I must say that I have been working in the ER for 6 years now so I am a leeeeetle partial to this rotation. My rotation was in a busy, level 1 trauma center. It was an intense, mind blowing 6 weeks. Stress levels run high and there is always a lot of action. There is also a disproportionately large amount of bull crap complaints, which you will notice right away.
I had an interesting emotional response during my ER rotation. We saw a few trauma patients with gun shot wounds. These were young men who died of senseless violence. One free Friday night my husband and I went to see the movie “Departed”. I know, one of the best crime movies with some seriously gorgeous men. Although I did enjoy Leonardo Dicaprio and Matt Damon, I walked out of that movie in a near panic attack. The shoot em’ up scenes hit me in a new way. I watched people die, in real life. The violence and death I experienced in the ER shook me deeper than I knew. The ER is a place where you see people at their most vulnerable and scary moments. We are a key player in these moments and that can take a toll on you emotionally.
The following are some tips to get you through your rotation.
1. Be on time…in fact, be early. Shift changes are key times of sign out and you will be better prepared if you know what is going on with the current patients. You will also likely learn something about diseases and treatments.
2. Make your presentations succinct. There is nothing more irritating then a long, drawn out, fumbling patient presentation.
3. Know your differentials. The ER is a little different than your primary care rotation in that the attending will want to know mainly the life or limb threatening possibilities. Always have five possible diagnosis and say them with confidence!
4. If you can be a part of an end-of-life discussion you should be there. This is more of the “art of medicine” that we all need more practice on.
5. Patient education takes a lot of time. A LOT of time. I had a patient who was scared because she thought she had “poop coming out of the wrong hole”. It was not. My cartoonish drawing helped clear that one up.
6. ATLS, PALS, ACLS are all important to know. When you are part of a code, try to think preemptively what meds and procedures should be done. You will understand the process better if you try to think for yourself.
7. In my ER, PAs do central lines, chest tubes, intubations, sutures, I and Ds, dental blocks, joint reductions, splint applications, among other procedures. You will not get a hang of these in 6 weeks but its important to know the indications, instruments, and meds used.
8. Nurses, Techs, Medics, HUCs…They all make the ER roll along and most of them know more than you do. Show respect.
9. Be assertive. There will likely be Med students, NP students, nursing students, medics in training all trying to get in on that code or procedure. If you don’t get yourself involved no one is going to coddle you along.
10. The ER may be the career choice for you if you enjoy fast paced, high adrenaline settings… and you don’t mind having a schedule that is opposite of all your friends’ and family’s. PAs get to use a large skill set and it is cool to help save lives in real time. You also see some really heart wrenching things and you have to be the type of person who can leave work at work. Did I say that I love the ER? Comment below if you have questions or great stories.