Well after waiting through 3 years of med school and countless hours of ridiculous time and energy, I finally completed my first shift in EM last night. I'm currently rotating at a very high acuity trauma center in a major urban environment. My first thought about kick starting my career path on an 11pm shift on a Sat. night in the aforementioned environment was, "Oh boy, here we go."
I got to the hospital around 10:30 and I felt like the little lost MS4 who was wondering around looking for my people. I finally made my way over to my appropriate pod and proceeded to waive and introduce myself. The 1 attending and 2 residents sitting around briefly lifted their eyes up from their respective computers for just enough time to nonchalantly say, "hey, welcome" and then quickly returned to their computers. I thought to myself, great, just like being back on surgery.
My resident finally finished up what she was doing and proceeded to orient me very quickly to what was going on. I put my bag down, and without adieu, said, "so, should I just grab a random patient?" They helped me figure out the computer tracker and to choose who had already been assigned and who had not. Unfortunately for me, the med students don't have logins to the computer system at my hospital. So I'm somewhat left to depend on hopping on someone else's already logged in compter. It's a bit of a drag.
So my first patient assigned was a toothache patient. I actually thought it was kind of ironic and a totally appropriate way to start off EM. I haven't taken care of a single tooth ache in med school, and I learned that much of my night would be spent taking care of a number of ailments that I had not seen a single episode of during my third year. It turned out that my tooth ache pt had been there 2 weeks ago for the same reason. He was given percocet and a referral to the dentist. Did he follow up with the dentist? Hell no! He wanted more narcs, of course. We ended up sending him home on Motrin and told him to get his ass to a dentist. He was not pleased.
My second pt was an AIDS pt who had come in with acute onset of n/v. I learned from this pt that the EM residents apparently hate consulting medicine, and will avoid it at all costs. I was actually kind of surprised by this. At my internal medicine site last year, there were no EM residents at the hospital. Almost everyone who came in sick got admitted. We eventually kept the guy over night and were planning to d/c him home the following morning because his vomiting was under control. I was surprised by this because the guy's CD4 count was 25. I felt the vomiting was most likely an ominous sign for him.
Once we dealt with him, trauma ensued. We had 2 GSWs, one in the R chest, and the other through the femur. Surgery was running traumas last night, so they stabilized the two patients. EM helped with the primary and secondary surveys. Once we got those under control, in walks a stab wound to the face. 11cm lac from ear to chin, full thickness all the way through. It was actually pretty impressive. Trauma can certainly be the sexy side of EM.
After the traumas were under control, we went back to work. The rest of my night included a vaginal d/c pt, conjunctivitis pt, and shingles pt. I think that's everyone...
There were parts of the night that were extremely fun, parts that were slow while I was waiting for my resident to get caught up with charting, parts that were challenging while I was trying to improvise on things I had never seen before, and parts where my adrenaline was in high gear and giving me that giddy feeling inside. It seems pretty par for the course for a typical EM night in an urban trauma setting.
As an MS4, I felt somewhat like a visitor. I really wish I could've helped more with the charting and getting my residents caught up. Because of the new EMR at my hospital, this was not possible. I'm still trying to find a balance between being helpful, but not annoying. I'm also trying to figure out how to be helpful with traumas, without overstepping my boundaries. I have trauma shears in hand, and I'm ready to throw an IV or foley at any time. I'm trying to avoid stepping on the toes of the techs who are doing those jobs in an acute setting.
Well the first shift is in the books. I'm heading back tonight and tomorrow night for my second and third shifts. I'm actually really excited to get back up there tonight. I'm pretty sure your first EM shift should leave you somewhat perplexed. The wide spectrum of ailments that come through can make one feel discombobulated while trying to figure out what to do. It's very different than IM where you have all the time in the world to write up extensive H&Ps; it's totally different from surgery where the only question is: do I bring them up or do I not? It's fairly different from psych where you actually can spend as much time as you want doing a MSE and all the other goodness of psych. It's definitely different from peds where everything seems to be RSV or asthma, although we did have pediatric cases in the ED last night. It's different from ob/gyn where many of the patients are healthy and are only there for prenatal checkups and yearly exams. And finally, it felt different from family med where the patients who come in are familiar faces and are there for a BP check or DM management. The fact is that while EM may be different than all those specialties, in a sense, it IS all those specialties. That has always been the appeal of EM to me. I'm very much hoping that tonight's shift proves to be more comfortable and controlled for me. I would like to walk out feeling better about my performance. Last night was not exactly overwhelming, just totally different.
To all the other MS4s out there who are rotating in EM currently, good luck with everything. This is a fun time for sure and I'm looking forward to what's in store.
Cheers
I got to the hospital around 10:30 and I felt like the little lost MS4 who was wondering around looking for my people. I finally made my way over to my appropriate pod and proceeded to waive and introduce myself. The 1 attending and 2 residents sitting around briefly lifted their eyes up from their respective computers for just enough time to nonchalantly say, "hey, welcome" and then quickly returned to their computers. I thought to myself, great, just like being back on surgery.
My resident finally finished up what she was doing and proceeded to orient me very quickly to what was going on. I put my bag down, and without adieu, said, "so, should I just grab a random patient?" They helped me figure out the computer tracker and to choose who had already been assigned and who had not. Unfortunately for me, the med students don't have logins to the computer system at my hospital. So I'm somewhat left to depend on hopping on someone else's already logged in compter. It's a bit of a drag.
So my first patient assigned was a toothache patient. I actually thought it was kind of ironic and a totally appropriate way to start off EM. I haven't taken care of a single tooth ache in med school, and I learned that much of my night would be spent taking care of a number of ailments that I had not seen a single episode of during my third year. It turned out that my tooth ache pt had been there 2 weeks ago for the same reason. He was given percocet and a referral to the dentist. Did he follow up with the dentist? Hell no! He wanted more narcs, of course. We ended up sending him home on Motrin and told him to get his ass to a dentist. He was not pleased.
My second pt was an AIDS pt who had come in with acute onset of n/v. I learned from this pt that the EM residents apparently hate consulting medicine, and will avoid it at all costs. I was actually kind of surprised by this. At my internal medicine site last year, there were no EM residents at the hospital. Almost everyone who came in sick got admitted. We eventually kept the guy over night and were planning to d/c him home the following morning because his vomiting was under control. I was surprised by this because the guy's CD4 count was 25. I felt the vomiting was most likely an ominous sign for him.
Once we dealt with him, trauma ensued. We had 2 GSWs, one in the R chest, and the other through the femur. Surgery was running traumas last night, so they stabilized the two patients. EM helped with the primary and secondary surveys. Once we got those under control, in walks a stab wound to the face. 11cm lac from ear to chin, full thickness all the way through. It was actually pretty impressive. Trauma can certainly be the sexy side of EM.
After the traumas were under control, we went back to work. The rest of my night included a vaginal d/c pt, conjunctivitis pt, and shingles pt. I think that's everyone...
There were parts of the night that were extremely fun, parts that were slow while I was waiting for my resident to get caught up with charting, parts that were challenging while I was trying to improvise on things I had never seen before, and parts where my adrenaline was in high gear and giving me that giddy feeling inside. It seems pretty par for the course for a typical EM night in an urban trauma setting.
As an MS4, I felt somewhat like a visitor. I really wish I could've helped more with the charting and getting my residents caught up. Because of the new EMR at my hospital, this was not possible. I'm still trying to find a balance between being helpful, but not annoying. I'm also trying to figure out how to be helpful with traumas, without overstepping my boundaries. I have trauma shears in hand, and I'm ready to throw an IV or foley at any time. I'm trying to avoid stepping on the toes of the techs who are doing those jobs in an acute setting.
Well the first shift is in the books. I'm heading back tonight and tomorrow night for my second and third shifts. I'm actually really excited to get back up there tonight. I'm pretty sure your first EM shift should leave you somewhat perplexed. The wide spectrum of ailments that come through can make one feel discombobulated while trying to figure out what to do. It's very different than IM where you have all the time in the world to write up extensive H&Ps; it's totally different from surgery where the only question is: do I bring them up or do I not? It's fairly different from psych where you actually can spend as much time as you want doing a MSE and all the other goodness of psych. It's definitely different from peds where everything seems to be RSV or asthma, although we did have pediatric cases in the ED last night. It's different from ob/gyn where many of the patients are healthy and are only there for prenatal checkups and yearly exams. And finally, it felt different from family med where the patients who come in are familiar faces and are there for a BP check or DM management. The fact is that while EM may be different than all those specialties, in a sense, it IS all those specialties. That has always been the appeal of EM to me. I'm very much hoping that tonight's shift proves to be more comfortable and controlled for me. I would like to walk out feeling better about my performance. Last night was not exactly overwhelming, just totally different.
To all the other MS4s out there who are rotating in EM currently, good luck with everything. This is a fun time for sure and I'm looking forward to what's in store.
Cheers
There was less craziness and more control throughout the night. Felt good. I have one more night shift tonight, then I'm off for a couple days. Looking forward to it.
