EM 1st rotation as an intern

[MariaG]

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Hey everybody,

My first rotation as a new intern (transitional) next month will be EM. I never did an EM rotation in med school so i wanted to get some advice. Any good pockets books out there and anything you reccomend reading before starting the rotation. Dont want to get off on the wrong foot 👍

 

[docB]

Everything I ever needed to know was in The House of God. Most important rule: They can always hurt you more.

 

[DocWagner]

Keep the bed side-rails up.

Pocketbook...Top 30 problems in EM sold at the EMRA website.

 

[Seaglass]

Second most important rule - Polish and turf.

 

[Febrifuge]

An ED is a machine, and you are one of the shinier parts. All the parts must work together smoothly for the machine to function well. Be excellent to the support staff, and they will be excellent to you.

It's also a boatload of fun. You'll have more oddball stories in a month than you'd get in six anywhere else. Please come back and let this crowd know how you fare.

 

[beyond all hope]

In the ED

1) Read up on basic DDxs and workups for common cheif complaints: Chest Pain, Headache, Weak and Dizzy, SOB, Abdominal Pain, Pediatric Fever, etc
Concentrate on the dangerous diagnoses like MI, appendicitis, etc and know how to rule them out.

2) Pick up a sheet of paper and make a scutlist each shift. Enter each patient like this:
Age, PMHx related to CC, CC. then a list of things that need to be done

e.g. 45 yo male h/o DM, HTN co CP x 2 hours
scutlist - make an empty box next to each item, then check the box when it's done. When all of the boxes are filled, you should have disposition
EKG
CXR
labs

3) During your history, don't go overboard on your review of systems. Stick to problems related to the chief complaint, otherwise you will end up working up an old lady's arthritis, GERD, hearing problem and anxiety when she came for asthma exascerbation. Everything is nothing, but one thing is everything: patients with a hundred symptoms are usually not sick, patients with one overwhelming symptom often are sick.

4) Remeber as an ER doc you're not as much responsible for making diagnoses as you are ruling out emergencies. If you think the patient is not sick, make sure you have ruled out clinically or with labs/images all possible dangerous diagnoses. It's okay to send someone home/upstairs without a diagnosis as long as they are stable and will get followup.

5) You're an intern. Ask questions and prepare to feel stupid. It's part of the learning process, and everyone understands you're new.

 

[southerndoc]

In the ED

1) Read up on basic DDxs and workups for common cheif complaints: Chest Pain, Headache, Weak and Dizzy, SOB, Abdominal Pain, Pediatric Fever, etc
Concentrate on the dangerous diagnoses like MI, appendicitis, etc and know how to rule them out.

2) Pick up a sheet of paper and make a scutlist each shift. Enter each patient like this:
Age, PMHx related to CC, CC. then a list of things that need to be done

e.g. 45 yo male h/o DM, HTN co CP x 2 hours
scutlist - make an empty box next to each item, then check the box when it's done. When all of the boxes are filled, you should have disposition
EKG
CXR
labs

3) During your history, don't go overboard on your review of systems. Stick to problems related to the chief complaint, otherwise you will end up working up an old lady's arthritis, GERD, hearing problem and anxiety when she came for asthma exascerbation. Everything is nothing, but one thing is everything: patients with a hundred symptoms are usually not sick, patients with one overwhelming symptom often are sick.

4) Remeber as an ER doc you're not as much responsible for making diagnoses as you are ruling out emergencies. If you think the patient is not sick, make sure you have ruled out clinically or with labs/images all possible dangerous diagnoses. It's okay to send someone home/upstairs without a diagnosis as long as they are stable and will get followup.

5) You're an intern. Ask questions and prepare to feel stupid. It's part of the learning process, and everyone understands you're new.

Excellent advice... thanks!

 

[MariaG]

Thanks for the responses

Anyone know of a good pocket manual to carry/read before i start?

Anyone think the Wash Manual Intern Survival guide is helpful?

 

[docB]

The Wash Manual is great but it's more for medicine wards than the ED. I like the Tarascon Adult Emergency Pocketbook and its counterpart the Peds Emergency Handbook are both very brief, not much text, lots of tables, but good info in a pinch.

Remember, the absolutely most important thing to get down in the first few months of ED residency is sick vs. non-sick.

 

[Sessamoid]

Get a PDA if you don't already have one. Personally, I like 5 Minute Emergency Consult, but if you're not going to be in EM permanently, it's not worth the cost. On the other hand, 5 Minute Clinical Consult would be a good thing to have on your pda for a transitional intern all year around. I've used Skyscape's Palm 5MCC during internship, and it was invaluable.