EM Sub- I

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I'm wrapping up my first EM rotation and I found it useful to have the emra antibiotic guide, the pocket notebook for emergency medicine, scissors, tape, a paper or small plastic ruler, pens, lube, hemoccult developer, reflex hammer, steth, and pen light

and chapstick
 
mihirtak said:
Was just wondering what things I should carry around with me on my EM rotations? Also whats the best pocket EM book that I can fit into my white coat? Thanks!
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Mandatory:
  • Stethoscope
  • Trauma shears (but if you are a med student, not the Raptors. Go with the generic $10 ones)
  • Pen
  • Flashlight
  • Phone (have WikEM app installed on it and read through it before presenting when possible)
Optional:
  • Stool guiac cards, lube, and developer
  • Pocket books (Stanford or EMRA antibiotic guide would be what I recommend; may also consider another chief complaint based handbook, though in lieu of those maybe just use WikEM on your phone)
  • Notebook
  • Reflex hammer
In general, I think less is more. Stick with the minimum you can. Rather than carry everything you may need in your pockets, take the time to learn where everything is located.
 
Apps are probably more acceptable now, but when I rotated as a fourth year (not even that long ago) a few students rotating with me at different sites told me they wished they had my pocket books instead of the app versions as people have commented they were always on the phone during the shift.
 
As far as pocket references, I liked EMRA's EM Basics, especially early on. Easy to get a quick reminder of common chief complaints and workups.
 
Depending on your site, one of those little portable finger pulse-ox’s can be great too. Let’s you walk a patient and see if they desat.

My 1st SubI most pts didn’t have continuous pulse ox so it helped to be able to assess oxygenation in the room.
 
Where in the hell are people rotating that a reflex hammer or pulse ox are even remotely useful to carry around? Same with lube, guaiac developer, tape. Weird. Anyway, I'd say stethoscope. For apps, I used the WikEM app most, followed by the EMRA abx guide. Early on I relied on the QuickEM app a lot also, but in retrospect WikEM was fine. If your hospital has an antibiogram or antibiotic guide easily accessed, that can be good also.
 
Yea so far Ive just been rolling with a steth, emra antibiotic, and ipad with wikiem/uptodate/mdcalc, and thats been sufficient.
 
Mr. Vandemar said:
Where in the hell are people rotating that a reflex hammer or pulse ox are even remotely useful to carry around? Same with lube, guaiac developer, tape. Weird. Anyway, I'd say stethoscope. For apps, I used the WikEM app most, followed by the EMRA abx guide. Early on I relied on the QuickEM app a lot also, but in retrospect WikEM was fine. If your hospital has an antibiogram or antibiotic guide easily accessed, that can be good also.
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I was thinking the same thing, like lube? wtf...
 
Listen2Savage said:
I was thinking the same thing, like lube? wtf...
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Lube, guiac cards, pulse ox are things that are readily available in a well funded ED.

At my county subI you need to have the attending put in the order for that stuff and then the charge nurse will unlock it from a locked cabinet - if it’s even stocked which it’s usually not.
 
The Knife & Gun Club said:
Lube, guiac cards, pulse ox are things that are readily available in a well funded ED.

At my county subI you need to have the attending put in the order for that stuff and then the charge nurse will unlock it from a locked cabinet - if it’s even stocked which it’s usually not.
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It's not that I expect these things to not be available, but when a student is new, it might take them a while to figure out where things are. Just having it on them until they do makes them look smoother, more in control, etc.
 
gro2001 said:
It's not that I expect these things to not be available, but when a student is new, it might take them a while to figure out where things are. Just having it on them until they do makes them look smoother, more in control, etc.
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Likewise, have a pair of gloves in your pocket. If you have to get them off the wall, that's a lost 10 to 15 seconds, and many docs won't wait for you.

"Show me a student from the “best medical school” (BMS) who only triples my work and I will kiss his feet."
 
Scope, pen, patient list, and spare gloves.....still trying to get my WikEM app to work though =/
 
A spare foley is always good...except some patients get weirded out when they see a bag of pee taped to your leg...haha
 
Apollyon said:
Likewise, have a pair of gloves in your pocket. If you have to get them off the wall, that's a lost 10 to 15 seconds, and many docs won't wait for you.

"Show me a student from the “best medical school” (BMS) who only triples my work and I will kiss his feet."
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Or just don't be a useless dickhead and wait 15 seconds? Why even bother having students rotate with you. If you can't even wait for them to put on gloves, then I can't imagine how that person would handle anything else students do. Just tell your faculty you don't have enough clinical confidence to take a student.

At the above, damn, did you guys all carry around a toolbelt for all that garbage? Stethoscope and EMRA antibiotic reference is all you need.
 
Rekt said:
Or just don't be a useless dickhead and wait 15 seconds? Why even bother having students rotate with you. If you can't even wait for them to put on gloves, then I can't imagine how that person would handle anything else students do. Just tell your faculty you don't have enough clinical confidence to take a student.

At the above, damn, did you guys all carry around a toolbelt for all that garbage? Stethoscope and EMRA antibiotic reference is all you need.
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Anger problems, much? You're a student, right? You sound like the one with confidence problems. You speak with an authority you do NOT have, and, maybe, when you are actually in the position, you'll have perspective.

And, if you are not there, ready to go, I'm not coddling you. Pro tip - the attendings you like as a student and intern are the same ones you don't like when you're senior. What did someone else post? "Being in the ED with EM 2's and 3's are like playing Doom on God mode". That ain't you.

But, call me more names, if that makes you feel good.
 
Apollyon said:
Anger problems, much? You're a student, right? You sound like the one with confidence problems. You speak with an authority you do NOT have, and, maybe, when you are actually in the position, you'll have perspective.

And, if you are not there, ready to go, I'm not coddling you. Pro tip - the attendings you like as a student and intern are the same ones you don't like when you're senior. What did someone else post? "Being in the ED with EM 2's and 3's are like playing Doom on God mode". That ain't you.

But, call me more names, if that makes you feel good.
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That's Tenk.

Psst. I trained him.
 
The Knife & Gun Club said:
Lube, guiac cards, pulse ox are things that are readily available in a well funded ED.

At my county subI you need to have the attending put in the order for that stuff and then the charge nurse will unlock it from a locked cabinet - if it’s even stocked which it’s usually not.
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lol ya

I'm just wondering who is cruising the ED with lube in their back pocket
Rekt said:
Or just don't be a useless dickhead and wait 15 seconds? Why even bother having students rotate with you. If you can't even wait for them to put on gloves, then I can't imagine how that person would handle anything else students do. Just tell your faculty you don't have enough clinical confidence to take a student.

At the above, damn, did you guys all carry around a toolbelt for all that garbage? Stethoscope and EMRA antibiotic reference is all you need.
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Im always accumulating gloves in pockets for this reason, usually two pairs

You're already a dumb@ss, why would you make the attending or resident wait the extra time

Your job is to trim the fat where you can bc being there is a huge time drain in itself
 
Rekt said:
Or just don't be a useless dickhead and wait 15 seconds? Why even bother having students rotate with you. If you can't even wait for them to put on gloves, then I can't imagine how that person would handle anything else students do. Just tell your faculty you don't have enough clinical confidence to take a student.

At the above, damn, did you guys all carry around a toolbelt for all that garbage? Stethoscope and EMRA antibiotic reference is all you need.
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you're the entitled kid on every rotation

zero perspective or situational awareness I'm sure
 
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Most Eds I’ve been in have gloves outside each room or somewhere nearby. I haven’t had an issue with that. I think it’s important the first shift to locate everything: from the crash cart to lac repair kit to where the ultrasound/interpreter machines are, etc. So when the attending or chief resident need something immediately, you don’t look like an idiot. This is what I’ve noticed during my first Sub-I.
 
Learn the ins and outs of the EMR system and make sure your login works prior to the start of your rotation. I did a lot of auditions, and this was often the most difficult thing to get used to, and is so vital in terms of following up on labs/ct on your patient.
 
Apollyon said:
Anger problems, much? You're a student, right? You sound like the one with confidence problems. You speak with an authority you do NOT have, and, maybe, when you are actually in the position, you'll have perspective.

And, if you are not there, ready to go, I'm not coddling you. Pro tip - the attendings you like as a student and intern are the same ones you don't like when you're senior. What did someone else post? "Being in the ED with EM 2's and 3's are like playing Doom on God mode". That ain't you.

But, call me more names, if that makes you feel good.
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Lol okay buddy. You're the physician that thinks every resident likes them, but in reality they hate you. You seem like you're the type to wear your white coat around the ED and insert your superiority at every moment.
 
Rekt said:
Lol okay buddy. You're the physician that thinks every resident likes them, but in reality they hate you. You seem like you're the type to wear your white coat around the ED and insert your superiority at every moment.
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You're in a hole, and going lower. And you are way off base. You know why I DON'T have to "insert (my) superiority"? Because I just stand there, and you fumble.

But, again, you do you. You are "Rekt", after all. Do you even lift?
 
Rekt said:
Or just don't be a useless dickhead and wait 15 seconds? Why even bother having students rotate with you. If you can't even wait for them to put on gloves, then I can't imagine how that person would handle anything else students do. Just tell your faculty you don't have enough clinical confidence to take a student.

At the above, damn, did you guys all carry around a toolbelt for all that garbage? Stethoscope and EMRA antibiotic reference is all you need.
Click to expand...

Personally I like to think I have angelic level of patience with students. I routinely let them intubate, place central lines, chest tubes, etc. Talk them through decision making and so on. However, not everyone has the same amount of patience. And it's not like the less patient attending will snap at med students for taking too long with the gloves or asking about where they can find this and that, but the OP asked for advice and I understood it to mean on how to shine and stand out from the pack. There is no question for me that the student who is a little bit smoother will shine a little bit more. Don't like the advice, don't take it.
 
Rekt said:
Lol okay buddy. You're the physician that thinks every resident likes them, but in reality they hate you. You seem like you're the type to wear your white coat around the ED and insert your superiority at every moment.
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Duuuude. As much as I like a good firebrand... this ain't it, chief.
 
Rekt said:
Lol okay buddy. You're the physician that thinks every resident likes them, but in reality they hate you. You seem like you're the type to wear your white coat around the ED and insert your superiority at every moment.
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PSA

You are a doo-ish

your SLOEs will suck

you will match low on your list.

For the insulted attendings...

Some of these Millenials are embarrassing

Consider older applicants while making your rank list this year

Im only 29, but damn, Rekt, stfu
 
mihirtak said:
The original post was intended to help new Sub-Is (like me) figure out what they needed to bring to the ED to be successful. I'm not sure how it devolved into this useless back n forth banter.
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dont be such a nancy boy
 
mihirtak said:
The original post was intended to help new Sub-Is (like me) figure out what they needed to bring to the ED to be successful. I'm not sure how it devolved into this useless back n forth banter.
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Sounds pretty par for the course for SDN, unfortunately.

I've been doing fine with a notepad, pens, stethoscope, and a phone with WikEM and UpToDate.
 
I carried trauma shears, two pens, a stethoscope, and books from the EMRA packet (always EM basics and the little book of medical and trauma clinical decision rules that I can't place the name of right now. EM Fundamentals on slower shifts.) Blank piece of paper folded into quarters.

EMhopeful2 said:
Most important is to figure out what residents give the best evals and avoid the dinguses.
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This is unfortunately true. Many of my co-residents just gave everyone 100's, I tried to stick to our official policy of 10% getting scores of honors. I'd tell the student I wanted a brief, focused HPI and exam, differential of at least three things unless a straightforward complaint, and to commit to a plan regardless of if they're right or wrong. I'd also like them to follow up results. I'm still surprised that only around 10% could manage that. I now do around 60% academic shifts with residents and the occasional student at the secondary county site, and I haven't had a single med student meet those requirements. I guess I shouldn't be surprised in this era of grade inflation, but if you try to actually do what we'd like a new intern to do you'll probably get honors.
 
i downloaded the EMbasic show notes by steve carrell on embasic.com to look up differentials and workups for chief complaints if i blanked or to make sure i didnt miss something as i was walking from the room to present and gathering my thoughts. PalmEM is an app for like 4 bucks which is incredibly useful. i always had the mra antibiotic book with me, i use the EMRA EM fundamentals book or had the the purple EM book

as far as podcasts to study from when you are off shift i would highly recommend embasic.com or EMRAP C3 podcast
 
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