ER: My first hospital rotation

           I started my ER rotation about two weeks ago and so far it is going well. Out of all my rotations this has been the biggest adjustment for me. I am not used to the “treat them and street them” approach. I am not sure if it is because it is my first rotation in a hospital or if ER is just vastly different from my other primary care rotations. Coming from rural PA, ER seems very fast paced but I enjoy that. I am never sure what will come through the doors. Most of the time, surprisingly there are cases that we consider “non-emergent”. However, I have had some true emergencies, on my second day I performed CPR. Unfortunately, the patient did not make it, and I experienced my first loss. The worst of it is confronting the family. No matter how hard you look at it there really is no easy way to lessen that burden. My preceptor did do an excellent job at telling the family.
       On a happier note, I have really gotten to do a lot on this rotation: sutures, staples, abscess drainage, splinting, cleaning a wound etc. I have also gotten to work with a lot of PAs! In the ER I am working in there is a fast track and the regular ER. The fast track is for cases like broken bones, lacerations, abscesses, and more quick fixes. I like it there the most because I get to work with PAs who have been preparing me more for the regular ER. For example, I have gotten a lot of tips on my presenting skills. For those that are unaware, my job currently is to see a patient, get a full history, do a physical exam and come back and present this to my preceptor or the attending on staff. This is your chance to show your stuff so to speak and make a diagnosis and treatment plan. As a student, I have found a lot of times you are correct and many times you are not. This is a processes that over time gets easier. In the ER I have found that you need to be quick, concise, and to the point otherwise the attending will lose interest or rush you to get to the point. Getting tips on this process is crucial! So far I have gotten only positive comments and constructive criticism. All of which have really helped me in the ER. For example, in primary care and in school I am used to using the head to toe approach. Meaning, when you present and when you do your physical exam on patients go from head to toe. In the ER, unless it is for a case that is pretty simple, I was told "go for the meat". Meaning, if someone comes in for back pain go straight to that when you are describing your physical findings, then go to other body systems.
       So, far I am enjoying my experience but I am not sure ER is for me. There is something about tracking a patient throughout their life and sharing that bond that primary care physicians have with their patients. In the meantime, I am getting the most out of my experience and enjoying the people I have met along the way.