Emergency MedicineIntro to Clinics Night

Evan Suzuki

Mike Abboud

Emergency Medicine

The Structure

4-5 approximately 10 hour shifts per week

Expect to work a few overnights and weekends

At HUP you will be paired with and present to a resident

At Presby, Pennsy, and Reading you will present directly to the attending

Weekly 5 hour HUP conferences on Wednesdays

Occasional roughly 3 hour CHOP conferences on Fridays

Getting Ready for the First Shift

Learn and practice reading EKGs in a methodical way EKG books Sample EKGs -

http://ecg.bidmc.harvard.edu/maven/mavenmain.asp

Review the DDx of COMMON and DEADLY causes of… Chest Pain, Shortness of

Breath, Abdominal Pain, Dizziness,Nausea/Vomiting,

Pregnant and Bleeding, Altered mental status,

Syncope, Joint/Back Pain

Review the EM booklet on VC2000 (hard copy given during orientation)

I am really helpful!

EMTRAKHUP’s easiest and most intuitive EMR

During orientation make sure you have EMTRAK access and ask Janae and/or HUP IT how to link to Medview

Before seeing a patientClick “Reports” then “Print Triage Report” to get a

sheet with the vitals, chief complaint, and triage notesClick the “prev” tab to see check out previous ED visit

recordsCheck MedView for an overview of their past EKGs,

problem list, hospital discharge summaries, and outpatient notes

“Chart biopsies” are important but don’t get too lost in the EMR before seeing the patient!!!

Under “Reports” you can find “print Triage Report” – this lets you have a sheet with the vitals and triage notes… all the residents use this!

Need to call a Consult?? Here is where you can look up the number for it!

Type your notes under this tab so you can edit them.

These tabs are all really useful, especially “Prev” … is this patient always having back pain??

Brings you to their clinical overview – use “cardiology” to look at previous EKGS

Doing H&Ps and Presentations Enter the room with a BASIC DDx, the info you gathered from the

EMR, and a mental or written list of questions to ask. For chest pain… Deadly DDx: dissection, MI, esophageal rupture, PE, tension PTX Common DDx: costochondritis, muscle strain, trauma, asthma, panic

attack, angina EMR info examples

Recent admission for NSTEMI and previous EKGs Frequent visits for chest pain without any

OPQRS questions

Focused but thorough H&P…don’t forget to ask about sex and drugs!

Be concise while presenting We care if a 60yo male patient’s father died of an MI We don’t care if a 20yo female’s grandfather died of prostate cancer Know more than you tell the residents and/or attending

The Perfect H&P Chief complaint

History of present illness with pertinent positive and negatives

Brief review of systems

Focused Past medical and surgical history

Focused pertinent medications and allergies

Very focused social history and family history if required

Vitals- highlight any abnormal vital signs

Focused and pertinent physical exam

Differential diagnosis

3 life threatening things, 3 more likely things

Which do you think is the correct diagnosis and why?

Plan: Remember, both diagnostics AND therapeutics!

http://embasic.org/2012/03/27/how-to-give-a-good-ed-patient-

presentation/

What else should I do?

Sometimes it’s helpful to obtain records from OSH and other EDs: offer to make those calls

Get involved with procedures! Blood draws, A-lines, LPsAlways offer to gather supplies & clean up (see a

map of supplies in the HUP pocket-guide)

If at HUP: watch any traumas or resuscitations

If at Presby/Pennsy: go to any codes, STEMI alerts, intubations. Get involved in chest compressions if you have the chance.

Studying for the Shelf

Departmental exam and NOT a standardized shelf

Modified in the middle of last year

All multiple choice questions (some poorly worded)

Short vignettes or straightforward fact questions

Most material covered on a circulating review sheet

Study no more than 3-5 days leading up to the exam and pay attention during didactics