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

you’re 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 we’ll 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 patients – both 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 you’re off, you’re 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 care – with 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 abused – and 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 taxing – especially 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。

basis – time 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 kitchen” situation 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。

In these cases, you are often forced to be the mediator, weigh the pros/cons of different

在這些情況下，你往往被迫成為調解人，權衡不同的利弊。

treatment plans, and be political about why one plan may be better in that situation than

療方案，並在政治上說明為什麼在這種情況下一種方案可能比另一種方案更好。

another.

另一個。

How can you decide if becoming a pediatric intensivist is right for you?

你如何決定成為一名兒科強化治療師是否適合你？

If you want a specialty where you can take care of sick children and utilize the full

如果你想要一個可以照顧患病兒童的專業，並充分使用

spectrum of medical knowledge, pediatric critical care has you covered.

小兒重症監護是醫學知識譜系中的一個重要組成部分，它為您提供了豐富的知識。

You should be patient, detail-oriented, and enjoy working in a fast-paced environment.

你應該有耐心，注重細節，並喜歡在一個快節奏的環境中工作。

You should also enjoy doing procedures and be comfortable communicating with patients

你還應該喜歡做手術，並能自如地與病人溝通。

and families – both the good news and the bad.

和家庭--包括好消息和壞消息。

And you should be willing to spend long nights and weekends in the hospital if it means making

而且你應該願意在醫院度過漫長的夜晚和週末，如果這意味著要讓

a lifelong difference in your patient’s health.

為你的病人的健康帶來終生的改變。

Huge shout out to Dr. Mark Dugan, board-certified pediatric intensivist, for helping me with

衷心感謝委員會認證的兒科強化治療師馬克-杜根博士，他在以下方面幫助了我。

the creation of this video.

本視頻的創作。

To learn more about his personal journey and tips he has for you, be sure to check out

要了解更多關於他的個人旅程和他為你提供的提示，請務必查看

Why I Did…

為什麼我做了...

Pediatric Critical Care on the Kevin Jubbal, M.D.

醫學博士Kevin Jubbal的兒科重症監護。

YouTube channel - link in the description.

YouTube頻道--描述中的鏈接。

Are you hoping to become a pediatric intensivist?

你希望成為一名兒科強化治療師嗎？

To get into medical school, match into pediatric residency, and get into a pediatric critical

為了進入醫學院，匹配到兒科住院醫生，並進入兒科的關鍵領域。

care fellowship, you’ll need to crush your exams and be a well rounded applicant.

照顧研究金，你需要粉碎你的考試，成為一個全面的申請人。

As you look at resources and companies to work with, seek out those who are actual M.D.

在你尋找合作的資源和公司時，要尋找那些真正的醫學博士。

physicians, not Ph.D. or other types of doctors that didn't go to medical school.

醫師，而不是博士或其他類型的沒有上過醫學院的醫生。

Look for those who have achieved stellar results themselves, a track record of success with

尋找那些自己取得過輝煌業績的人，有成功記錄的人。

positive ratings from customers, and a systematic approach so you know you'll always receive

客戶的積極評價，以及一個系統的方法，所以你知道你將永遠收到

high-quality service.

高質量的服務。

If you decide on Med School Insiders, we'd love to be a part of your journey in becoming

如果你決定選擇Med School Insiders，我們很願意成為你的旅程的一部分，成為

a future physician.

未來的醫生。

Visit us on MedSchoolInsiders.com.

請在MedSchoolInsiders.com上訪問我們。

Thank you all so much for watching!

非常感謝大家的觀看!

If you enjoyed this video, check out So You Want to Be a Pediatrician, or another specialty

如果你喜歡這個視頻，請查看《你想成為一名兒科醫生》或其他專業的視頻。

in our So You Want to Be playlist.

在我們的So You Want to Be播放列表中。

Much love and I’ll see you guys there.

非常感謝，我們會在那裡見到你們。