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New grad starting a job in the ED, advice?

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Get an EMRA guide and a tarascon; think about picking up PEPID on your iPhone if the group doesn't have UpToDate. Depending on where you will be at in the ED, and your previous experience, for the Fast track stuff, read up on: Peds fever, asthma, back pain (ddx), headache, sports med, and basic fx/dislocations/splinting. Throw in simple and complex wound repair- multi-layer/contaminated/ ect.. There are some good apps out there for free that will give you hundreds of X-rays/ CTs to look at; focus on CXR, KUB, wrist/elbow/ankles and knees. Know your NEXUS criteria and Ottowa ankle/foot rules.


Review the antibiotic classes, and coverage. Review the big guns for admits- vanc/ zosyn, ect..


For main side, read up on: CP, ACS, PE, COPD, CHF, Sepsis, ARF, Acid-base disorders, IDDM, arrhythmias, stroke, dizziness and Abd pain (ESP female). Review EKGs; review your ACLS and look at RSI. Know your WELLS criteria, PERC, AND REVIEW Risk factors. Know what SIRS means, and the criteria. Gloss over trauma assessment (primary/secondary).


Make nice with the nurses early. They smell fear and eat their young.


The rest will come, and KEEP coming. Above all, know what you DONT know, and when to ask.


Congrats and welcome to EM!

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If you have an iPhone or something of that nature, start writing down pediatric dosing (ml/kg, etc.). It'll save time and frustration.


Don't get overwhelmed by how slow you'll initially be. Speed will come.


Know your limits and when to ask for help. Even the seasoned vets include the docs on decision making.


Volunteer for any complex procedures that you want to learn. Have the willing docs teach you. Don't shy away from complex because those patients will help you grow. But again, limits.


Thank the nurses for anything they do to make your life easier.


Read. Read. Read. Something you'll forever do.


Look at vital signs closely on every patient.


When you get the opportunity, go to the Emergency Medicine Bootcamp in Vegas. Money well worth spent.


PM me with any questions.

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honestly with no prior er experience get a mentor on every shift

ask questions, but have your best answer figured out so you dont appear stupid or lazy

ANYthing beyond the crazy simple ask!


one of the best tidbits of advice I ever got for er and any field when you are learning...... come up with a Ddx with atleast 5 things... if you cant think of 5 Ddx for a sore throat (easy right?) you should not be treating the ST



ask your department head if (on your time) you can shadow other parts of hospital..... might help huge to travel with hospitalist for a day to befriend them but also get a feel for it..... you want to be on best behavior as your entire first year is basically a job interview for the entire hospital system.... people will get to know you and form opinions


keep nurses happy but realize they have their own agenda too.... many are great (figure these out!) but some will hang you out to dry with a smile on their face. I have been saved more then once by nurses catching things, but also have been burned by they as well....


look back at old records if yu have EMR...... just a few weeks ago did a per diem shift (no longer in ER full time) and 45 yr old male with abd pain, started to go down the appy route, till looked in EMR and saw 11!! CT's in past 2 years for abd pain, and + urine tox screens...... this is not abd pain...... this is drug seeking....


On that thought..... think hard before ordering CT, especially on reproductive age females, children, and someone who has already had a bunch...... abd.pelvis CT with and without is ~ 300! xrays..... and radiation causes cancer..... I have all too commonly seen new grads just step to advanced imaging as it is easy and defensible... but not always right....... ie abd pain ight not be appy... might be SMA occlusion, but if you don't stop and think you will never get there (SMA occlusion is one of my alltime favorite catches!)

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