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Emergency Medicine SubI

Emergency Medicine SubI : Emergency Medicine Sub-Internship : EM SubI

UCSF STUDENTS

Emergency Medicine SubI : Emergency Medicine Sub-Internship : EM SubI

Emergency Medicine Books

Click on the links or images below to learn more about these EM books.

Emergency Medicine: A Comprehensive Study Guide 6th edition by Judith E Tintinalli

     

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Emergency & Critical Care Pocket Guide by Paula Derr

     

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Additional books you should get.

Click on the links to learn more about them.

Pocket notebook EM

NMS clinical manual emergency medicine

(breaks down a lot of the common problems; read through it before you go; common presentations)

ClI had the pleasure to talk to an emergency physician attending about his life as an EM doctor and some advice he has for me on how to succeed on an EM sub-internship.

I asked him a few questions.

1) What is life like as an EM doc?

2) Any specific advie you have regarding working at Highland hospital?

3) Typical patient presentations at Highland hospital?

4) Working effectively with other memebers of the health care team?

5) What separates an average student from an excellent student?

6) What surprised you about being a resident at Highland hospital?

Here were his answers.

Attendings at Highland are a really laid back bunch.

As a resident in your 4th year, you can moonlight.

The patient population at Highland hospital is similar to the patient population at any other hospital. They patients are usually really sick when they come in. As in any county hospital, there are typical patient presentations. Knows the ones listed below well.

– Typically, you will get patients presenting with end stage disease

– Abdominal pain

(always do pregnancy test in women; pelvic exam on all women)

– Chest pain, treatment (eg. NTG,e tc)

– EKG interpretation (ST depression (ischemia); ST elevation (infarct); Mobitz, afib

– Atrial fibrillation

– CHF (often 2/2 HTN) (treatment eg. enalapril, lasix, bipap)

– Sepsis (treatment, eg. lactate lab, central line, fluids, Abx, etc)

– UTIs

– DVT, PE (eg. d-dimer, CT scan)

– Dialysis patients (hyperkalemia, etc. ) (treatment)

– ESLD (ammonia, etc)

– Ectopic pregnancy (type & screen, CBC, Bhcg, <1500 vs >1500, US, call GYN, etc)

– Trauma (you are usually standing watching it being managed. There’s lots of it.)

– Medical codes (can go to these too)

– abscess I&D’s

About 2-3 UCSF students rotate through Highland too and their experience is that it’s a pretty chill place to work.

For medical students doing their rotation at highland hospital or any EM setting, here are some tips:

– During the first week, you will get a feel for how things work.

– Most of your interactions will be during night shifts.

– Be inquisitive, ask questions; ask questions that are relevant

– Be efficient

– Know the differential diagnosis for common presentations, and know the DDx for your patient’s presentation

– Come up with a good concrete plan for the patient

– Your oral presentation should be an EM med presentation (short). You don’t need to present everything about your patient. It is OK not to present everything as long as you have the answer when the attending asks it.

– It is OK to ask the attending “what do you want to hear in my presentation?”

– Interact with the residents

– Be helpful to the team

– Don’t take on too much

– Be steady, confident, and not cocky; don’t overshadow an intern

– Ask the nurses questions

– Procedures: Put in your own IV, draw blood from the patient yourself; try to do a central line placement. When you start, put in IVs in all your patients. Be at least great in putting in IVs. Come out of that rotation at least being able to throw in a line.

– Get good at IVs. A really good place is the wrist, just below the hand, in the distal third of the forearm. There are veins that pop up. Use 20 or 22 gauge in them.

– Be proactive about doing procedures. At some point, you just have to ask, “At some point, I’d like to do …”

– If you ask, “Do you think we can use US to find IJ’s?” that shows that you are taking initiative.

– Might also be good to take a patient who might need a procedure done. Heroin addicts often need central lines.

– Doubt you will need to put in chest tubes.

– There will be opportunities to do intubations.

– Opportunities to do procedures is attending dependant and also depends on how much they trust you. Some attendings will be calm and patient.

Highland hospital is becoming more academic. If you like the county experience, it’s a really cool place to be a resident. Highland is a 4 year program, and therefore has a lot of 8 hour shifts. This is unlike Stanford, which is a 3 year program, and therefore has a lot of 12 hour shifts. A 4 year program is not the same as a 1 + 3 program, because the 1st year is not in EM, and therefore you end up working mainly 12 hour shifts in the 1 + 3 programs too.

The residents are also very interesting, and have a diversity of interests.Residents rotate through UCSF every month. As a first year, you really get involved in patient care. You do lots of central lines and cricothyrotomies. 1/3 of Highland residents go into academics or fellowship. A lot of the residents go on to work in the community.

Some people choose to do a fellowship after residency. In the past, ultrasound was the fellowship to do. Many people who did an US fellowship became US directors.

After residency, one can choose to work in many different settings. Working for Kaiser is pretty low stress and is a popular option. One can also work part time for Kaiser, and part time as a locum. Kaiser, compared to other places to work, can be considered “easy money”. You can work there, and also work at a few other places.

Working as an emergency physician has its perks. If you want to work a lot, you can. If you don’t, you don’t have to. The job is very flexible. With EM, you can get a job where you work 18 shifts a month. You will also have your own style of practice. Most people working work 14-15 shifts a month.

The income for EM physicians is also good. It is easy for an EM physician to make around 200,000 a year.

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Emergency Medicine SubI Day 7 Shift 4

Sunday, 6/14/09 was my 7th day working in the ED as a subI.. Since this was Sunday, the ED was a bit less busy.

Some patients who came in…

36 y/o male presents with left facial abscess and surrounding cellulitis, who had failed outpatient Abx treatment

23 y/o in custody with a h/o seizure disorder, presents s/p witnessed tonic-clonic seizure.

40-something year old male presents with very large and thick cucumber in rectum.

Several people came in with stab wounds (knife, screw driver, etc) to the back and chest.

Young women presents with abd pain, found to have free fluid in pelvis

Some psych and EtOH patients

All in all, it was a great day with really great learning, fun residents and attendings, and great and thankful patients. One of my patients though was super hungry and kept asking for food. He was the one in custody, and asked for a sandwich before we sent him “home.”

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