what to learn while in the ED

[badasshairday]

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I'm in the ED this month. What should I focus on to maximize applicable knowledge for this upcoming July when I start radiology? Kind of tired of seeing febrile kiddos, flu, copd exacerbations, asthma exacerbations, chest pain... The true emergencies are cool, but the lower acuity stuff, what should I try to focus on and see in particular?

 

[shark2000]

I'm in the ED this month. What should I focus on to maximize applicable knowledge for this upcoming July when I start radiology? Kind of tired of seeing febrile kiddos, flu, copd exacerbations, asthma exacerbations, chest pain... The true emergencies are cool, but the lower acuity stuff, what should I try to focus on and see in particular?

Welcome to true practice of medicine. 95% of the cases are 3-4 mundane diagnoses. Probably as a DR, you see more interesting cases in one day that any other doctor sees in the hospital in one week.

Internship is a true waste of time. My recommendation:

1- Do the bare minimum.
2- Go late and leave early.
3- Nobody will give you credit because you were a good ED intern as a future radiology resident.


Learn the most important clinical aspect of modern medicine: Send the patient to CT scanner directly from ED. Then Call radiology department only 3 minutes after the scan is done (or sometimes before the scan is done) and complain why the report is not there. Ask for a prelim report. Then call a consult or send the patient home.

I can not think about anything you can do useful. Many may say start to look at CXR or CTs or MRs. This is useless. You can do it, but really does not help. It is like a high school student dabbling in an anatomy book.

 

[badasshairday]

Learn the most important clinical aspect of modern medicine: Send the patient to CT scanner directly from ED. Then Call radiology department only 3 minutes after the scan is done (or sometimes before the scan is done) and complain why the report is not there.

Literally LOL.

I think I'm going to try to see the injuries, like all the foot injuries etc. Try to correlate physical to imaging finding. I'm sure that 1 out of 20 will have a fracture at least...

 

[EeePC1005PR]

I'm in the ED this month. What should I focus on to maximize applicable knowledge for this upcoming July when I start radiology? what should I try to focus on and see in particular?

Keep a log of patients you've ordered images on but never quite got to see the formal report before the end of your shift. Next shift when you have time, load up those images, spend a minute or two going through them and see if you can find anything abnormal or peculiar. Then read the formal report.

Depending on where you work and which ED consultant, you might come across some consultants who like to scan people. No need to confront them but in your mind see if you can justify doing or not doing those requested scans.

If some of the senior ED doctors do ultrasound, you can learn from them as well.

 

[XerxesOfPersia]

Haha shark's post was indeed funny.

I did my ED rotation back in September and I just tried to get a basic feel of what the attendings, consulting services, etc. were looking for when ordering scans or reading the reports that would actually help them with patient care. Nothing more than that really.

In my opinion, the ED docs at my TY were actually pretty good when it came to ordering studies. They usually talked me through their decision making, which occasionally included specific reasons not to scan somebody, and they let me play around with the ultrasound machine if they did anything bedside. Not that I remember a great deal from it but it did make the month more interesting.

 

[cowme]

the most important thing you can do is get perspective. We always roll our eyes at the stupid things the ED docs do, but I remembered a lot of radiology reports that were completely worthless while on clinical rotations (hedging, not addressing the clinical question, egreious typos that nearly led to bad outcomes---you'd be shocked at how dangerous a dictaphone can be when it drops the word "no"). Just remember how things are on the other side.

 

[deleted6669]

yup. "unable to read this abd ct without po contrast for presence of appendicits. suggest clinical correlation".

 

[shark2000]

yup. "unable to read this abd ct without po contrast for presence of appendicits. suggest clinical correlation".

If it is true appendicitis, it will show up on IV contrast only CT and Oral contrast does not matter.
Anyway, I understand the importance of turn around time for ED. But, if I want to irradiate my abdomen-pelvis, I'd rather have the best quality study which includes oral+IV. ED docs skip this just to decrease turn around time and this is stupid. Why should we irradiate someone without doing the best possible study? There is almost no harm in giving oral contrast.

There are subpar people in all fields including radiology, ER, internal medicine, ... The problem is are work is judged by another doctor. If an ER doc does not practice high quality medicine, more likely it will go unnoticed because the patient does not know what exactly a high quality practice is. From patient's perspective, the best one is the one that he/she has the best interaction with.

The truth is we are supposed to do internship to learn clinical medicine. But, no such thing as clinical medicine is left. The reason that people scrutinize radiology report meticulously, is tremendous impact of imaging on clinical medicine. Internship is a waste of time.

 

[deleted6669]

If it is true appendicitis, it will show up on IV contrast only CT and Oral contrast does not matter.
.

I know this. you know this. the literature supports this. pretty much every rad under 50 believes this and is happy to report appropriately and many rads over 50 won't even try without a 2-3 hr oral prep. and since many surgeons won't touch a patient without a ct report, 2-3 hrs is a big deal....
now we just ask the young guys to read the abd ct studies for us....,

 

[Rad2013]

Learn to have a social life and enjoy not working 6 days a week.

 

[colbgw02]

Every now and then I'll call acute appendicitis off of a non-con, like a renal stone protocol. It's not hard to do if the patient has enough natural peritoneal contrast and it's full-blown appendicitis. Even with an unequivocal report, half the time in residency the surgeons would re-order the CT with oral contrast because they wouldn't take the patient to the OR unless the appendix didn't fill. It was such a waste. Luckily, the surgeons at my current gig don't do this.