Emergency MedicineIntro to Clinics Night

Evan SuzukiMike Abboud

Emergency Medicine

The Structure4-5 approximately 10 hour shifts per weekExpect to work a few overnights and weekendsAt HUP you will be paired with and present to a

residentAt Presby, Pennsy, and Reading you will present

directly to the attendingWeekly 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 EMRDuring orientation make sure you have EMTRAK access

and ask Janae and/or HUP IT how to link to MedviewBefore seeing a patient

Click “Reports” then “Print Triage Report” to get a sheet with the vitals, chief complaint, and triage notes

Click the “prev” tab to see check out previous ED visit records

Check 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 callsGet 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 resuscitationsIf at Presby/Pennsy: go to any codes, STEMI alerts,

intubations. Get involved in chest compressions if you have the chance.

Studying for the ShelfDepartmental exam and NOT a standardized shelfModified in the middle of last yearAll multiple choice questions (some poorly

worded)Short vignettes or straightforward fact questionsMost material covered on a circulating review

sheetStudy no more than 3-5 days leading up to the

exam and pay attention during didactics