moonlighting

[allendo]

What are the must have resources when moonlighting?

---

Members don't see this ad.

 

[EM_Rebuilder]

What are the must have resources when moonlighting?

An internet connection is my primary resource. I also always carry a Tarascon Phamacopoeia in my pocket. I usually have the EMRA Antibiotic Guide in my laptop bag. I use my wifes cellular internet card (from her work), although I do not think I have been to a hospital without internet yet and I have worked in approx 10 shops (5K/yr to 35K/yr).

 

[anonymousEM]

Agree with the above, but more importantly as resources go...how do you get a sick patient out? Know who your receiving places are, what gets admitted, what stays, who to call for an ICU transfer, things like how long it will take you to get a respiratory therapist in at 2 am on a holiday weekend, etc. In my experience, the nurses have been really helpful but there are certainly things to think about in a small shop that never come up when you're at a big hospital like in your residency.

 

[Hamhock]

things like how long it will take you to get a respiratory therapist in at 2 am on a holiday weekend.

What does an ED doc need a respiratory therapist for at 2am on a holiday weekend?

(other than transfer)

HH

 

[Arcan57]

What does an ED doc need a respiratory therapist for at 2am on a holiday weekend?

(other than transfer)

HH

Many places, the RT is the only one that can get the vent. Bagging a patient for a half-hour after you've intubated them as you wait for RT to show up happens, in some places commonly.

To the OP, what are your back-up airways? If they don't have a glidescope or bougie, then buy (steal) a bougie and keep it with you. What diseases can't you handle? I've worked at a place that had excellent (and relatively fearless) general surgeons that could repair a AAA except that our blood bank maxed out at 4 units pRBCs and 2 units of FFP. It can be tough to get a feel for how situations are handled, and it's usually worth sitting down with the director (or you're off-going colleague) and inquiring about a few archetypal situations. Working in an academic center, you're used to looking down on "dumps" from community/rural hospitals. Remember that just because you can handle the ED portion of the case doesn't mean the hospital can handle the entirety of the patients care. Simple stuff at the academic center (r/o intussuception comes to mind) cam be impossible if you don't have an US tech that's experienced in looking for it, or a peds surgeon who can deal with the complications from an air enema.

 

[Zanegray]

A pair of clean underpants.

 

[Daiphon]

The books so far are all good; I like the EMRA guide for ABx choice...

I'd also make your own book (or make sure the ED has one) of your transfer protocols and important numbers.

The best resource, though, is knowing what you have & don't; and if you're moonlighting in a critical access hospital (e.g. "the sticks"), then you need to be able to MacGyver some things sometimes... so,

Other things I couldn't live without:
-A headlamp (Petzl Tikka - great for suture work without the overhead lamp)
-Leatherman
-Handheld cobalt blue lamp (can get a Maglite with a Cobalt filter) - works like a wood's
-Extra phone charger (sometimes your only internet is through the phone - and that KILLS battery life)
-Perc Cric Kit (as above with the bougie, "borrow" one if necessary)
-Motrin/APAP/Sudafed/Zyrtec/Pepcid for the inevitable headache & reflux (your own). d=)

Have fun!
-t