EM Bound

As medical students it can be hard at times to find ways to contribute to the care of our patients and teams. Sure, we see and evaluate patients on our own, but that doesn't preclude a more senior member from also doing their own evaluation, work-up, and note. Most everything we do needs to be approved or observed: our orders must be signed, procedures must often be carried out under watchful eyes, and patients are sometimes (understandably so!) unwilling to let the junior members of the team practice basic skills on them. When you know that asserting yourself in the care of your patient requires everyone else to chip in, it is easy to feel like a burden rather than a team player, especially in the fast-paced and busy environment of the emergency room. The flip side, of course, is that if you can find a way to carve out a niche for yourself by owning certain areas of your patients' care, you can work within the team to ease the workload of everyone around you and drive patie...

AVS is characterized by rapid onset of vertigo, nausea/vomiting, and gait unsteadiness with head motion intolerance and nystagmus.   The most common cause tends to be viral in nature, affecting the inner ear.   While this may be the domain of our esteemed neurology colleagues, there are 2.6 million ED visits for dizziness or vertigo annually in the United States, where the differential between a benign viral cause of vertigo or dizziness must be delineated from potentially lethal causes such as brainstem or cerebellar strokes. Vertigo and dizziness, especially in cases of labyrinthitis, is caused by inflammation along the semicircular canals, affecting the flow of fluid throughout the system and causing the brain to interpret tilt or head spinning when there is none.   However, these same systems can be disrupted by central nervous pathologies that affect the vestibulocochlear nerve or the pons, which CN VIII enters.   Acute stroke in the vertebrobasilar circula...

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!

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).

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,...

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...