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Tuesday, January 17, 2012

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.


  1. When you decided you wanted to go to PA school did you feel comfortable about doing things in the ER like sutures and draining abscesses? Did you feel more comfortable after doing a few than you did before or were you always prepared? I am interested in PA school and have shadowed PA's in the ER but some things in the ER seem scary/uncomfortable for me. How did you get through it?

    Good luck with the rest of your rotations!


  2. Hi Jessica,
    When I applied to PA school I made sure to know everything that schooling and life as a PA could entail. On a the websites for school many of them say what rotations you are required to do, most of them are the same honestly. I know there are some rotations that I will like more than others but everything is about the collective experience. We were taught about suturing and abscess drainage in our last semester in school so I know the right way to do it. Knowing and doing are different things though, so yes, I was super nervous my first time but the great thing is you have other people there to help you and tell you what to do the first few times. I feel much more comfortable now than I ever did.

    ER is really scary at times, although, I shadowed in the ER too a while back and when you are watching it is different than actually working in the ER. Maybe it was the adrenaline for me but I really surprised myself in what I was able to handle. I was not the type to run away for hard cases, I actually found myself wanting to learn and do more. So, maybe you will surprise yourself in those cases in the future. A lot of PA school is a learning experience so even if you were to go into work scared to death just know you will be fine and other people are there to help you. That is how I made it through.

    Good luck to you in the PA school application process and in the future, I have faith you will do great.