EM Bound

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