EMED Rotation

[marktheshark89]

My first rotation is Emergency medicine and I wanted to see if anyone had any advice for good, digestible study resources for the month that I am on the rotation and just in general advice about succeeding in the rotation and having a good experience. Thanks.

[True Anomaly]

For a good but concise (and therefore cheaper) book, hard to beat the baby Tintinalli- officially known as the "Emergency Medicine Manual":

http://www.amazon.com/Emergency-Medicine-Manual-O-John/dp/0071410252/ref=cm_lmf_tit_5

 

For a phone app, again a cheap but good one is ERRes- there's an iPhone and Android version of it.  Just type in "ERRes" into the search in either store and it should come up.

 

For general advice, show up ready to work and have a positive attitude about seeing any patient.  It's always better to volunteer to see patients and have your preceptor kind of reign you in rather than being a wallflower and waiting for your preceptor to assign you patients (unless that's how your particular rotation operates, of course).

 

Always keep tabs of your patients in the ED- if you see the patient and order tests, be proactive in trying to find those results if you're able to.  If you don't have access to the diagnostic studies, be proactive about asking your preceptor to view the results so you can see it together.

 

I always appreciate a student who is at least able to formulate some sort of plan from a basic list of differentials- it shows you're engaged and thinking about each patient, rather than a robot just doing focused histories and physicals on the patients you see.  Don't be afraid of being wrong- we can always tweak your plans and differentials- I just want to see you having a vested interest in the patient and play the role of the PA.

 

Do you see a theme?  BE PROACTIVE

[winterallsummer]

Case Files emergency medicine.

 

Yep ask to do as many procedures as possible even DRE and pelvic exams. If people see you want to work they'll let you do the fun stuff like suturing too.

 

Try to think of questions to ask your PTs that your preceptor may miss. Eg belly pain find out when exactly was last colonoscopy? What surgeries and why? If important and the nurse didn't get then get the PTs med list.

 

If its a pt with a laceration set up the suture tray and offer to get started eg say hey I set up want me to numb the site up and irrigate then when you can come in perhaps I can suture? Always ask to do whatever even boring things like staple removing.

 

As with any rotation you must separate good medicine and bad habits. Don't pick up bad habits of rushed H and P, CTing everything even when uncalled for, or giving narcs to addicts. Oh and if you are in the fast track make sure you spend adequate time in the main ED. Finally you will meet both good and bad, friendly and nice clinicians. Your job is to learn and when frustrated just remember its only a short rotation.

[gbrothers98]

Not only proactive but take ownership.

 

That means dont expect the attending, your preceptor or the janitor to find the answer for you.

 

It is reasonable to ask where the cafeteria is. It is not reasonable to ask your preceptor to answer your question about the proper evaluation of someone with chest pain. A student should come up with the majority of that themselves based upon their differential diagnosis.

 

Here is a list of what I think will help in the ED (and also some other rotations)

 

Tarascon Pharmacopiae, pocket edition, 2014 (can use in all rotations)

 

EMRA antibiotic guide, either app or pocket book (can use in all rotations)

 

EMRA Basics of Emergency Medicine, either app or pocket book

 

http://www.emdocs.net/mini-intern-bootcamp/

full pdf at bottom

 

Mediquations or other app to do medical calculations, scores, etc (can use in all rotations)

 

The first chapter of An Introduction to Clinical Emergency Medicine.

 

Also:

http://journals.lww.com/em-news/Fulltext/2006/02000/The_ED_Chart__Attention_to_Detail.19.aspx

 

Good luck

G Brothers PA-C

[marktheshark89]

Thanks for your responses so far!

[G. Davenport]

My advice is a little different:

 

1.  Don't study like going to a job.  You can't possibly know what you will see that day.

2.  Do take notes throughout shift and review cases each night 

3.  Volunteer to do anything and everything

4.  Watch everything and anything that may be going on

5.  Ride with the paramedics once or twice if you can

6.  Don't be a scut monkey

7.  Don't take a lunch break (get a quick bite between cases)

 

If you study to impress, you will miss out on learning opportunities.  Go with an open mind and jump into the pool.  Learn on the spot.  Learn by not knowing and saying I don't know.  Let them show you but when you come the next shift, know it.  

 

YOU ARE A STUDENT.  BE one.  Be an eager one.  

 

Now on the flip side, EMEDPA and I flunked a student's ER rotation because s/he did nothing, took breaks, and could care less.  Don't do that.

 

G

[marktheshark89]

Thanks, I appreciate it. We actually get to do a week in an ambulance if we want to so I will definitely take advantage of that.

[whoRyou]

Sounds awesome, I am kinda envious, but in a good way! Just curious Mark where are you going to school? I concur I would DEFINTELY  take advantage of that GOLDEN opportunity riding the ambulance (and how often does that happen, unless you are sick). Go for it!

[marktheshark89]

I go to Yale.

[whoRyou]

I go to Yale.

Good Luck!

[jen0508]

Pocket Emergency Medicine is a must-have, to keep in your coat pocket. Saved me a lot during my EM clinical, it is good for quick reference while you are out on clinical, though detailed enough to learn from.

 

If possible, make friends with the nurses and tech's. Be humble, friendly and helpful. They will help you out a lot. If there is down time, instead of sitting around, team up with a nurse or tech and practice putting in IV's or drawing blood (if you havent already done this in a prior occupation), practice putting on splints, etc. Often times it was a nurse who informed me of a lac on the other side of the ED, or an interesting patient to see.

 

I agree about the advice to be pro-active. don't be a wall-flower. if you are shy, snap out of it. ask to see patients, ask to do procedures. Push yourself and get out of your comfort zone. If you aren't comfortable with lacs, do LOTS of them. If you arent comfortable with cardiology, see that CP or palpitations. Now is the time! Get over that discomfort as a student. Wouldn't you want to get over it now (as a student) instead of later (as a graduated PA at your first job) ?