You are halfway through your very first Emergency Medicine shift. You have a 23 year old male patient who appears to be a slam dunk for acute appendicitis – he has symptoms that are consistent with the presentation, pain on palpation at McBurney’s point, a high white count, and CT findings of appendicitis. Your staff is being pulled in a thousand different directions, and asks you if you feel comfortable calling General Surgery …
How to Read Patient Monitors
It’s your first day as a clerk in the Emergency Department and your staff has asked you to see an 80 year old patient with known COPD presenting with increasing shortness of breath. He reminds you to check the patient monitor when you go in there to look for any abnormalities and to record a new set of vitals on the chart. Patient monitors can be overwhelming early in your training when you’re …
How to Write a Procedure Note
Emergency Medicine is known for being a relatively procedure-heavy specialty. Whether it be suturing up a forehead laceration, performing an incision and drainage of a forearm abscess, reducing and casting a Colles fracture, or performing a diagnostic lumbar puncture on a patient with altered mental status, it’s highly likely that you’ll have the chance to perform multiple procedures throughout your EM rotation. However, this also means that you’ll be responsible for documenting the …
Time Management in the ED: Is there such a thing?
Being efficient with your time during an ED shift is an important skill to develop. Not only will this help you (and your staff) keep up with the demands of a busy emergency department, but as a learner this will also provide you with the opportunity to see more cases and have more time for teaching and feedback. This blog post will outline some tips and tricks for managing your time effectively throughout …
A Guide to Charting in the ED
It’s your first Emergency Medicine shift in clerkship. You’re asked to see a 25-year-old female with abdominal pain. What are things you want to make sure you ask about and examine, and how should you document your assessment without spending most of your shift on paperwork? Documenting patient encounters is a core skill in all medical specialties; in fact, it is a legal requirement of all physicians providing patient care. In the fast-paced …
Disposition Decisions: What do we need to consider and why?
Being able to think patients through to their final disposition can be a challenging skill at the clerkship level. However, a good clinician should start thinking about a patient’s disposition as soon as they pick up the chart. Before you take a patient’s history, look at the triage note and start to think through your differential diagnosis, diagnostic workup, therapeutic management, and disposition plan. What are the “most common” and “cannot miss” diagnoses …