I just finished my Emergency Medicine rotation, and I seriously LOVED every minute of it. I was at a busy, Level 1 trauma in the center of DC and it was such a great learning experience! While sometimes it could be challenging to get hands-on procedural experience – there are a LOT of residents also vying for these opportunities – I really enjoyed being at a teaching hospital. I felt like being at a teaching hospital meant that everyone I came across, whether they were a tech or a specialty attending, wanted to actually teach me! It also seriously helped that this hospital color codes us, so every student wore green scrubs and we were instantly identified as slightly lost individuals.
Day one I get to my rotation and I instantly feel so overwhelmed. This rotation was my first at this hospital, and there are a TON of medical students who do pretty much all of their rotations at there (so they really know their way around).
I think I wore my white coat for about 30 minutes before I decided it was more of a hassle than a help. So for the rest of my rotation I ended up keeping all of my resources in my two (very sad) scrub pockets. Here’s a look a what I carried around with me.
So I’m maybe 10 minutes into my first shift with an attending who’s double board certified in Plastics and Emergency Medicine when he tells me that there’s no need for me to wear my stethoscope to this rotation. He informs me that everything we need to know would be seen in a picture (x-ray). I kind of just looked at him with a shocked expression until he laughed and told me that he was messing with me. He then proceeded to tell me that anyone who claims they “can’t hear anything” with their stethoscope in the ED is full of it and needs to work on their physical exam skills. I was seriously thrown off by this entire conversation and terrified that I was going to do something wrong in front of this attending. I had absolutely nothing to worry about though. My ERKA stethoscope allowed me to hear clearly no matter how loud the surrounding environment was. I have the ERKA Finesse2, and it’s been such a wonderful tool for me throughout all of my rotations. Medelita recently allowed me to gift my mother with an ERKA Precise (she’s only ever had Littmann stethoscope during her career in medicine) and she is obsessed as well!
I’ve talked about this series of pocket books for every one of my core rotations. They’re super informative and easy to read guides for the “big hitters” of the specialty. I can’t even tell you how many copies of this book I saw floating around the ED in everyone from my attending to intern to rotating resident’s pockets. I went into more detail about how these books are set up back in my PRIMARY CARE post, but basically the book is organized by system and then broken down further into subjects. There were definitely a couple of topics I wish it went a little more in depth in, and I did always double check any information I didn’t feel completely comfortable with, but overall its a great resource. I especially like the fact that its a hard-copy book, so when I was looking things up my preceptors knew I wasn’t just goofing around on my phone.
I’ve carried around this same pocket guide for most of my rotations. It’s super light weight and small but packs of couple of big hit topics. Realistically, most EMR systems are going to give you the ranges for lab values so that part of the book is kind of useless. I found it most helpful for the ACLS algorithm, History/Physical Exam, Neuro Exam, and Visual Acuity sections. I also loved the fact that it had a couple of blank sheets at the back because I was able to add in some of my own notes that I found were super helpful. Some of the things I added in include SIRS criteria, Perc/Well’s Criteria, Criteria to clear a C-spine/head injury, and then what a trauma white vs trauma yellow (moderate versus critical trauma) at my hospital was.
I’ve used a Moleskin notebook for every rotation, so you guys have already heard about this by now. One thing I did differently for this rotation was to use the second half of the notebook for note taking instead of having my notes in with all of my patient logs. I went into the ED knowing I was super interested in possibly doing this as a career, and so I wanted to make sure I got the most out of it. I basically was that student who wrote down 99% of what my preceptor said. Even if I didn’t go back later and look at these notes as much as I thought I would, I think the act of writing it down just helped me learn.
I have used the PERFECT H&P NOTEBOOK for some of my other rotations, and while I really like the set up of it, it wasn’t something I used this rotation. Honestly, the main reason why is because of its size! I only had two pockets in my scrubs and it didn’t fit in either one of them. So I ended up making my own template for this rotation – mainly because I was worried I was going to forget to ask some question in the intensity of the ED or forget some piece of the HPI the patient told me. Probably halfway into my rotation I realized that I didn’t need this anymore, but it was still a great resource for me to use at the beginning.
I chose to carry around a penlight with me for a couple of different reasons. The one I have has a ruler on one side and then also has the pupil size, two things I struggle with estimating. Also, even though the hospital I was at had Welch-Allen light sets on the wall, they didn’t always work and sometimes I wanted a brighter, whiter light. Plus it was small and easy to cart around with me.
A lot of providers will use their stethoscope to check reflexes. I’ve found that I’m just not super good at this method and that I do a lot better with an actual reflex hammer. Plus something about swinging around my stethoscope like that bothers me. Similar to the penlight, it was just super easy to cart around and there was no major reason not to.
- Chapstick: I can’t even begin to tell you how dry my lips got in the ED. It was pretty warm in there and the artificial heat just dries my skin out so much. I ended up bringing a chapstick with me to every shift so that I wouldn’t end up with cracked lips
- S’well: The absolute biggest tip I have for surviving the ED, especially night shift, is to start hydrated!!! The environment is super chaotic and it can be hard sometimes to remember to drink as much. I loved having my S’well because of how cold it kept my water and how easy it was to carry with me.
- Pen: I personally love to have different colors to write with, but hate carrying around multiple pens. This is my FAVORITE pen to use!
I definitely think I would have carried around more resources with me had I used my white coat or had better scrubs, because I don’t believe theres such a thing as being too prepared in the ED. Overall though, I felt like the resources I did decide to bring where very useful and made me stand out as a prepared student. I am interested to see if the things I carry around with me change at all when I start working as a provider in the ED (this is still the goal, so fingers crossed!)