However, this was my first time in the ED as a provider, and even in the student capacity, this caused me a little anxiety. Additionally, I don't feel prepared going into rotations (although I often find I am more prepared than I realized), but especially for the ED, where you need to think fast and know your stuff! I had not studied EKGs the way I wanted to and the suture kit I purchased for practice had not been touched. But, I talked with a student who completed the rotation, and loved it, which helped me feel a little better!
On my rotation I worked 11 hour shifts, including weekends. I am told this was to make sure students understood the nature of shift work in the ED, which I understood completely to begin with. But, I get it. And they didn't require me to work Thanksgiving, which was nice. Because 2 new grad PAs were just starting, besides my first day starting at 7am, I worked 11a-10p, and the training PAs worked the day shift. There was also an optional (for me) 5p-3a shift that the PAs rotated through. My commute each day was 45 min to 1 hour each way.
So, I really enjoyed this rotation! The PAs mostly work in a rapid medical evaluation area on this rotation. We do see critical patients, but these patients are quickly transferred to the main ED.
On day one, the first patient was a female with a double reproductive system who presented with abdominal pain. I went in to her room first and got the HPI, PMH, etc, and performed a PE, excluding the pelvic exam. Then I presented to my preceptor, including discussing the diagnostics to order, and differential diagnoses. Then I went in to the patient's room with my preceptor and he repeated some of the PE and performed the pelvic exam.
This was the routine for much of my time there. I worked most closely with 5 different preceptors, who all had a slightly different style. Generally, I assessed the patient first, and then the preceptor went back in with me to introduce him/herself and repeat some of the exam (or not) and we discussed diagnostics and differentials.
Day 2 I performed a digital block and sutured a laceration. I got really good at laceration repairs (if I may say so myself) and repaired lacerated fingers, hands, faces and scalps, etc. I'm most proud of a laceration repair I performed my last week where the scenario was man vs. chainsaw. The wound had jagged edges with visible fascia, so I repaired it using both internal dissolving and external sutures. Hopefully this will help me on my surgical rotation in a few months.
Due to my experience doing pelvic exams at my prior rotation at the Teen Health Clinic, and often being the only female provider around, I did many pelvic exams and procedures as well. I learned how to do a few other procedures also, such as how to fluorescein stain and exam the eye and I was able to get in plenty of practice doing I&Ds on abscesses, which is a good skill to have.
I also learned so much more about antibiotics and other medications, and practiced with reading EKGs daily. Mental health conditions were also commonly addressed at this facility.
In conclusion, I did not get to intubate anyone or do chest compressions, (although I would go to code calls when I could) but I learned something in every patient interaction and have many new skills.
Next stop, inpatient medicine on a heme/onc service.
Welcome to the ED!
Handy little device
Pretty snow, but ice too = sprains, strains, and fractures in the ED!
