Pediatric Pulmonology Inpatient Consultation Note

Date/Time: [Date and time of consultation note entry]

Location: [Hospital name], [Unit/setting: floor / PICU / NICU], [Primary service], [Attending of record]

Consultant: [Pulmonology attending / fellow / APP name and role]

Reason for Consult

Requested by: [Name], [Role], [Service]

[Brief reason for consult in one sentence]

• [Consult question 1] (Use verbatim phrasing from the request when available.)
• [Consult question 2] (Add additional bullets as needed.)

Sources of History

[Patient / Parent-guardian / Bedside nurse / Respiratory therapist / Primary team / Chart review / Outside records] (List all applicable sources. Note reliability qualifiers when relevant, e.g., limited by age, intubation/sedation, language barrier with interpreter used, caregiver not present.)

Consult Summary

[One-sentence patient summary: age (and corrected gestational age if relevant), key chronic conditions, current setting, consult-triggering problem.]

Urgent safety issues: [Airway instability / Impending respiratory failure / High-risk device issue / Severe hypercapnia / None identified]

Answers to consult question(s):

1. [Answer to question 1] (Direct, action-oriented; detailed rationale in Assessment and Plan.)
2. [Answer to question 2] (Add items to match the questions listed.)

Recommendations at a glance:

• Diagnostics/Monitoring: [Key immediate tests and monitoring plan]
• Therapeutics/Respiratory support: [Immediate treatment actions and support adjustments]
• Airway clearance: [Indicated techniques and frequency] (Include only if applicable.)
• Disposition considerations: [Ward vs. ICU needs, criteria for transfer or step-down]
• Escalation triggers: [Objective thresholds prompting pulmonology notification and/or ICU evaluation]

History of Present Illness

[Narrative description of presenting respiratory problem and time course] (Start with current problem and how it changed from baseline. Describe therapies tried and objective response.)

[Hospital course timeline beyond admission day if applicable] (Summarize key turning points: oxygen/ventilation trajectory, bronchodilator use/response, relevant medications, and significant events.)

[Symptom characterization tailored to the consult] (Include hypoxemia triggers/positional/sleep vs wake; wheeze/asthma nocturnal symptoms and SABA response; obstruction timing, feeding association, voice changes; secretion volume/character/clearance effectiveness. Add pertinent negatives only when they inform differential diagnosis.)

Respiratory Baseline

(Include this section only if baseline history informs recommendations; omit entirely for acute self-limited issues.)

• Prior pulmonary diagnoses and severity: [Asthma control category and prior ED/admissions/PICU/intubations, known triggers, controller adherence / BPD-CLD with GA and NICU respiratory course / Airway disorder specifics and prior surgeries / Sleep-disordered breathing study results and home PAP settings / Aspiration risk]
• Home respiratory supports: [Home oxygen (flow/timing/targets), home ventilation settings, airway clearance regimen, inhaled medications with device type]
• Prior testing: [PFTs, bronchoscopy, baseline imaging patterns, echocardiography for pulmonary hypertension, swallow study results] (Include only if available and relevant.)

Medical History

• Medications (inpatient, respiratory-relevant): [Medication, dose, route, frequency]
• Home medications (respiratory-relevant): [Medication and regimen] (Note controller adherence.)
• Recent exposures: [Systemic steroid exposure (timing/dose), recent antibiotics]
• Allergies: [Substance and reaction]
• Other history impacting pulmonary decisions: [Cardiac disease, immunodeficiency, neuromuscular disease, craniofacial anomalies, prior thoracic/airway procedures, growth/nutrition, family history, social/environmental factors] (Include only domains relevant to this consult.)

Review of Systems

[Targeted review of respiratory and closely related systems: constitutional (fever, fatigue), ENT (congestion, stridor, voice changes), respiratory (cough, wheeze, dyspnea, apnea, sputum), GI (vomiting, choking with feeds, reflux), neurologic (somnolence, weak cough)] (Keep targeted; omit non-contributory systems. For nonverbal, sedated, or intubated patients, note inability to obtain ROS directly and source of collateral information.)

Physical Examination

• Vitals/Respiratory support context: [T, HR, RR, BP], [SpO2 range and trend], [Device/interface], [Flow/FiO2], [NIV or ventilator mode and key settings if applicable], [Tolerance/synchrony]
• General: [Appearance, distress level, work of breathing, ability to speak/cry/feed]
• Respiratory: [Retractions (location/severity), nasal flaring, head bobbing (infants), air entry symmetry, wheeze, crackles, stridor, prolonged expiratory phase, cough strength, secretion burden]
• Cardiovascular: [Perfusion, heart sounds, signs of pulmonary hypertension or right heart strain]
• HEENT: [Tonsillar size, nasal patency, craniofacial features, upper airway obstruction cues] (Include if relevant to consult.)
• Neurologic: [Mental status, fatigue, concern for CO2 narcosis]
• Device examination: [Tracheostomy site condition, tube type/size, cuff status, stoma condition, secretion appearance; gastrostomy details if aspiration/nutrition relevant] (Include only if applicable.)

Data Review

• Respiratory support trajectory: [Chronologic device/flow/FiO2/mode changes and response], [Monitoring status: continuous vs. intermittent pulse oximetry]
• Positive pressure support details: [Mode], [Set RR], [Target Vt or PIP/PS], [PEEP], [FiO2], [Peak pressures], [Measured Vt], [Leak %], [Recent changes and response], [SBT/extubation readiness if relevant] (Include only if on NIV/IMV.)
• Blood gases/CO2 monitoring: [ABG/VBG/cap gas values with timestamps and trends], [EtCO2 trends if used] (Correlate with clinical status; note trajectory as improving/worsening/stable.)
• Labs: [CBC highlights], [Electrolytes (K/Mg especially if on beta-agonists)], [Inflammatory markers], [BNP if cardiac concern], [Culture results] (Include only decision-relevant values.)
• Microbiology: [Viral panel results], [Bacterial cultures with collection dates]
• Imaging: [CXR findings with date/time and comparison to prior], [Other imaging key findings] (Separate radiology report summary from pulmonology interpretation.)
• Cardiac studies: [Echocardiogram findings relevant to pulmonary hypertension or shunt physiology, RV pressure estimates] (Include if available and relevant.)
• Pulmonary diagnostics: [Spirometry], [Bronchoscopy results], [Sleep study], [Swallow study] (Include only if available and relevant.)

Assessment

[Diagnostic summary statement integrating history, exam, and data] (Use qualified language when appropriate, e.g., "most consistent with," "cannot exclude.")

1. [Problem 1]: [Status/severity characterization] — [Key supporting evidence]. [Differential diagnoses if uncertainty remains.]
2. [Problem 2]: [Status/severity characterization] — [Key supporting evidence].
3. (Add problems in descending order of severity and time-criticality.)

Plan

Global Recommendations

• [Oxygen target policy and monitoring approach]
• [Airway clearance regimen] (If applicable.)
• [Aspiration precautions / Feeding plan] (If relevant.)

[Problem 1]: [Title]

• Diagnostics: [Tests to obtain with timing and responsible team]
• Therapeutics/Support: [Medications with dose/route/frequency; respiratory support adjustments with specific settings/targets]
• Monitoring: [Parameters, frequency, and success metrics]
• Pulmonology notification: [Specific triggers for when to call]

(For condition-specific problems, include relevant elements below within the problem section.)

[Problem 2]: [Title]

• Diagnostics: [As above]
• Therapeutics/Support: [As above]
• Monitoring: [As above]
• Pulmonology notification: [As above]

Contingency Planning

• If [FiO2 > threshold or worsening work of breathing] → [escalate support, obtain blood gas, notify pulmonology/ICU]
• If [hypercapnia rises above threshold or pH below threshold] → [increase support per pathway, consider ICU transfer]
• If [apnea/bradycardia/desaturation clusters] → [urgent ICU evaluation, consider airway intervention]
• [For device-dependent patients: plan for tube obstruction or accidental decannulation, spare trach location (same size and one size smaller), immediate steps]

Condition-Specific Elements

(Include relevant elements within the corresponding problem section above. Select only those applicable to this consult.)

• Hypoxemia: [Likely mechanism], [Oxygen target with rationale], [Support escalation pathway], [Atelectasis prevention plan]
• Wheeze/Asthma: [Exacerbation severity and response], [Bronchodilator delivery and MDI/spacer transition plan], [Steroid agent/route/duration], [Controller recommendations], [Follow-up timeframe]
• Bronchiolitis/Viral LRTI: [Supportive care approach], [Oxygen strategy and monitoring intensity], [Feeding/hydration plan], [Avoid low-value testing unless indicated]
• Airway obstruction/Stridor: [Localization and severity], [ENT/anesthesia involvement], [Imaging vs endoscopy plan], [NPO/aspiration precautions], [Emergency deterioration plan]
• BPD/CLD of prematurity: [GA and corrected age], [Current support trajectory], [Rationale for diuretics/steroids/bronchodilators], [Pulmonary hypertension screening], [Home oxygen planning]
• Tracheostomy/Ventilator: [Trach details], [Current vs baseline ventilator settings], [Weaning plan with criteria], [Airway clearance and humidification], [Safety elements and caregiver competency]

Communication and Follow-up

• Discussions held: [Primary team name/role], [RT], [Bedside nurse], [Family/caregiver] (Summarize key points, questions addressed, and any disagreements with resolution.)
• Follow-up plan: [Pulmonology to follow daily / PRN], [Outpatient follow-up timing], [Studies needed before follow-up], [Pending tests and responsible party]
• Order responsibility: [Orders placed by consult service / Recommendations for primary team to enter] (For ICU patients, clarify shared ventilator management roles.)

Time Documentation

(Include only if required for billing or local policy.)

[Total time] minutes on [date] spent on [data review, examination, counseling, care coordination, documentation].