Pediatrics Basics

[Boleslao Drinker]

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This new coding resource begins with an overview of medical coding, followed by a more detailed review of the different types of codes commonly used in pediatrics. The book then discusses how to effectively use the different types of codes together for billing purposes.

The AAP Committee on Coding and Nomenclature (COCN) is responsible for reviewing of all proposed changes to Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding structures to determine whether the Academy will endorse the proposal; participates in the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) survey process by validating clinical vignettes, evaluating survey data and deciding on physician work and practice expense relative value units (RVUs) to recommend to the RUC; and serves as a review panel regarding other activities such as identifying Academy positions on the Medicare Resource-Based Relative Value Scale (RBRVS).

Knowledge of ventilator waveforms is important for clinicians working with children requiring mechanical ventilation. This review covers the basics of how to interpret and use data from ventilator waveforms in the pediatric intensive care unit.

Patient-ventilator asynchrony (PVA) is a common finding in pediatric patients and observed in approximately one-third of ventilator breaths. PVA is associated with worse outcomes including increased length of mechanical ventilation, increased length of stay, and increased mortality. Identification of PVA is possible with a thorough knowledge of ventilator waveforms.

Mechanical ventilation is a widely used therapeutic modality in the pediatric intensive care unit (PICU). Clinicians who take care of PICU patients must not only have a thorough understanding of the different ventilators and their function but also knowledge of how those ventilators can interact with the patient. Conventional ventilators used today provide for evaluation of respiratory mechanics with graphics. These graphics, or waveforms, can tell the bedside clinician important information about airway resistance, lung compliance, and patient-ventilator synchrony. Therefore, it is important that clinicians using mechanical ventilation have a thorough understanding of ventilator waveforms and their interpretation.

Volume versus time scalar. The volume versus time scalar showing the volume of air upon inspiration and expiration. The second scalar shows a sudden drop off in volume, representing a potential air leak

Flow versus time scalar. a The first scalar represents the square waveform pattern in volume control. The second scalar shows a decelerating pattern in pressure control. b Examples of scalars with flow waveform abnormalities representing changes to airflow resistance or obstruction

Pressure versus time scalar. a The first scalar represents a control breath. The second scalar represents a volume control breath. Peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) are shown. b A graphical depiction of plateau pressure

Pressure-volume loop. a Pressure-volume loop showing a typical pattern. The lower inflection point (LIP) and upper inflection point (UIP) are shown. b The representations of overdistension and hysteresis in a pressure-volume curve

Flow-volume loop. a A typical flow-volume loop with inspiration on the top and expiration on the bottom. b A flow-volume loop showing an obstructive air flow pattern with lower peak expiratory flow, a scooped out expiratory limb, and air trapping

Trigger asynchrony. a Ineffective trigger shown as a deflection from the baseline expiratory flow and no breath delivered. b Double triggering shown as a second breath being triggered immediately after the first

Modern ventilators provide multiple graphics that help guide the clinician in evaluation and management of respiratory failure. In addition to describing the basics of how a breath is delivered to a patient, these graphics also give valuable information regarding how well a patient is interacting with the ventilator. A detailed understanding of ventilator waveforms and the ability to identify alterations in them that may indicate asynchrony is crucial to the clinician taking care of patients requiring mechanical ventilation.

Are you nervous about giving your newborn baby a bath? Bathing a slippery baby may feel daunting at first, but with a little practice, you'll start to feel more comfortable at bath time. Start by learning baby bath basics.

That's up to you. Choose a time when you're not rushed or likely to be interrupted. Some parents opt for morning baths, when their babies are alert. Others prefer to make baby baths part of a calming bedtime ritual. If you bathe your baby after a feeding, consider waiting for your baby's tummy to settle a bit first.

Undress your baby and wrap him or her in a towel. Lay your baby on his or her back in the prepared area. To keep your baby warm, only expose the parts of your baby's body that you're washing. Wet the washcloth with plain, warm water. Then wring out excess water and wipe your baby's face. Wipe each eyelid from the inside to the outside corner.

To clean your baby's body, use a dampened washcloth dipped in plain or soapy water. If you use soap, make sure it's mild and moisturizing. Pay special attention to creases under the arms, behind the ears, around the neck and in the diaper area. Also wash between your baby's fingers and toes.

Once your baby is ready for a bath, you might use a plastic tub or the sink. Line the tub or sink with a clean towel. Gather the supplies you'd use for a sponge bath, a cup of rinsing water and baby shampoo, if needed, ahead of time. This will allow you to keep one hand on the baby at all times. Never leave your baby alone in the water.

A common recommendation is 2 inches (about 5 centimeters). During bath time, always be sure to give your baby undivided attention and hold your baby securely. If you forget something you need for the bath, take your baby with you. Never leave your baby alone in the tub even for an instant.

Warm water is best. To prevent scalding, set the thermostat on your water heater to below 120 F (49 C). Always check the water temperature with your hand before bathing your baby. Aim for bath water around 100 F (38 C). Be sure the room is comfortably warm, too. A wet baby can be easily chilled.

If your newborn has hair and you think it needs washing, go ahead. With your free hand, gently massage a drop of mild baby shampoo into your baby's scalp. Rinse the shampoo with a cup of water or a damp washcloth, cupping one hand across your baby's forehead to keep suds out of his or her eyes.

Most newborns don't need lotion after a bath. If your baby's skin is very dry, apply a small amount of unscented baby moisturizer to the dry areas. The massage might make your baby feel good. If dryness continues, you might be bathing your baby too often.

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Now you can get your SLP CEU certificates online. Just choose your ASHA CEU courses, enroll, watch the video or listen to the podcast, and then you will take an online assessment and receive your certificate by email.

2 hour Introductory DEI Course appropriate for SLPs and other therapists (OT, PT, and EI Developmental Specialists/Therapists) who work with pediatrics in various settings including state or county-based early intervention providers, outpatient pediatric therapy clinics, infant/toddler and preschool programs, and other academic settings

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A growing, multi-community learning network with locales in the United States and abroad, where stakeholders are using The Basics Strategy and contributing to a reservoir of insights for supporting families and young children.

A local backbone organization in each affiliated community recruits and equips partner organizations from multiple sectors. The organizations, in turn, engage parents and caregivers with information and supports for incorporating The Basics Principles into everyday family routines. For example:

The Basics Amarillo is led by a local collective group called Operation First Five who tackle tough issues facing families who have children birth through 5. We seek to build a community where every family and every child feels safe, cared for, supported, and nurtured.

United Way of the Lowcountry serves as the Backbone of The Basics Lowcountry and the Lowcountry Early Childhood Coalition, a group of public, private and non-profit organizations who are working together to educate our community on the importance of early childhood development and to provide solutions to parents and caregivers to make sure their young loved ones have the best opportunity for success.

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