October 27, 2013

A day in the ER

So I thought it'd be nice to share about what my days are like in the ER at Children's.

If I work a 10AM-6PM shift, my day usually starts out uneventful. Only red and orange are open and  not as many patients come in during the morning hours, so I'm usually not needed. So, during those hours I normally just study. At 11AM yellow opens, so more patients start coming in and so I get the chance to see some of those patients. When I see an open patient on the monitor, I quickly sign up for them and ask the preceptor if I can see them or not. If they say yes, I open a note, jott down the patient info and vitals, and record the time I go into the room. Then I go in, introduce myself, and do my history and physical exam. 

Once I'm finished with that, I present to my attending and tell them my assessment and plan. At times the attendings get really busy and so sometimes I have to wait awhile before I can present. During the morning hours it's usually pretty easy to get in touch with them. After I present I will either go into the room with the attending, or they will go into the room while I write up my note. Then once the patient has been seen, the attending will let me know what kind of orders they are going to get. And from there everything depends on lab results and patient status.

When mid-afternoon comes around, it starts to get a bit busier. And then once evening comes around, the ER is usually pretty swamped, especially during the transition between day and evening shift students and residents, because there is some overlap in our schedules. So when 5PM comes around, we have a TON of people working. From this time to around 1-2AM, the ER is really busy. It has been especially hard, in the last couple of days, to find attendings and present, get labs ordered, patients discharged, and etc. It's chaotic at times. 

Then once it starts to get into the early morning hours, things start to quiet down. Working the 11PM-8AM shift is probably my favorite because it doesn't feel as rushed, there are less patients, and less people working. So I get to see a decent number of patients during these hours, and it is also much easier to get in touch with the attending and get things done. Surprisingly, it has been very easy for me to stay awake during these hours. It's probably a combination of staying busy, drinking coffee, and not ever knowing what time of day it is.

Most of the time I will only take on 1 or 2 patients at a time, but sometimes I'll have 3 if things are busy.  On average I see about 3 or 4 patients a day. Not a lot, but good enough considering the circumstances. Usually the patients I get are not emergent and can get in and out in decent timing...Usually like 2 or 3 hours. Sometime they have to stay longer if they have labs or imaging, or if we have to observe their condition or admit them.

When I'm not dealing with patients or talking to the attendings, I'm writing up notes, researching, talking with residents or other PA students, or getting consults from ortho, plastics, cardio, etc. Then once patients are ready to go, I print discharge instructions, sign my note, and alert the nursing staff that the patient is ready for discharge. Then I go in and talk to them, give final instructions, and let them go home.

Sometimes I'll get to a point in my shift where I won't be able to take on any more patients (like if my shift ends at 6 and I discharge my last patient at 5:30), so sometimes I'll leave early. Other times I'm too lazy to sign my patients over to another resident or student, so I'll stay up to an hour and a half after my shift is over sometimes. I really don't mind it, though, because I like being there and working. When my shift is over, I head home eat, sleep, or do hw, depending on what time of the day it is. 

This week I worked 5 days. Mon 5-1AM, Tue 11-8AM, Thur 10-6PM, Fri 5-1AM, and Sat 5-1AM. So it's been a fairly busy week. Just got home about 1 1/2 hours ago (around 1:45AM) and decided I wasn't tired yet, so that's why I'm writing this now. I may even do some homework while I'm awake, but we'll see. Fortunately I don't work tomorrow, so I'll have the chance to get caught up on some assignments/studying. This coming week is my last week in the ED, which is crazy! Kinda sad because I do like this setting and I love all the cute little kids that let me examine them, but also glad to be moving onto sometime other than pediatrics.

Some things I've taken away from this rotation: 1) I love acute care, but the ER scares me sometimes. 2)  you lose all sense of time while working in the ER. 3) You no longer know what weekends are or what they're meant for. 4) kids are cute, but screaming kids are not. And kids that spit on you because you're trying to take their IV out are also not cute. 4) Examining a baby is torture. 5) Not all attendings are nice. 6) Parents LOVE reassurance. 7) the ER is abused by people with nonemergent complaints that are virtually a waste of your time, although you can't tell them that. 8) The good thing about the ER is the wide variety of complaints, which keeps things interesting. And 9) Working in the ER is tough.

October 12, 2013

Children's update #2

So the more I'm working in the ED, the more I like it. I still am not seeing a ton of patients on my own, but that's okay. I'm meeting more and more residents and attendings, and so far I really like them all. They're all really helpful, and the attendings are great teachers (well, most of them). Haven't seen any really interesting cases yet, but hopefully I'll get to observe a few traumas before the rotation is over.

On Thursday I worked my first overnight shift, 11PM-8AM. I tried to sleep in that morning, but it didn't really work. Luckily I barely even got tired during the night. I also worked that shift with a friend from my class, so that also made it easier to stay awake, and it was just a lot of fun. It's been fun getting to work with other students and residents, which surprised me, because I thought I would hate it. Anyway, that night I always had at least 1 or 2 patients, so I stayed busy pretty much all night. I saw a total of 6 patients that shift, which is a lot compared to what I've been seeing on a normal day. I liked that there were only a few people working, because I got to see more patients and it was easier to find my preceptor and get patients in and out on in a timely manner. That shift was also the first time I got to work with my actual preceptor for the rotation. He is nice, but doesn't talk very much. I kind of like having a lot of different attendings because they each give you a different experience, but at the same time, it is hard to gauge how much you're improving.

When I got home Friday morning I tried to stay awake for a little bit, but that didn't happen. I slept for like 3 hours and then stayed in bed for a bit and watched netflix. Then I just didn't feel well at all...I think I might of got food poisoning or something. So I stayed in bed basically the whole day and fell asleep around 7PM for the night. I must say, even though I loved working the overnight shift, it really really messed up my sleep. Kind of sucks I only work 1 more 11-8, but also kind of glad to not have my sleep cycle messed with.

This week I work 4 days and then I'm off 3 days. I'm going to Hocking Hills for our annual fall family reunion, so I'm pumped for that. It's always a lot of fun, and Hocking Hills (or Old Man's as we call it) is always so beautiful this time off year. Hopefully it cools down for the weekend, as it's been a little too warm for my liking lately. 

Well that's pretty much it...Hopefully this week is more interesting so I'll have some stories to share next time I write!

October 5, 2013

Children's ED Week 1

So this week I started my pediatric rotation in the Children's Hospital emergency department here in Pitt. The first day was just orientation, where we kind of got familiar with the electronic records and how to get around the unit. Not a whole lot of instruction from the preceptor. Basically he just said that we'll be acting as hired PA's and to just show up and start working. Which was a very scary thought and still kind of is!

Tuesday was my first day actually working. I showed up at 10AM. I only saw 2 patients on my own throughout my entire 8 hour shift! It's really hard to get signed up for a patient because there are always so many attendings, residents, med students, PAs, PA students...And since the PA students have to first get permission from an attending, the residents always snatch up the patients before we get the chance to even ask. So that's a bummer. But it was nice having my own patients and being in charge of their care. My first patient was a 15-year old male with a shoulder injury. The second was another 15-year old kid with costochondritis. The patients that we are allowed to see are the pretty easy ones...We're not allowed to do procedures or handle complex or critical cases. I'm okay with this, because emergency medicine is very intimidating to me! Although I would like to be able to do procedures! There are a lot of people that come in with abscesses, and I wish so badly we could do INDs!

The next shift I worked was on Thursday, 5PM-1AM. When I got there, I think there were like 18 providers working my unit. It was insane. Needless to say, I did not get to see any of my own patients for quite some time. I did get to shadow some residents and see patients that way, so that was nice. Then I also got to assist in a fracture reduction. It was a 7-year old girl who broke her arm. After she was sedated, the orthopedic reset the fracture and casted it. All I did was hold her arm, but it was still cool to watch. The only patient I saw on my own was a 9-year old boy with an asthma exacerbation brought on by a virus. Nothing too crazy.

So far I have had really awesome attendings. They are very helpful and willing to teach you. So far they haven't criticized my presentations, which I am bad at, but rather have focused more on the information I am presenting and what things I may have missed. The only bad thing is that there are only 2 attendings working at a time in my part of the ED, so it's really hard to find time to present or ask for their advice/help, etc. All of the residents and other students have been great too. All have been very nice and are willing to let you shadow or to answer questions about documentation, etc. Hopefully I can get involved in more cases with the residents and really get a better sense of what the Dr/PA relationship is like.

Overall, my experience so far has been mediocre, but hopefully things will pick up! I'm not sure how I feel about emergency medicine, but I definitely like the acute care setting. So, we'll see what this next week holds. I work tonight 5-1AM. Then I have 2 days off and then work 3 shifts in a row: two 10AM-6PM shifts and one 11PM-8AM shift. I'll be sure to update next week and let everyone know how the week goes!