Hi. I'm a soon-to-be PGY-1 IM intern and my first rotation is in the ER. I'm kind of nervous right now and I'd really appreciate any advice on how I can survive the ER rotation. What books to read, what subjects to study and any useful tips would be truly appreciated. Thank you!
How to prepare for the ER
- Thread starter healuv
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There are two kinds of patient presentations in the ER. Neither of these are like the 15 minute biopic you give on IM rounds. There's the quick heads up to the attending or the senior about what you have. "Old guy, chest pain, gonna get admitted but looks good." would be a good quick report. The longer presentation that usually happens when it's time to dispo should take about 2 minutes and be very complaint specific.
The most important thing for newbies in the ER to pick up is sick vs. not sick. 90% of patients in the ER are not sick. You can piddle around with them for hours and it won't cause a problem. If you run across someone who is sick go get the attending or the senior. Sick patients are those who are unresponsive, cool pale and diaphoretic, hypotensive or any combination of those.
The most important thing for newbies in the ER to pick up is sick vs. not sick. 90% of patients in the ER are not sick. You can piddle around with them for hours and it won't cause a problem. If you run across someone who is sick go get the attending or the senior. Sick patients are those who are unresponsive, cool pale and diaphoretic, hypotensive or any combination of those.
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Continuing with the deceptive theme: NEVER trust triage vitals, especially the temp - take your own. In an elderly patient who looks sick with nomal numbers, get a rectal temp.
Other "pearls" :
-Show up 15 minutes early and be prepared for sign out.
-When your shift ends - it ends. That means you go home. (exception below)
-Don't ever, EVER, sign out a pelvic or a rectal - even if it means staying past your shift. - No one wants to introduce themselves to someone like that.
-Make a decision and stand by it - your nurses are busy and don't like to have their orders changed every 5 minutes. If you don't know something - ask the nurses, they like to help and (most of the time) won't steer you wrong.
- Every phone call you make and every resident you speak to will most likely be working with you in some form for the rest of your residency - don't burn any bridges.
- Take note of the admission process from the ED doc's perspective, and remember it when you take new admissions for IM - understanding each other makes the world go 'round.
- Have fun - don't be intimidated by the work or the patients, planning a disposition for your patients will be the hardest part of your job, and once you get comfortable with it - the job really becomes pretty easy...
Other "pearls" :
-Show up 15 minutes early and be prepared for sign out.
-When your shift ends - it ends. That means you go home. (exception below)
-Don't ever, EVER, sign out a pelvic or a rectal - even if it means staying past your shift. - No one wants to introduce themselves to someone like that.
-Make a decision and stand by it - your nurses are busy and don't like to have their orders changed every 5 minutes. If you don't know something - ask the nurses, they like to help and (most of the time) won't steer you wrong.
- Every phone call you make and every resident you speak to will most likely be working with you in some form for the rest of your residency - don't burn any bridges.
- Take note of the admission process from the ED doc's perspective, and remember it when you take new admissions for IM - understanding each other makes the world go 'round.
- Have fun - don't be intimidated by the work or the patients, planning a disposition for your patients will be the hardest part of your job, and once you get comfortable with it - the job really becomes pretty easy...
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Another pearl: Rectal thermometers go in the rectum, and not in the mouth. Similarly, suppositories follow this same philosophy. 🙂NinerNiner999 said:
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My PD highly recommends this book for rotators/students/interns. It's $75, reportedly very readable, and has color pics, ECG's, etc.
An Introduction to Clinical Emergency Medicine : Guide for Practitioners in the Emergency Department
by S.V. Mahadevan (Editor), Gus M. Garmel (Editor)
An Introduction to Clinical Emergency Medicine : Guide for Practitioners in the Emergency Department
by S.V. Mahadevan (Editor), Gus M. Garmel (Editor)
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The Tarascon Adult Emergency Pocketbook is a good, cheap reference. Almost no text though.kbrown said:
https://www.tarascon.com/products/index.php?PID=25
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kbrown said:
30 common problems in EM by EMRA is a nice quick reference. I just picked it up again just last month and it's just as good of a review now as when I was a 4th year.
Wilco. I like the Approach to the EM patient by Sloan, what did you think of the book for 4th year. I thought it was a good overview of how to approach your patient from a chief complaint point of view. I haven't seen the other book you recommended above.
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If you own a Palm or PocketPC, PEPID is not to be missed (www.pepid.com). Think of it as a better version of the 5 Minute Emergency Consult, Epocrates PRO, and every medical calculator you'd every want plus an eye chart, etc rolled into one. Yes, you have to pay for it, but it's updated every 6 weeks or so, and they do offer a resident discount (the last time I checked). Everybody I've gotten to try it has loved it as well. It's the little things it has like the dosing calc built into each drug which rocks when you're treating kids as well as the "Dispo" guidelines in each section which really help when you're dealing with something unfamiliar.
And, most importantly, "Don't Panic!"
And, most importantly, "Don't Panic!"
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Hercules said:
PEPID saved me in third AND fourth year rotations (gotta love the differential Dx section on each diagnosis) and continues to save me in PGY-1 (love the dispo stuff!). I also can't believe more people aren't using it - but now most of my intern class is after borrowing mine for a shift.
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deleted52758
i really enjoyed the washington manual for emergency medicine. it's a bit tougher to find, but it saved me several times in thinking of differentials and the first step to working up patients.
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PEPID is really expensive!!! $80 for 6 months! That's way too much money for a lowly PGY-1 living in poverty in Los Angeles. 36K in LA doesn't allow for frivolous expenses like this. Too bad, because it looks like good software.
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It's the PEPID ER/ED whatever - the one specifically geared towards emergency care.
Yeah, it's a lot. But you can get a free trial (or at least could last year...) I used a free trial month for my away rotation, and was quite thankful for it more than a few times.
Now that I've moved and have a new IP address, I wonder if I could get another free month...
Yeah, it's a lot. But you can get a free trial (or at least could last year...) I used a free trial month for my away rotation, and was quite thankful for it more than a few times.
Now that I've moved and have a new IP address, I wonder if I could get another free month...
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EctopicFetus said:
How good is the trial? Does it limit you to only certain topics or drugs like the other free trials?
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12R34Y said:
Sorry here's the second addition of the book. It was by hamilton and sloan as a first addition and I butchered the title of the book. Sorry it's been 3years since I used the book.
http://www2.acep.org/bookstore/index.cfm?go=product.detail&id=10109
