My emergency medicine rotation consisted of being in an emergency room doing 12-hour shifts three days a week for five weeks. Some of the shifts were during the day (7a-7p) and others were overnight (1p-1a), and most weeks I worked on a weekend day. I really enjoyed my five weeks working in the emergency room. I saw many different patients with a myriad of different pathologies and ailments. I saw close to a dozen patients every day.
The emergency room consisted of two separate triaging areas. One of the areas called Fast Track consisted of lower acuity patients with muscle aches, dental pain, and eye problems. I enjoyed seeing the patients in Fast Track because we saw many different types of people with many different types of issues. Many patients who came in with foot, ankle and back pain were given X-rays, and those without fractures or other pathologies were sent home with pain medication and possible referrals to their respective clinicals. I learned a lot in Fast Track. Even if you think a patient might have a sprain or a strain to a muscle, your differentials must always be casting a wide net. Ankle pain can mean a sprain, fracture, or possible dislocation. Chest pain can be musculoskeletal, or a myocardial infarction waiting to come out. Some patients who were thought of as lower acuity were sent to the main emergency room because their ailment needed further work up.
The main emergency room was split up between the A side and the B side. The A side had the patients that were inebriated and the B side had patients with more behavioral issues. Patient that came in with other complications were split up between both sides. The other area of the emergency room was the acute area where very sick patients were being taken care of. I did not get to rotate in that area. Every day, I worked with a new PA and I really enjoyed the way it was set up. I learned different strategies on how to interact with patients, get histories, do physical exams, expand on my differentials, and what the next step was. My responsibilities consisted of getting histories from patients and doing a physical exam on them. Then I reported what I heard and saw to my preceptor that day and we both went to see the patient together.
I saw many different types of patients from all different types of backgrounds. Many patients did not speak English, so we used translators that helped facilitate getting a history from the patients. As I started the rotation, my history and physicals weren’t up the standards I wanted to be in, but as I saw more and more patients I started to elicit more targeted histories with pertinent questions asked and more expanded physicals including the neuro exam. I learned that I needed to keep my differentials broad, even if I think I might know what the diagnosis is within the first two minutes of speaking to the patient. I also needed to rework my thought process about what an emergency room is. My thought process was, let us try to fix this chronic problem, but that is not what the ER is for. Stabilizing a patient and making sure the patient is not going into an acute problem where the patient might decompensate is the main goal.
Overall, I really enjoyed my time at my emergency medicine rotation. I really learned about history and physicals should be elicited from an emergency room perspective and I saw many different types of pathologies along the way. Someone coming in with chest pain could be having GERD, while someone with abdominal pain can be having an MI. General survey was very important in what the provider thought might be going on with the patient. Vitals were essentially vital in what was going on with the patient (as the director of the ED said “Vitals First!”). Sometimes the emergency department was very quiet and slow, and other times there was over 100 people in the ED and you could feel the walls vibrating. I took a lot from my emergency room rotation and I am eternally grateful for all of the PAs that let me shadow them.
