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.
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