Advanced Emergency Medicine Orientation

1
Advanced Emergency Medicine Orientation

• Course 547 630D
• Two Week Curriculum
• UCI Medical Center

2
General Overview

• See Working in the ED in your packet
• If questions please ask or see Irma Castaneda in
  the office
• Introduce yourself to the R3 and the Attending
• You might work with many different R3s and
  Faculty
• You are also working alongside students
  residents from many different services
• Pediatrics, Family Internal Medicine, Trauma
• Ultrasound students
• We continually try to improve your experience

3
Agenda

• Welcome to Emergency Medicine
• Orientation Video
• Ask questions
• Receive Reading Packet
• Receive Rotation Schedule

4
Rotation Goals

• Learn Directed History and Physical Exam
• Present in a succinct, professional manner and
  with a differential diagnosis
• Become comfortable presenting to senior residents
  and interacting with Faculty
• Learn Procedural skills (Roberts and Hedges)
• Read about them and ask questions
• Perform under supervision when available

5
Rotation Goals

• Learn presentation, diagnosis and acute care for
  life-threatening diseases
• Cardiac, Pulmonary, Neurologic, Trauma, Obstetric
• Learn X-ray/EKG reading
• Learn use of internet and reference based care of
  patients

6
Nursing

• Introduce yourself to the nurse
• Be polite, dont argue, always wear your name tag
  and white coat
• If you have any concerns consult your resident
  first
• Learn the names of the nurses and try to ask the
  nurse for your patient
• Keep them informed of the plan of care
• Ask if you have questions
• Dont assume

7
Approach to the Patient

• Charts are placed on right side of board (pending
  on the left)
• Light in the resident room signals new patients
• Bedside manner is extremely important
• White coat/ID at all times
• Scrubs on night shift only
• Only address patients by last name
• Do not use diagnosis and bed number
• No more than 10 min initially with patient

8
Presentations

• You present directly to the Senior Resident asap
  after you see the patient
• Accompany the attending to bedside after case is
  presented
• Ask questions about your cases as often as needed
• Read about cases after your shift- extremely
  helpful in learning
• Your presentations should be thought process
  driven

9
Patient Volume

• Max two active patients at a time then consult
  resident before picking up more patients
• Do not pick up level 1 or 2 charts (life
  threatening at bottom left)- you can follow those
  patients with the resident
• Trauma- go into trauma runs with the R3
• Learn ED Trauma management
• Listen and look for trauma activation

10
Physician Orders

• All medication order, labs, x-rays need to be
  documented on the nursing order sheet
• Enter lab and x-rays into TDS also
• Call Radiology for notification of CT and
  Ultrasound studies (except non-contrast CT head,
  CT abdomen for stone)
• CT results will be called back to the R3

11
X-rays

• A sheet will be placed in the x-ray in box when
  completed
• Look on Web1000 for films
• Call ER radiology (x5331) if there is delay
• Go over x-rays with R3 and Attending
• Look up old x-ray finding on TDS when the patient
  is complicated

12
ED Ultrasound

• Ask the patient for admission
• Do at least 5 Ultrasounds while on the rotation-
  more opportunity to do in the ED
• Do it with the R3 do not handle the machine
  alone
• See reading material in your packet
• Ask the Ultrasound student to help

13
Consultants

• R3 should talk to consultants
• Document time of consult
• Document name of resident and attending called
• Complete consult needs to be on chart before
  discharge from the Emergency Department

14
Documentation

• Be complete and must be legible
• Resident/Attending name
• Time seen
• Be careful about documenting significantly
  positive finding (i.e. check with
  resident/attending)
• Peritonitis, guarding, altered, lethargic,
  combative
• Legibly sign every chart
• Document result of x-ray, all lab/EKG findings

15
Documentation

• Dont discharge patient without completing your
  documentation
• You can wait to document till after you present
  to the R3
• Use rough notes first if it helps to get a more
  legible and neat chart
• Discuss Medical Decision Making with the R3 and
  document with their help

16
Cases

• Use references in the Department or Library
• Rosen, Tintinalli, Harwood-Nuss, Roberts
  Hedges, John Harris
• Ask for more
• Use the internet
• MDConsult.com
• Emedicine.com
• Uptodate.com
• Micromedex through UCI Internet
• National Library of Medicine
• Ask Faculty and Residents for further references
• Course Director is available to meet with you and
  go over your cases daily

17
Opportunities

• Suturing and other procedures
• Read about them ahead of time
• Ask your resident and look for them
• Read about your cases in depth
• Learn X-ray/EKG reading- go over with
  Resident/Faculty
• Follow-up admitted patients and provide feedback
  to your Residents/Faculty
• Follow-up culture results, final x-ray reading to
  get a complete picture for the patient seen
• Bring interesting cases and discuss at Conference

18
Shifts

• Three shifts (AM, PM, Urgent Care)
• Shift schedule can be changed only in cases of
  emergency if you have another medical student
  that wants to change the shift, then first talk
  to Irma in the office
• If you cannot attend your shift because of health
  reasons please notify the Shift Attending
  directly before your shift and subsequently email
  the office
• Be on time or early to your shifts
• Your shift might be longer than schedule for
  patient care reasons
• Strive to keep your schedule as clear as possible
  and responsibilities well defined

19
Teaching Conferences

• We have teaching sessions weekly (1-2x)
• Time to be assigned (see schedule) and conference
  room availability with Course Director
• Wednesday conference Noon 4PM
• Presentation by Faculty and Resident Lecturers
• Attendance is required
• Come prepared with questions and packet reading
  completed
• Suture lab
• Integrate clinical and lecture material to give
  you a complete experience

20
Grading

• Shifts and Conference attendance is required
• Patient log is required
• Shift Evaluations (ED with R3 and UC with
  Attending)
• Majority of grade is based on performance at
  clinical shifts, Conference attendance and
  participation
• Exam is required to pass
• Can meet with you to go over your progress,
  review grade and provide feedback at anytime

21
Honors

• Power-point presentation is required
• Integrate problem based learning, computer
  assisted learning, retrieval of information from
  the web and source books, literature review, and
  to incorporate audio-visual aids
• Complete handout
• Approve case with Course Director
• Does not guarantee Honors

22
Honors

• Ride Along
• Required for Honors for the 4 week rotation
• Get packet from Irma
• Arrange your ride along date and location in the
  first 3 days of your rotation with Carerie Kozak
• For honors grade you will need superior
  performance on All Evaluations and Test

23
End of Rotation

• Test is the last Friday at 11 am with Kelly
  Fulford
• Turn in your Patient log to Irma before the end
  of your roatation
• Let us know suggestions
• Have a great time!!!