Clerkship: Emergency Medicine

The goal of clerkship rotations is for students to acquire a defined body of knowledge, skills and attitudes necessary for the recognition, understanding and management of the common and unique health care problems. During each core clerkship and elective rotation, the PA student will participate, in a supervised capacity, in the care of patients presenting to the specific health care setting (Emergency department, Clinic, in-patient ward, etc).

Emergency Medicine Rotation

  • Location: Sunnybrook Health Sciences Centre, Toronto, Ont
  • Length: 4 weeks

Read more as I write about:

  • A typical shift
  • Common encounters I had, procedures I was able to do/assist
  • Some of my most memorable cases

A typical shift

The emergency department is divided into four different sections, somewhat based on the level of acuity. I had an even number of shifts amongst the four. Each shift, I would be working with a different doctor each shift depending on who is covering that section. There is usually a resident on the same shift. Towards the end of my rotation, there was a medical student with us as they are starting their ER rotation. I had both day and night shifts (no overnight shifts though). Dress code is SCRUBS. So comfy 🙂 The smallest sized scrubs at Sunnybrook is too big for me, so I usually tuck my top in.Point Blur_Dec182015_225725

When arriving, I’d introduce myself to the physician and the resident. In the low acuity zone, I’m allowed to pick up any chart I want and see the patient. In the other zones, I usually ask the physician which patient would likely give me a good learning experience. Sometimes, if I’m interested in something, I’ll let them know I want to see this particular patient. For example, I asked to see all eye related cases that shift so that I can master the eye exam and slit lamp exam. After taking history and physical, reviewing labs, I will review with the physician regarding further investigations and plan.

Common ER complaints I encountered

  • Lacerations
  • Fractures
  • Eye pain
  • Chest pain
  • Abdo pain
  • Shortness of breath
  • Headache

Procedures I learned/performed

  • Would closure – Suturing, Glue
  • Splinting
  • Reduction for dislocated joints
  • Eye exam with Slit lamp and Intra-ocular pressure

Some of my most memorable cases

  • Finger reduction
    • This patient came in with a dislocated left 5th digit at the PIP, diagnosed on x-ray. He got it from receiving a dodge ball in a funny way. With the physician, we tried to reduce it without local anesthesia but it was too painful, so he ended up getting it anyway. Which worked! Post reduction film showed success!
  • My first posterior slab on my own
    • Many patients will come in with rolled ankles. Using the Ottawa Ankle Rules, we determine if they need an x-ray or not (eg. fracture vs. sprain). Most of the time, they do meet the criteria and get an x-ray. I’ve assisted a few times applying a posterior slab for Weber fractures. The last time I saw ankle fracture, I told the physician that I was comfortable doing it on my own…and she let me! I was pretty proud with my final product 🙂

(Flash back to Fracture Day in Year 1)

  • Watching a conscious sedation and cardioversion for atrial fibrillation
  • Perianal abscess incision and drainageretina_group_slit_lamp_side_view
  • Eye and Slit lamp exam
    • This was the one thing I wanted to really nail down during my ER rotation because we were NOT taught how to use one in school. I think I nailed it by the end of my rotation. I had the combination of watching youtube videos, reading up on the exam, and having a physician walk me through the steps on how to maneuver the slit lamp – the first time I used it on my own, I didn’t know what knob to turn! I have caught foreign material in a patient’s eye and 6th nerve palsy a few times.

Overall

I enjoyed most of my time in the low acuity level area where patients are coming in with fractures, lacterations, eye concerns, rashes. Though they can have a serious underlying condition if not assessed quickly, I love the hands on portion of the exam and management.

This rotation was done very early in my clerkship. I feel like I am still not comfortable with managing acute presentations (chest pain and acute abdomen especially). In the future, when I have more experience through my other rotations, I may do another few weeks of Emergency to reassess my competence and comfort with emerg.

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