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!