EM Bound

The Emergency Medicine sub-internship website has been updated!!  Our goal is to expand the online resources available to you, and create a place for medical students to find help with everything from, how to succeed during your EM clerkship, applying for away rotations. how to get letters of recommendations and your ERAS application. You can find all these new resources in the left menu under a section called 'Preparing for your EM sub-i" Don't forget to follow this blog to keep up to date on both education and application resources, and if  you have a great resource or want to share something with our EM student community please send it our way!

If dispo is king in the ED, the plan is the prince. But imaging plans can be tricky. You want to look at someone's abdomen, sure. But CT or MRI? Or is this one of the rare instances plain films help? Do they need IV contrast? PO contrast? By no means exhaustive, the guide below outlines common points of confusion with radiology. X-ray -AP vs PA Lateral: The "AP" or "PA" refers to the direction the beam is traveling to the receiver - either anterior to posterior (AP) or posterior to anterior (PA). Despite this being an x-ray this matters because is changes the observed size of images. Imagine your lamp is the x-ray beam and your desk is the receiver: putting your hand close to the desk results in a small hand shadow, moving it towards the lamp increases the size of the shadow. Why we care about this happening at all is the cardiac shadow on a chest x-ray. When the beam goes AP the heart, being more anterior, casts a bigger shadow that may overemphasize

Make your sticks stick. This is a Haiku Deck full of tips from NYP ED nurses on how to get good at starting IV's. These nurses do this all day every day. They know what they're about. Click here to go to the full version including the full length tips and tricks! EM Bound - Created with Haiku Deck, presentation software that inspires Further Reading : The Anesthesia Consultant Blog with some tips for difficult sticks . Songs or Stories on pediatric IV tips (that apply to adults equally as well).

One task every EM sub-I should know how to do is place an IV. But frequently the ED may be the first time you really place an IV - most patients come to the floor with an IV already in. The video will walk you through placing an IV, with a quick text summary below. Materials: -Fluid Bag -Flush -Cannula and needle -IV Start Kit (tourniquet, tape, transparent dressing, alcohol, gauze, small extension) -Tubing Technique: Before any procedure: Wash your hands and use proper protective equipment (here: gloves) Also remember you can change the position of the patient and the lighting in the room. These can make an enormous difference in your success rate (not to mention sparing contorting yourself into uncomfortable positions). 1. Set up and flush all the lines. This means spike the bag, clamp it off, and put the flush syringe on the small extender 2. Find the vein. Place the tourniquet on to help. 3. Prep the patient. Use the alcohol to clean the site,

As a sub-I you may be called on to consult a service – that is, after all, one of the two end pathways of anyone who walks into the ED (ignoring AMA). Calling a consult from the ED is just as much a skill as intubation or IV placement. It can take a whole residency to develop, but having the basics will move you away from shadowing med student towards functional sub-I.  Below is your step-by-step walkthrough of the process at the sub-I level. 1. Know why you’re consulting. Hopefully this is your patient, but if things get busy you might be asked to help with other patients (more so if the consult should be straightforward). Know the case, and specifically what you're calling for. Do you want the team to take them to the OR urgently, do you want them to come to the ED and write a note? This is something your senior residents and attending will help you identify. Phrase it as a question: "Does this patient need an emergency endoscopy? If not, we are wondering wh

Whether anybody likes it or not, the truth is in EM you will be graded mainly on your presentations to attendings. Following on the heels of our discussion of thinking EM , what makes a good EM presentation? First, brevity. Nobody - absolutely nobody - in the ED wants to listen to even a quarter of a medicine presentation. This isn't just personal preference - there are too many patients with too high of an acuity to waste time. Is the patient nice, personable, have a really cool job? Save it for after the presentation during downtime. Which brings us to: Keep it relevant to the chief complaint. You'll hear this a lot without much explanation. The truth is this kind of communication is a skill that will become easier as your knowledge increases - how relevant is past surgery to nausea and vomiting? This is complicated by the fact different attendings will consider some things "relevant" that others don't. This will come with experience, but in the meantime,

The only thing you'll see more than chest x-rays in the ED will be EKGs. Even if you've never seen a specific pathology before you need to be able to read it. In other words, you need a system! In the end, whatever works for you is important, but this is one I learned: Technical ABCDE. Technical This is all the non-anatomy parts of the film. ID: name, type of image, position of image (AP vs PA), correct date and MRN tend to be skipped, though some attendings will like to hear them. You should still verify these regardless. Image: Inspiration (can you count 8-10 posterior ribs), penetration (usually less of an issue with digitally captured x-rays), and rotation (look for symmetric angle of clavicles with sternum in non-rotated film). Patient: Any tubes, wires, catheters you see - especially note where central lines, PICC lines, and ET tubes end. A Airway: Is the trachea midline or deviated? B Bones: Look for overt fractures, dislocations, and lytic lesions

Welcome to EM BOUND. A blog for medical students interested in pursuing emergency medicine as a career.  As program directors for the sub-internship in emergency medicine @NYPEM  we've been noticing a need for more trusted, student focused, and curated online content. The EM BOUND project is designed to fulfill that gap. It is a collaborative project run by medical students and the NYPEM faculty to give you a high yield focused view of the EM bound process.  Here you will find regular posts relevant to where you are in your career when you need it. To start we have created an EM Handbook on Flipboard  filled with curated and original content that will help you plan your fourth year, succeed in your sub-internships, and get your  ERAS and interview skills honed to perfection. Please follow along and stay tuned for more great EM BOUND educational content in the days ahead. The EM BOUND Team @NYPEM

No matter how much you eagerly anticipate your first shift in the ED as a medical student, it is also intimidating. For the first time you are presented with a completely undifferentiated patient and asked to come up with a differential, plan, and disposition. No more "Go see the COPD exacerbation in the ED" or "Why does this CT show a case of appendicitis?" Medical school does not train you to think like an emergency physician. Completing a history and physical, then ordering lab tests and imaging, waiting for them to arrive, interpreting them, and finally making a diagnosis and treating the patient is not an option when they are bleeding out before your eyes (or having a stroke, or an MI, not breathing, seizing, possibly bleeding in their brain, foaming at the mouth, loss of consciousness, etc.). In the ED, it is not your job to come up with an iron clad diagnosis, it is your job to rule out life threatening conditions or treat them if they exist. And to do th

One of the skills most frequently taught and asked for by EM bound students is suturing. It's also one of the ways to shine as student rotating in the Emergency Department. Repairing lacerations is a common task for most emergency physicians on an average shift and is part of our core knowledge, but it is also time consuming. Offering to assist is a great way to help your EM team on shift. In many academic centers complex lacerations involving the face and other cosmetically important areas might involve a plastics or OMFS consult, but not always. On one shift in a rural hospital I covered I once spent two and half hours suturing an ear back together that had been blown apart by a firecracker. Here are some key pieces of advice and my favorite online resource to get you started so you're ready to jump in and help on your next shift. Spend some time at home learning and practicing. You won't be much help if you don't have at least some of the basic skills u