first intern EM shift

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golghiapparatus

EM bound
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Do you have a good story about your first EM shift as an intern? What were you thinking, what did you do, any pearls of wisdom for those of us who are starting in July?

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Do you have a good story about your first EM shift as an intern? What were you thinking, what did you do, any pearls of wisdom for those of us who are starting in July?
Be open minded. Realize that you're close to the dumbest person in the room, so everyone has something to teach you. Whether or not you learn it is up to you.
 
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haha that would be hilarious if my attending verbalized that to me... 'nVictus, youre the dumbest guy in the room.'
 
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Be open minded. Realize that you're close to the dumbest person in the room, so everyone has something to teach you. Whether or not you learn it is up to you.

I already have that down pat....
 
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True story here.. I as drove to the hospital for my first shift (mind you it was an overnight), Motley Crue's Dr. Feelgood came on the radio. Now if that's not a sign of things to come, what is?
 
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We were signing out as a team and I was handed a census and I had no idea what the heck was going on. I hadn't thought about a patient in about 6 months and was used to zoning out during such sign outs as a med student. By the time I even realized what was going on, sign out was done and people were off seeing new patients. I didn't even know who my patients were! I had to go to the senior resident and figure out how things even happened. Luckily everyone was really supportive and helpful and I caught on fast.

I went to go see my first patient, 48 yr old F w/ abd pain and naturally I had a limited differential of basically just appy and diverticulitis. Looking back on that its crazy how stuff I take for granted in my knowledge base as second nature I was so green on not too long ago.

I would just recommend coming to the realization that you are the stupidest person in the room and most likely stupider in your known fund of knowledge than you've been since starting 3rd yr of med school. You can never have enough humility as this stage and keep an open mind and ear when your senior residents and attendings give you advice. A lot of what you will learn will happen from listening to conversations between others in passing so make sure you're listening to what's going on. Keep a good attitude, work well with others, and people will like you and throw you opportunities when they come.

We are lucky to be in a specialty where the structure is relatively flat so as interns we don't have to feel like we are getting dumped on (at least in my program), since we all basically have our own patients and report to a senior person be it a senior resident or attending. Intern year in EM is great, its a time to learn, be humble, explore, and actually become doctors. Enjoy it!
 
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My first patient was the son of an internist....who was in the room. It was awkward introducing myself as Dr. TimesNewRoman for the first time then hearing the pt say "this is my son, he's a doc, too."
 
I'll be starting residency in July so it is nice to hear that I am not the only one feeling like the deer in headlights. I am not as worried about my first EM shift, because there is always a senior and an attending in the ER, but I am worried about my first on-call shift as a general intern, where my lack of experience will be very apparant.....
 
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Hey, Congrats on matching! That nervous feeling is a sure sign that you are about to grow in awesome ways. Relish it... The next time you feel that green is coming out of residency...

Just relax and try hard. You will do great.
 
My first shift I learned not to give Toradol to a headache patient until you're sure it's *really* a migraine!
 
My first shift I learned not to give Toradol to a headache patient until you're sure it's *really* a migraine!
At first I read this and I was like:
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"Toradol is great for headaches... what the problem, it's not like its a..."

Then I suddenly realized what you meant:
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My first shift I learned not to give Toradol to a headache patient until you're sure it's *really* a migraine!

So I understand the theoretical risk w/r/t decreased platelet aggregation in the 2% of patients or so who turn out to have a bleed -- but my understanding was that this concern was overblown and that studies of patients who received NSAIDs before the dx was confirmed showed no difference in outcomes. Anyone have better info on this? Some quick (<10 min) pubmed searching didn't give me much except a mediocre lit review:

http://www.ncbi.nlm.nih.gov/pubmed/22950380


Back on topic, I'd love to hear more intern year stories. I'm terrified about starting intern year in a couple months!
 
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I honestly have not done a lit search on Toradol given to SAH. And that patient didn't end up having one. But I can't imagine the conversation going well " Hey, Dr. NSG. I've got a patient down here with a SAH. Also, I gave an NSAID. Have fun in the OR!"
 
Echo what another person said, be open minded, it's okay to ask questions, the worst is to pretend like you know what's going on or you can take care of more than you know. It's easy to teach someone who's open to learning, it's another to try to convince someone who thinks he knows something that he knows nothing. My first intern shift, saw 4 patients, probably at least 2 of them got dispo'd by my attending before I even figured out what the heck was going on. Be nice to the nurses, first impressions are important and will make a difference as far as who has your back in the years to come. Goodluck and have fun!
 
So I understand the theoretical risk w/r/t decreased platelet aggregation in the 2% of patients or so who turn out to have a bleed -- but my understanding was that this concern was overblown and that studies of patients who received NSAIDs before the dx was confirmed showed no difference in outcomes. Anyone have better info on this? Some quick (<10 min) pubmed searching didn't give me much except a mediocre lit review:

http://www.ncbi.nlm.nih.gov/pubmed/22950380
The issue is that there are significantly better migraine medicines that have no risk of worsening a SAH. And some of them don't even start with "d".

Back on topic, I'd love to hear more intern year stories. I'm terrified about starting intern year in a couple months!
 
My first shift I learned not to give Toradol to a headache patient until you're sure it's *really* a migraine!

On my 2nd EM away rotation I got absolutely crushed by a PA on this point right in front of the attending. Yelled at me for a good 5 minutes about it. It was a rough overnight :\
 
On my 2nd EM away rotation I got absolutely crushed by a PA on this point right in front of the attending. Yelled at me for a good 5 minutes about it. It was a rough overnight :\
Why would they yell at you? I assume you were a medical student, and generally nowhere can a medical student order therapy on a patient (at least where I've been).
 
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Maybe he included it in his A&P during a presentation.
 
True; but that'd be more an opportunity to educate than chew out. Chewing out would be if an intern/resident screwed up and possibly/actually harmed a patient.
True. Perhaps the PA was also a douche
 
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no, ultrasound guided. but used the femoral/long needle because i didn't know any better, and was way past the vessel on short axis.

but i got my first chest tube out of it!
 
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My first shift as an Intern. It was in the ED, night shift. I was so nervous I didn't sleep for like 3 days before. I was sleep deprived and disheveled. I think I was slurring my words at one point because I was so tired and I'm pretty sure my attending thought I was drunk. My best advice… try not to do that!
 
no, ultrasound guided. but used the femoral/long needle because i didn't know any better, and was way past the vessel on short axis.

but i got my first chest tube out of it!

only thing left to do is to give the pt. 4 of dilauded and get an intubation out of it as well!
 
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Why would they yell at you? I assume you were a medical student, and generally nowhere can a medical student order therapy on a patient (at least where I've been).
Yeah, I was a fourth year student (still am, but just matched at my top choice!)

I hadn't ordered anything; was just talking with the PA about my plan. Left that shift feeling really terrible about myself but after a few weeks realized he was just a mean dude and tried to forget about it.
 
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My first shift I learned not to give Toradol to a headache patient until you're sure it's *really* a migraine!

I made this mistake 1/3 the way through :/ Luckily medication hadn't been given and when I saw the CT w/ the SAH I stopped the toradol in its tracks. Shook me the rest of my shift, but a mistake I won't make again.
 
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I usually give reglan, benadryl, and 1 L of NS. Every once in a while I add toradol but only to the patient that says this is exactly like my previous headaches...etc. and are young and healthy. Toradol is horrible on the stomach and thus I don't give it to older patients.
 
I gave Toradol for a headache as an intern, the patient got relief, and, as it was >10 years ago, I don't recall why, but I CT'd her head - and she had subarachnoid blood. My attending was flabbergasted, as the dogma was that you don't get pain relief with intracranial bleeding. The patient did well.

I work with a guy now that says "Toradol doesn't cause head bleeds." Well, if it ain't broke, don't fix it. He can do that, but I'm not.
 
My first shift as an intern I got taken for like 4 mg do dilaudid by a junkie claiming abdominal pain--first patient of residency.

For headaches I generally give compazine, but have had fantastic success with droperidol when I have an attending who'll let me use it. Here's a quick question for you all: what's your practice for patients who bounce back with a post-LP Headache?
 
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