ER Rotation Reflection 

I did my Emergency Medicine Rotation at NYPQ. This rotation was extremely fruitful and I leaned a lot! I used to scribe in Stony Brook University hospital ER for over 2 years, and I really enjoyed the Emergency Room environment. I was so amazed how everyone in the team, from the doctors, nurses, EKG techs, and even students, worked together very smoothly and swiftly to care for patients coming in seeking emergent care. This patients are often need to emergent and fast actions, and the ability of these providers to think on their feet and provide such complete care while still being empathetic to the patients was very respectable. I had a similar experience here in NYPQ at this rotation, as everyone was so helpful, and so willing to teach and train the students.  

The ER in NYPQ is split into several sections, each with its own role and acuity. The sections include Blue, Green and Gold which are part of the main ER. There there’s the urgent care which is of lesser acuity, however we were able to see a lot of procedures here. Then finally we have ER Red, which is the trauma room. This is were all the critical care trauma patients such as strokes, MIs, stab wounds, gun shots, falls, etc would be brought to. With the way our preceptor set up our schedule, we were able to have multiple shits in each location. We were also expected to do 12 hour shifts, that were either in the day or over night. This way we got a very complete and holistic introduction to emergency medicine. I really enjoyed this because we were able to see so many different types of patients, with a variety of complaints and a variety of acuity levels.  

How our every shift went was very dependent on team we were with as every attending and resident worked with students differently. Often times the provider would have us go see the patient first and conduct a full pertinent interview and perform a physical exam. We would then discuss the case with the team and they would ask us how we want to manage this patient, what labs and imaging we want to do and what differentials I had and why. This was both very intimidating yet very rewarding at the same time. This challenge made me think on my feet and when I wasn’t sure or got something wrong, everyone was very willing to teach, which I thought was very helpful. I am not very strong with lab work and what we will see with what pathology and this rotation really helped with that. Also a lot of the residents were very helpful with teaching us how to read EKGs properly since practice makes perfect. Whenever we had traumas and a FAST ultrasound exam was done, the attending would often speak about the findings outload to ensure that we were following along.  

In the beginning of the ER rotation, I was not seeing or practicing many procedures. However, towards the middle and the end of the rotation, all the nurses were very helpful with IVs, and other bed side procedures such as would cleaning and putting on splints. At this rotation I learned how to do reductions, put on differently types or splints and wraps, as well as giving needle anesthetic and doing sutures. This was very exciting for me as I have not had a lot of suture practice in my other rotations, and as with everything, the more we do the better they get. I also assisted in ultrasound guided IVs and arterial blood gases.  

With every patient I interviewed, I learned a lot and was able to apply what I learned in my didactic training to a real world setting. I was able to think in a way that challenged what I knew, as no patient presents with textbook symptoms. The attendings taught me the importance of keeping the differentials wide and always working to rule out the worst case scenarios first. For example in all the patients with chest pain, it was crucial to rule out any cardiac pathology first, and for any headache patients it was important to rule out any stroke or hemorrhage first. One really memorable patient interaction for me was during one of my night shifts we had a trauma called. We had a elderly patient who fell and had a period of altered mental status, brady cardia, and had a 8cm open head lactation that was actively bleeding. Based on her presentation our immediate differentials included a subdural herniation, a uncal herniation, increased intracranial pressure, and a epidural herniation. However with appropriate imaging and labs we were able to rule this out. I was then asked to suture her 8cm laceration,  which was very exciting since this was the first large laceration that I sutured completely by myself. With proper guidance from my supervisors I was able to do this successfully and gained a lot of confidence and experience.  

Overall this was truly an amazing rotation, where I learned so much and got to do so much. I do need to improve my history taking in that I need to ensure I am focusing on their most emergent complaint, and not all the issues they have as in the ER our priority is to stabilize the patient.  I also need to continue practicing my physical exams, and my knowledge of what proper labs and imaging pertain to what disease. Overall this was a great learning experience.