-  - The nurses will offer ideas as to the best cups to try. Please bring the cup with you to the hospital the day of surgery.
+=====International Vietnam Rotation=====
-  - Please don't give your child any ibuprofen products (such as Motrin®, Advil®) for one week before surgery
+**-Prior resident tips**:\\
-  - A Surgery Scheduler will call you a few days before surgery to tell you when your child has to stop eating and drinking. They will also tell you what time to come to the hospital pre-op area and the time of surgery.
+   *Don't bring scrubs unless you're very large\\
-  - If your child is sick anytime in the week before surgery, call the nurses in the Cleft Lip and Palate Program, to make sure the surgery doesn't need to be rescheduled. The nurses are available Monday through Friday for any concerns/ questions you might have before the surgery.
+   *IF you want good gloves in OR, latex free, or double glove, or are above size 7, bring from USA\\
+   *Bring few disposable gowns if you're large for county hospital as they run very small in Vietnam\\
+   *Bring lots of suture (prolene, monocryl, nylon, vicryl on small needles for clefts)\\
+   *Bring Adson's, unavailable here\\
+   *Bring head lamp with chargers - Ronan may donate?\\
+   *Ho Chi Minh hospital less equiped than Hanoi, so bring everything (only have vicryl and nylon)\\
+   *Shoes optional - would only bring if you have big feet\\
+   *Other supplies to consider: surgical pens (sterile don't exist), eye protection (not a thing here), Bacitracin, clipifiers, mccabe, avagard, scrub brushes, wex spears, greenies, photo of a micro set up, skin staplers, non-sterile latex free gloves, doppler)
+   *Hair conditioner was not available in either hotel
+\\
+-**Application**: Do early October/November \\
+-Initial GME application: \\
+- https://studyabroad.ucdenver.edu/index.cfm?FuseAction=Programs.ViewProgram&Program_ID=36142\\
+- Will need Nguyen CV\\
+- Need valid passport that doesn't expire within 6 months of trip\\
+- Appeal: Considered high medical risk, so may require appeal process
+https://studyabroad.ucdenver.edu/_portal/tds-program-brochure?programid=75200 \\
+- SOS App: information/assistance for emergencies while in Vietnam. Download this during application period. //
+https://www.internationalsos.com/subscriber/assistance-app \\
+CU Membership Number: 11BCAS000006 \\
+\\
+**- Host institution**: \\
+ Vietnam National Children's Hospital Plastic & Reconstructive Surgery\\
+lane 879 La Thanh Street Lang Thuong, Dong Da Hanoi, Vietnam\\
+\\
+**Host organization or third-party provider**: Nouy Reconstructive National: an NPO, https://www.nuoy.org/\\
+**Name of primary contact with host organization and/or third-party provider:** Phuong Nguyen, MD \\
+**-Rotation goals & Academic Objectives**: copy & paste this into application\\
+The chief resident is expected to be able to perform straight forward cleft lip and palate surgery with minimal assistance from the attendings and to instruct more junior residents in pediatric plastic surgery cases. Case logs will be reviewed to ensure that sufficient experience is obtained in all categories by the conclusion of the rotation.\\
-After the Surgery:
+Medical Knowledge Congenital, Aesthetic and Functional Problems of the Skin Goal: The resident will demonstrate knowledge of the common congenital disorders and disease processes of the skin, as well as the pathophysiology of aging. Objectives: • Explain the basic physiology of the aging process of the skin. • Describe the basic physiologic processes of sun exposure and its effect on the skin. • Discern the role of lasers in the management of various skin conditions. • Describe common inflammatory disorders of the skin such as cellulitis, lymphangitis, hidradenitis suppurativa, necrotizing fasciitis, and its medical and surgical treatment. • Discuss common generalized dermatologic diseases such as: scleroderma, dermatomyositis, lupus erythematosis. • Discuss the common congenital disorders of the skin, such as: xeroderma pigmentosa, Ehlers Danlos syndrome, basal cell nevus syndrome, etc. • Recite the basic principles of medical management and surgical treatment of common congenital disorders of the skin. • Explain the surgical aspects of treatment of patients with skin disorders such as scleroderma and lupus erythematosis.\\
-  * Your child will be watched closely in the Post Anesthesia Recovery Unit (PACU) for 1-2 hours after surgery. As soon as your child is awake, the PACU nurse will call you to join them.
+Medicolegal and Psychiatric Aspects of Plastic Surgery Goal: The resident will demonstrate a clear understanding of medicolegal and psychiatric aspects of plastic surgery practice, regularly obtain informed consent from patients, and perform a basic psychological evaluation when appropriate. Objectives: • Discuss the medical and legal perspectives of the contractual agreement between a physician and his/her patient. • Discern the concepts of informed consent and implied guarantee. • Discuss the role of the medical record as a legal document. • Discern the impact physical deformity can have on patients and their families. • Discuss techniques to explore the motivations of patients seeking cosmetic surgery, and how to distinguish acceptable, unacceptable, and pathological motivations. • Recite the legal and ethical ways to sever the physician/patient relationship. • Discuss the various types of malpractice insurance. • Discuss the basic principles of risk management. • List the psychiatric and psychological treatment optionsfor patients with physical deformities and their families. • Discuss the strategies to effectively treat the dissatisfied patient/family.\\
-  * Your child will usually stay in the hospital for 1-2 nights. Parents/guardians are allowed to stay in the room with the child.
-  * You should make sure you have childcare for siblings while your child is in the hospital.
-Feeding After Cleft Palate Surgery:
-  * Your child will have an IV (tube in a vein) to give them fluids and medicines while they are recovering in the hospital.
-  * Along with drinking out of a cup, your child's surgeon may suggest a special TenderCare® feeder or a syringe with a Brecht® tubing for feeding. These feeding devices will lower the chance of injury to the surgical site.
-  * Sometimes the surgeon will let infants go back to drinking from the bottle they were using before the surgery.
-  * Within 1-3 days, your child should go back to drinking the same amount of liquids as they were drinking before the surgery.
-  * For 2-3 weeks, your child will be on a pourable liquid or blenderized diet.
-  - A pourable liquid diet includes anything you can put in a blender and add enough liquid to make it a pourable consistency.
-  - We suggest you add liquids that are higher in calories such as cream, whole milk, regular chicken/beef stock.
-  * After a weeks, your child may start eating a soft diet.
-  - A soft diet includes foods that are not crunchy, hard or sharp and can be eaten with little biting or chewing.
-  - Examples are: baby food, soft, over-cooked pasta, scrambled eggs, soft cooked veggies, and ground or finely chopped meats.
-  * Only an adult should feed your child.
-Positioning While Feeding: Hold your baby in an upright position and feed slowly to prevent choking. Burp often, holding the baby in a sitting position on your lap rather than over your shoulder. To prevent dehydration, the target volume (amount) of liquids your baby should be taking daily is about 28 ounces a day. This is 3-4 8-ounce bottles.
-Safety: It is very important to protect the surgical site while it is healing. The stitches will dissolve on their own. Complete healing of the palate will take about 6 weeks.
-When in bed, put your baby on their back or side. Your baby should NOT be placed on their tummy with their face down towards the mattress.
-Children must wear elbow restraints at all times for 2-3 weeks following surgery. These are Velcro restraints that fit over the arm and keep your child from putting their hands to their mouth. Restraints should be taken off at least every four hours while your child is awake to exercise the joints and to check the skin.
-You can take the restraints off when you are holding your child or supervising them and able to keep them from putting their hands or other objects in their mouths.
+Patient Care Goal: The resident will provide patient care that is compassionate, appropriate, and effective for the treatment of pediatric plastic surgery patients. Objectives: • Obtain cephalometric measurements and analyze cephalometric data in the presurgical planning. • Perform a comprehensive head and neck exam followed by facial form analysis. • Utilize radiographic and special diagnostic studies to evaluate head and neck anomalies. • Formulate a definitive short- and long-term treatment plan for common congenital disorders, choosing the most appropriate surgical or nonsurgical modality. • Draw the reconstruction of a cleft lip and palate. • Diagnose and develop a treatment plan for velopharyngeal incompetence. • Coordinate nonsurgical treatment of congenital head and neck disorders. • Participate in the Cleft-Craniofacial Team’s multidisciplinary evaluation and treatment planning for congenital disorders of the head and neck. • Provide perioperative care and participate in surgical treatment of patients with craniofacial anomalies. • Perform systemic therapy and local injection of steroids for treatment of facial hemangiomas. • Perform laser treatment for vascular malformations. • Participate in the reconstruction of congenital deformities of the lower extremity • Participate in surgery on patients with congenital skin disorders.\\
-  * Only take one splint off at a time so you can supervise and keep your child from putting their hands in their mouth.
-  * Check the skin under the restraints for red areas. If red areas develop, massage the spot gently.
-  * The restraints can be worn over a long-sleeve shirt to keep them from irritating and make it harder for your child to take them off.
-  * Move your child's unrestrained arm fully; bending the elbow and wrist joints several times to keep the joints from getting stiff.
-  * Restraints are to be worn all night and at nap time.
-Special care should be taken to avoid injury to the palate. Don't put anything in the mouth beyond the teeth. Do not let siblings or friends feed your child or take off the elbow restraints. Comfort your child when they cry by holding your child, singing to your child, and giving pain medicine as ordered.
+Practice Based Learning and Improvement Goal: The resident will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and improved patient care practices. Objectives: • Use information technology to prepare forsurgical cases, bringing to theOR the knowledge of current modalities of care for patients and the scientific evidence for that care. • Routinely analyzes the effectiveness of own practices in caring for patients. • Improve own practices in the care of patients by integrating appropriately gathered data and feedback. • Educate medical students and other healthcare professional in the practices of surgical patients. • Function independently with graduated advancement and appropriate faculty supervision in the evaluation and treatment of patients. Interpersonal and Communication Skills Goal: The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates. Objectives: • Educate patients and families in pre- and post-operative care of pediatric and cleft patients. • Demonstrate compassion for patients and families with congenital and acquired anomalies. • Provide adequate counseling and informed consent to patients. • Listen to patients and their families. • Assimilate data and information provided by the craniofacial team and other members of the health care team, in the care of patients with congenital head and neck anomalies. • Foster the doctor-patient relationship with pediatric patients. • Effectively obtain truly informed consent from patients.\\
-Supervise all play activities, especially when there are other children involved.
+System Based Practice Goal: The resident will demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Objectives: • Function within the organization of specialty clinics (Cleft Palate Center, Craniofacial Clinic) including the coordination of all special services in the evaluation of children with these anomalies. • Be able to coordinate the nonsurgical treatment of patients with congenital anomalies among contributing specialties (prosthetics, orthodontics, speech therapy). • Advocate for congenital craniofacial patients within the health care and insurance system. • Understand the benefits and functionality of multidisciplinary craniofacial teams. • Refer craniofacial patients to the appropriate practitioners and agencies. • Appreciate the functioning of the multispecialty fetal diagnosis and treatment committees and the potential role prenatal diagnosis plays in the family unit. • Facilitate the timely discharge of patients. • Partner with pediatricians in the combined care of infants undergoing systemic steroid therapy for head and neck hemangiomas. • Demonstrate knowledge of cost-effective surgical care. • Advocate for patients within the health care and insurance system.\\
-Mouth Care:
+Professionalism Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Objectives: • Develop a sensitivity of the unique stress placed on families under care for surgery. • Exhibit an unselfish regard for the welfare of patients. • Demonstrate firm adherence to a code of moral and ethical values. • Be respectful to patients and their families especially in times of trauma and stress to the family unit. • Respect and appropriately integrate other members of the healthcare team. • Provide appropriately prompt consultations when requested. • Demonstrate sensitivity to the individual patient’s profession, life goals, and cultural background as they apply to their surgical diagnosis. • Be reliable, punctual, and accountable for own actions in the OR and clinic. • Understand the physician/patient relationship. • Understand the benefits and functionality of multidisciplinary health care teams. • Refer patients to the appropriate practitioners and agencies. • Facilitate the timely discharge of patients.\\
-  * Give your child water after they eat to rinse the palate
+\\
-  * Use a moist washcloth on your finger and rub along your babies outer gum line both on the upper and lower gum. Don't put your finger past your baby's teeth/gums.
+**-Pre-travel request via concur**: come up with budget for flights/hotels\\
-  * You may also use the pink mouth swabs to clean the outer gum line of the mouth only. Don't put the swab past your baby's teeth/gums.
+Hanoi Hotel: Hong Ngoc Hotel - it’s owned by our partners so we get a pretty hefty discount.  https://hongngochotels.com/cochinchine\\
+Ho Chi Minh: \\
+-Make sure you include budget for roundtrip USA to Vietnam trips as well as flights between cities if rotating at both
+\\
+\\
+\\
-Medicines after Surgery:
-Your child will usually go home on acetaminophen (Tylenol®) as well as a narcotic pain medicine such as oxycodone. Depending on your child's surgeon, you may be able to use ibuprofen (Motrin®, Advil®). If antibiotics are ordered after surgery, please be sure to follow the directions carefully. If ear tubes were placed, give eardrops as ordered.
-Call With Any Questions/Concerns, or If Your Child:
-  * Has an injury to the surgical site.
-  * Has redness, swelling or drainage that is increasing.
-  * Has a large amount of bleeding from the nose or mouth.
-  * Has a fever above 101.5°F for more than 24 hours that doesn't go down after taking Tylenol or ibuprofen (do not take the temperature by mouth)
-  * Has signs of dehydration: infants/babies less than 3-4 wet diapers in 24 hours, big decrease in the child's activity level, or a child who is difficult to wake up, not making tears, or has a very dry mouth.
-  * Has a foul odor from mouth.
-  * If your child has ear drainage lasting longer than 5 days please call ENT
-For Any Concerns or Questions Please Call:
+=====Oral Boards=====
+As part of your rotation at children's, occasionally attendings will hostoral boards. Dr. Khechoyan tries to make these as straight forwarded as he can. The cases come from the book [[http://libgen.li/search.php?req=9781604068207&lg_topic=libgen&open=0&view=simple&res=25&phrase=1&column=def|Plastic Surgery Case Review: Oral Board Study Guide]]. He gives you 5 cases: Unilateral cleft lip (French), bilateral cleft lip (Mason), cleft palate (Khechoyan), facial paralysis (Domeshek), and syndacytly (Domeshek).\\
+\\
+Unilateral Cleft Lip (French):
+  * Make sure you understand the 3 phases of non-invasive intervention before surgery: Lip taping, Naso-alveolar Molding and palatal lift.
+  * Explain what Nordoff's point is (thinning of the white roll)
+  * You will want to have frequent appointments to make sure the baby is feeding well. So see the baby 1 week after leaving the hospital. Don't just schedule surgery at 3 months and trust other services.
+  * You will be asked about special bottles and how they work. They all use a gravity fed reservoir that squirts the milk into the mouth as the baby bites.
-Plastic Star 70 777 L40G The Cleft Nurse at-720-777-5364 Monday through Friday 8-4:30pm. -Your-surgeon's office.
+Cleft Palate (Khechoyan):
-To reach the ENT office after hours, please call 720-777-8501. -The BH To reach the plastic surgery office after hours please call 720-777-1234 and ask to speak with the plastic surgeon on call.
+  * Asks for two syndromes associated with cleft palate: Van der Woude (Lip pits), Stickler Syndrome (Retinal detachment)
-Follow-Up after Surgery: Your child should be seen for a follow-up appointment 1-2 weeks after surgery. Then 4-6 weeks after surgery with your surgeon.
+  * Then asks for a sequence - Pierre Robin Sequence. This patient will need a sleep study and maneuvers for breathing: prone positioning, nasal trumpet, lip tongue adhesion stitch vs distraction
-If follow-up appointment is not with a Children's Hospital Colorado doctor please call your doctor's office for an appointment.
+  * Asks to explain the aberrant anatomy
-/20 2ND Pine Plastic Surgerwin Minuten
-• To schedule a post-op appointment in 1-2 weeks please call-Kathy at 720-777-3880. . To schedule a post-op ear evaluation in 4 weeks please call ENT at 720-777-8501.
-To schedule a post-op appointment in 4-6 weeks with your child's surgeon please call: 7 P each
-• Plastics Office 720-777-6409 option #1 -- wice plan 7 Follow us
-•
-month
-+ The dept dinic in ENT Office 720-777-8501
-lycer parger
-For all other questions, please call the Cleft Clinic at 720-777-2572.
-st post-op chee
-with me goto
-e
-please
-call Them
-To thedule.
-ok.
-a