I truly enjoyed my emergency medicine rotation at Woodhull Hospital in Brooklyn. I got to rotate through the critical/trauma area in addition to the main emergency room. At first I was hesitant when I saw that my schedule would mostly be overnight shifts, but I came to really appreciate my nights in the ER. My shifts were 7 PM to 7 AM. When there were less patients (usually between 3-5 AM) the PAs would take the opportunity to teach about EKGs, DKA, basic life support, and other vital ER topics.
I got to perform many procedures, including IV placement, I&Ds, splinting, FAST exams, nasopharyngeal swabs, chest compressions, and intradermal injections. I especially enjoyed increasing my skills at suturing lacerations. I got more comfortable with placing sutures on the hands, feet and arms. I also assisted the OMFS residents with facial sutures. Assisting with more complex procedures was also helpful for my education. I observed a chest tube insertion, sono guided arterial draw, and elbow joint aspiration.
Coming to the ER right after my family medicine rotation was a big change. In family medicine, the providers must manage all of the patients’ comorbidities. The doctor would make sure to schedule frequent follow ups for patients with chronic conditions so they have continuity of care. In the ER, the goal is to provide treatment for the acute concern that the patient presented with. This shift in focus was difficult for me at first. I had to get used to identifying the most urgent conditions and keeping up with the constant flow of new cases. The high patient volume encouraged me to practice taking a thorough history and physical and doing a rapid assessment. I practiced developing a differential diagnosis in my head before seeing the patient, based on their chief complaint. I then targeted my history towards my differential. I discussed the differentials with the PA and the labs and imaging that the patient may need. Some of the PAs gave me opportunities to write up notes for them and based on their critique I learned more about proper documentation.
One memorable patient encounter was a young man who came to the ER in DKA. He had extensive family history of DM 2, but had never been diagnosed with it previously. After the PA explained his diagnosis he began to cry because he was worried for his future. I sat with him for a while, spoke with him, and was able to calm him down. We talked about the medication plan and lifestyle changes that he should begin once he is discharged. Once he felt that his situation was not hopeless and he had concrete plans on how he could improve his health, he began to have a more positive outlook.