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  • So you want to be a pediatric intensivist.

    所以你想成為一名兒科強化治療師。

  • You love children and want to help take care of some of the sickest patients in the hospital.

    你熱愛兒童,並希望幫助照顧醫院裡一些病重的病人。

  • Let’s debunk the public perception myths and give it to you straight.

    讓我們揭穿公眾認知的神話,直接給你看。

  • This is the reality of pediatric critical care.

    這就是兒科重症監護的現實。

  • Dr. Jubbal, MedSchoolInsiders.com.

    Jubbal博士,MedSchoolInsiders.com。

  • Welcome to our next installment in So You Want to Be.

    歡迎來到《你想成為什麼樣的人》的下一篇文章。

  • In this series, we highlight a specific specialty within medicine, such as pediatric critical

    在這個系列中,我們強調醫學中的一個特定專業,如兒科危重病人。

  • care, and help you decide if it’s a good fit for you.

    護理,並幫助你決定它是否適合你。

  • You can find the other specialties on our So You Want To Be playlist.

    你可以在我們的So You Want To Be播放列表中找到其他專業。

  • If you want to vote in upcoming polls to decide what future specialties we cover, make sure

    如果你想在即將舉行的投票中投票,以決定我們未來涵蓋的專業,請確保

  • youre subscribed.

    你已經訂閱了。

  • If you’d like to see what being a pediatric intensivist looks like, check out my second

    如果你想看看作為一名兒科強化治療師是什麼樣子的,請看我的第二篇文章。

  • channel, Kevin Jubbal, M.D., where well be covering a day in the life of a pediatric

    在這裡,我們將報道一位小兒科醫生的一天,他叫凱文-朱巴爾,醫學博士。

  • intensivist in the future.

    未來的強化治療師。

  • Pediatric critical care is the specialty of medicine focused on the treatment of seriously

    兒科重症監護是專注於治療嚴重疾病的醫學專業。

  • ill children from birth to 18 years old and beyond.

    從出生到18歲及以上的患病兒童。

  • Much like pediatricians, pediatric intensivists are the masters of physiology and pharmacology.

    與兒科醫生一樣,兒科強化治療師是生理學和藥理學的大師。

  • They use the wide breadth of knowledge from medical school and residency and apply it

    他們利用從醫學院和住院醫師那裡獲得的廣泛知識,並將其用於

  • at the bedside on a daily basis.

    每天都在床邊。

  • On any given day, a pediatric intensivist could be called to take care of a burn patient,

    在任何一天,一位兒科強化治療師都可能被叫去照顧一個燒傷病人。

  • a type I diabetic in diabetic crisis, or a patient with a respiratory infection on a

    處於糖尿病危機中的I型糖尿病患者,或呼吸道感染的患者,正在接受治療。

  • ventilator, each with their own set of needs.

    呼吸機,每個人都有自己的一套需求。

  • As such, they need to have a working knowledge of every body system and the various ways

    是以,他們需要對每個身體系統和各種方式有一個工作上的瞭解。

  • that things can go wrong with each one.

    每一個人都可能出錯。

  • Furthermore, pediatric intensivists see patients across the entire developmental spectrum.

    此外,兒科強化治療師看到的病人跨越了整個發展光譜。

  • Patients that are up to 1 month old have different needs than patients who are 1 month to 1 year

    1個月以內的病人與1個月至1年的病人有不同的需求。

  • old or 2-4, 5-10, or 10-18 years old.

    或2-4歲、5-10歲或10-18歲。

  • Each developmental range has different normal values for vital signs, lab results, drug

    每個發育範圍都有不同的生命體徵、實驗室結果、藥物的正常值。

  • doses, and so on.

    劑量,等等。

  • Pediatric intensivists have to always consider the patient’s specific disease or condition

    兒科強化治療師必須始終考慮病人的具體疾病或狀況

  • within the context of their age.

    在他們的年齡範圍內。

  • Unlike many other specialties within pediatrics, pediatric intensivists perform a variety of

    與兒科內的許多其他專業不同,兒科強化治療師進行各種

  • different procedures.

    不同的程序。

  • They perform intubations for children needing ventilatory support.

    他們為需要呼吸機支持的兒童進行插管。

  • They place arterial catheters for children needing blood pressure monitoring and venous

    他們為需要監測血壓的兒童放置動脈導管,為需要監測血壓的兒童放置靜脈導管。

  • catheters for the safe delivery of some medications.

    用於安全輸送某些藥物的導管。

  • They place chest tubes for children with pneumothoraces or pleural fluid collections.

    他們為患有氣胸或胸腔積液的兒童放置胸管。

  • And they perform a number of procedures for children needing artificial organ support

    而且他們為需要人工器官支持的兒童進行了一系列的手術

  • whether that be the heart, lungs, kidneys, or another organ.

    - 無論是心臟、肺部、腎臟,還是其他器官。

  • There are a few ways to categorize a pediatric intensivist’s work.

    有幾種方法可以將兒科強化治療師的工作進行分類。

  • First, there’s academic vs community and private practice.

    首先,是學術界與社區和私人診所。

  • Academic pediatric intensivists are typically employed by a hospital or university affiliated

    學術性的兒科強化治療師通常受僱於一家醫院或大學的附屬機構。

  • with a medical school.

    有一所醫學院。

  • They will split their time between treating patients in the hospital and teaching.

    他們將在醫院裡治療病人和教學之間分配時間。

  • Many academic positions also require administrative involvement or committee work within the hospital.

    許多學術職位還需要參與醫院內的行政管理或委員會工作。

  • In contrast, community pediatric intensivists are employed by a community children’s hospital

    相比之下,社區兒科強化治療師是由社區兒童醫院僱傭的。

  • and private practice pediatric intensivists are employed by a private group that provides

    和私人診所的兒科強化治療師受僱於一個私人集團,提供

  • care to a children’s hospital.

    護理到兒童醫院。

  • They will generally have less academic involvement; however, hybrid positions do exist.

    他們一般會有較少的學術參與;然而,確實存在混合職位。

  • Relative to other specialties, the day to day life of a pediatric intensivist in the

    相對於其他專業而言,小兒科強化治療師的日常工作是非常重要的。

  • academic vs private practice vs community setting does not differ much.

    學術界與私人診所與社區環境沒有太大區別。

  • Given the nature of pediatric critical care, physicians working in this specialty will

    鑑於兒科重症監護的性質,在這個專業工作的醫生將

  • almost always work in the hospital setting and take care of a wide variety of critically

    幾乎總是在醫院環境中工作,照顧各種各樣的危重病人。

  • ill patients.

    患病的病人。

  • In terms of lifestyle, there is also little difference between academic, private practice,

    就生活方式而言,學術界、私人診所之間也沒有什麼區別。

  • and community pediatric intensivists.

    和社區兒科強化治療師。

  • On-call responsibilities are more dependent on the specific hospital or group that you

    隨叫隨到的責任更多的是取決於你所在的具體醫院或集團。

  • work for than they are on the type of practice.

    他們的工作比他們的實踐類型更重要。

  • In some hospitals, you may be required to be on call several nights a week.

    在一些醫院,你可能被要求每週有幾個晚上待命。

  • In others, you may have a more typical 8-5 schedule with on-call responsibilities occurring

    在其他情況下,你可能有一個更典型的8-5的時間表,並有隨叫隨到的責任發生。

  • less frequently.

    較少發生。

  • In terms of compensation, pediatric intensivists working in the private practice or community

    在報酬方面,在私人診所或社區工作的兒科強化治療師

  • settings will typically earn more than their academic colleagues.

    設置通常會比他們的學術同事賺得更多。

  • According to the 2020 MGMA Physician Compensation Report, the average salary is between $290,000

    根據2020年MGMA醫生薪酬報告,平均工資在29萬美元之間。

  • and $372,000 per year.

    和每年372,000美元。

  • This brings me to the next way of differentiating a pediatric critical care doctor's practice

    這讓我想到下一個區分兒科重症監護醫生業務的方法

  • which is critical care vs pediatric sedation.

    這就是重症監護與兒科鎮靜。

  • Whereas most pediatric intensivists will work in a hospital’s pediatric intensive care

    而大多數兒科強化治療師會在醫院的兒科重症監護室工作。

  • unit and take care of critically ill children, there are some who perform primarily pediatric

    照顧危重病人,也有一些人主要從事小兒科工作。

  • sedation.

    鎮靜。

  • Pediatric sedation is typically offered within a children’s hospital or radiology center

    小兒鎮靜通常在兒童醫院或放射科中心內提供。

  • where you have children who are too young developmentally to know to stay still.

    如果你有孩子,他們在發育上太年輕,不知道要保持靜止。

  • In order to perform the required study or procedure, these children are given sedatives

    為了進行所需的研究或程序,這些兒童被給予鎮靜劑。

  • and monitored by a pediatric critical care physician to ensure there are no unforeseen

    並由兒科重症監護醫生進行監測,以確保沒有不可預見的風險。

  • issues.

    問題。

  • Some pediatric intensivists will do pediatric sedation in addition to their pediatric ICU

    一些兒科強化治療師除了做兒科ICU外,還會做兒科鎮靜治療。

  • responsibilities whereas others will do it full-time.

    而其他人則是全職工作。

  • In terms of compensation, pediatric intensivists working predominantly in sedation will generally

    在報酬方面,主要從事鎮靜工作的兒科強化治療師通常會

  • earn less than their pediatric ICU colleagues.

    他們的收入比兒科ICU的同事少。

  • Let’s clear up some of the misconceptions about pediatric critical care.

    讓我們澄清一些關於兒科重症監護的誤解。

  • The biggest misconception is that it’s a sad job.

    最大的誤解是認為這是一份悲哀的工作。

  • Unlike adult critical care, the majority of children admitted to the pediatric ICU improve

    與成人重症監護不同的是,進入兒科重症監護室的大多數兒童都能得到改善。

  • and ultimately leave the ICU.

    並最終離開ICU。

  • Multiple studies estimate that the mortality rate for children admitted to the pediatric

    多項研究估計,小兒科收治的兒童的死亡率為0.5%。

  • ICU is only around 3%, meaning that approximately 97% of children recover.

    ICU的比例只有3%左右,這意味著大約97%的兒童可以康復。

  • This isn’t to say that you won’t experience death or sad outcomes; however, it is less

    這並不是說你不會經歷死亡或悲傷的結果;然而,它是較少的。

  • common than you might think.

    比你想象的更常見。

  • Many people also believe that respiratory infections make up the bulk of a pediatric

    許多人還認為,呼吸道感染構成了小兒疾病的大部分。

  • intensivist's workload.

    強化治療師的工作量。

  • In reality, pediatric intensivists see a broad spectrum of patients with a variety of issues.

    在現實中,兒科強化治療師看到的病人範圍很廣,有各種各樣的問題。

  • To become a pediatric intensivist, you must complete 4 years of medical school, followed

    要成為一名兒科強化治療師,你必須完成4年的醫學院學習,然後是

  • by 3 years of pediatric residency, and 3 years of pediatric critical care fellowship.

    通過3年的兒科住院醫師培訓,以及3年的兒科重症監護研究。

  • Some will opt for an additional chief year during residency to increase their competitiveness

    有些人會選擇在住院期間增加一個首席年,以增加他們的競爭力。

  • for fellowship.

    為團契。

  • There are also dual pediatric critical care and anesthesiology fellowship programs that

    也有小兒重症監護和麻醉學的雙重研究計劃。

  • are 5 years in duration and allow pediatricians to become dual-board certified in pediatric

    為期5年,允許兒科醫生成為兒科的雙板認證。

  • critical care and anesthesiology upon completion.

    完成後,將成為重症監護和麻醉學專家。

  • In terms of competitiveness, pediatric critical care is one of the more competitive pediatric

    就競爭力而言,兒科重症監護是競爭力較強的兒科之一。

  • subspecialties along with pediatric emergency medicine, pediatric cardiology, and pediatric

    與小兒急診醫學、小兒心臟病學和小兒護理學一起,成為小兒科的亞專科。

  • gastroenterology.

    胃腸病學。

  • As for the type of medical student that typically goes for pediatric critical care, they are

    至於通常去做兒科重症監護的醫學生的類型,他們是

  • usually detail-oriented, patient, love working with children, and enjoy a fast-paced work

    通常注重細節,有耐心,喜歡和孩子一起工作,喜歡快節奏的工作。

  • environment.

    環境。

  • After completing fellowship, there are a few options for additional subspecialization.

    在完成研究金後,有幾個選擇可以進行額外的亞專業學習。

  • Pediatric cardiac critical care is a 1-year fellowship that provides additional training

    小兒心臟重症監護是一個為期1年的獎學金,提供額外的培訓

  • in acute cardiac diseases and congenital heart problems in critically ill infants, children,

    在急性心臟疾病和先天性心臟問題的重症嬰兒、兒童。

  • and adolescents.

    和青少年。

  • Physicians who pursue this fellowship will receive additional training in extracorporeal

    從事這項研究的醫生將接受體外循環的額外培訓。

  • membrane oxygenation, or ECMO, post-cardiac surgical care, transplantation care, ventricular

    醫學上稱為ECMO,心臟手術後的護理、移植護理、心室護理等。

  • assist devices, and echocardiography.

    輔助設備,和超聲心動圖。

  • It should be noted that there are various other pathways to pediatric cardiac critical

    應該指出的是,還有其他各種通往小兒心臟重症的途徑。

  • care including anesthesiology, neonatology, and pediatric cardiology to name a few.

    包括麻醉學、新生兒學和小兒心臟病學等在內的護理。

  • Pediatric neurocritical care is a 1-year fellowship that provides additional training in a wide

    兒科神經重症護理是一個為期一年的研究項目,在廣泛的領域提供額外的培訓。

  • variety of neurologic illnesses and injuries.

    各種神經系統疾病和傷害。

  • Pediatric neurologists may also apply for fellowship in pediatric neurocritical care.

    小兒神經科醫生也可以申請小兒神經重症監護的研究金。

  • There’s a lot to love about pediatric critical care.

    兒科重症護理有很多值得喜愛的地方。

  • To start, you get to see an incredibly wide variety of patientsboth in terms of age

    首先,你可以看到各種各樣的病人--無論是在年齡方面還是其他方面。

  • and pathophysiology.

    和病理生理學。

  • One minute you could be playing peekaboo with a baby recovering from surgery and the next

    前一分鐘你還在和一個手術後恢復的嬰兒玩躲貓貓,而下一分鐘

  • you could be talking to a diabetic teenager about video games.

    你可能在和一個患糖尿病的青少年談論電子遊戲。

  • In addition, having the opportunity to use all of the information you learned in medical

    此外,有機會使用你在醫學上所學到的所有資訊。

  • school and consider all of the nuances of patient care in different age ranges can be

    在學校,考慮到不同年齡段的病人護理的所有細微差別,可以

  • incredibly fun and rewarding.

    令人難以置信的樂趣和回報。

  • In terms of lifestyle, pediatric critical care has a lot to offer.

    就生活方式而言,兒科重症護理有很多東西可以提供。

  • Similar to emergency medicine, most pediatric intensivists don’t take work home with them.

    與急診科類似,大多數兒科強化治療師不把工作帶回家。

  • Unlike other specialties that are married to their pager and have to answer calls at

    與其他專業不同的是,他們與傳呼機結婚,必須在

  • all hours of the day, you don’t own your patients as a pediatric intensivist.

    作為一名兒科重症監護醫生,你並不擁有你的病人。

  • When you clock out, your patients become the responsibility of the next physician on shift.

    當你打卡下班時,你的病人就成了下一個當班醫生的責任。

  • When youre off, youre truly off.

    當你離開時,你是真正的離開。

  • There is also some career flexibility.

    也有一些職業靈活性。

  • If you reach a point in your career where you no longer want to spend nights in the

    如果你在你的職業生涯中達到了一個點,你不再想在夜裡度過。

  • hospital, you can transition to a pediatric sedation role and work more regular 9-5 business

    醫院,你可以過渡到兒科鎮靜劑的角色,並從事更多正常的朝九晚五的工作。

  • hours.

    小時。

  • Lastly, pediatric intensivists have the opportunity to collaborate with various other specialties

    最後,兒科強化治療師有機會與其他各科室合作

  • while still remaining the quarterback of the patient’s care.

    同時仍然是病人護理的主導者。

  • Given the variety of conditions that pediatric intensivists treat, they regularly consult

    鑑於兒科重症監護醫生所治療的疾病種類繁多,他們經常諮詢

  • with various surgical and non-surgical specialists.

    與各種外科和非外科專家合作。

  • Interacting with colleagues and coming up with a care plan is often incredibly enjoyable.

    與同事互動並提出護理計劃往往是令人難以置信的快樂。

  • But no matter how many other physicians you consult with, you will often be the final

    但是,無論你向多少其他醫生諮詢,你往往都是最後的決定者。

  • decision-maker in the patient’s carewith some exceptions of course.

    照顧病人的決策者--當然有一些例外。

  • While pediatric critical care is an awesome specialty, it’s not for everyone.

    雖然兒科重症監護是一個了不起的專業,但它並不適合所有人。

  • To start, treating children who are sick, or in some cases dying, is always difficult.

    首先,治療生病的兒童,或者在某些情況下死亡的兒童,總是很困難。

  • Having to tell a family that their child isn’t going to make it is never easy, even for the

    不得不告訴一個家庭他們的孩子不能活了,這絕不是一件容易的事,即使對他們來說。

  • most experienced of physicians.

    最有經驗的醫生。

  • You may also encounter patients who have been mentally or physically abusedand that

    你也可能會遇到那些在精神上或身體上受到虐待的病人--而這

  • can be difficult to cope with emotionally.

    可能在情感上難以應對。

  • Additionally, patients without good family support can be challenging to navigate.

    此外,沒有良好的家庭支持的病人可能是具有挑戰性的。

  • Some families are disconnected from the realities of their child’s condition and may have

    一些家庭與他們孩子的現實狀況脫節,可能有

  • unrealistic expectations about what their child’s recovery will look like.

    對他們孩子的康復有不切實際的期望。

  • Although there are benefits to the lifestyle of a pediatric intensivist, you will likely

    雖然兒科強化治療師的生活方式有很多好處,但你可能會

  • have to work nights and weekends on a regular basis.

    必須定期在晚上和週末工作。

  • This can be both emotionally and physically taxingespecially when you expand it over

    這可能是情感和身體上的負擔--特別是當你把它擴大到

  • the course of a career as you practice into your 40s, 50s, and 60s.

    當你練到40多歲、50多歲和60多歲時,你的職業生涯的過程。

  • Pediatric intensivists also have more complex patients requiring multisystem approaches.

    兒科強化治療師也有更復雜的病人需要多系統的方法。

  • As such, things like orders and charting take up a greater amount of time on a per-patient

    是以,像訂單和製圖這樣的事情在每個病人身上佔用了更多的時間。

  • basistime that could instead be spent with patients or away from work.

    在此基礎上--這些時間可以用來陪伴病人或離開工作。

  • Lastly, having to collaborate with other specialties comes with its own set of challenges.

    最後,必須與其他專業合作,也有其自身的挑戰。

  • Occasionally you will encounter a “too many cooks in the kitchensituation where each

    偶爾你會遇到 "廚房裡有太多的廚師 "的情況,即每個人都有自己的想法。

  • specialist recommends something different.

    專家推薦了一些不同的東西。