I thoroughly enjoyed my ED rotation at Metropolitan hospital. Shifts in the ED are very fast paced and challenging, but I was able to see a lot of patients with various complaints encompassing nearly every body system. I was able to work with and learn from PAs, third year residents, attending physicians, and other staff such as nurses and social workers. During the 5 week rotation I spent 4 weeks in the main ED with 1 week being overnight shifts and 1 week in fast track/express care.

The beginning of my first shift was a little overwhelming, the ER was packed and I was also getting acclimated to everything. As the first week progressed and over the course of the following weeks I was able to work on my history taking and exam skills and use that to start developing my assessment and plan before presenting to the provider I was with that day. The plan was often the toughest part because in other settings I would usually have the opportunity to sit down and think about the plan thoroughly before presenting, in the ED I had to be ready quickly with the labs, imaging, and treatment that I would want to give to the patient.

The rapid pace and quantity of patients with various complaints allowed me to hone my physical exam skills. In particular the neuro exam and cranial nerves, GI exam, and musculoskeletal. In the ED many patients come in with complaints that make you need to be able to reliably do a comprehensive neuro exam. A lot of the neuro exam focused on the cranial nerves as part of the evaluation for stroke. Many patients also come in with musculoskeletal complaints with or without trauma and it was important to be able to do a thorough musculoskeletal exam of the affected body parts as well as other parts of the body that may have been affected. It was also important to know diagnostic criteria such as Ottawa ankle rules and Canadian C-spine in order to evaluate whether or not imaging is required. I was also able to do many procedures and hone those skills. Many were skills I learned at previous rotations, some were new skills. I was able to do IV placement, I&D, speculum exams, ocular tonometry, woods lamp/fluorescein stain, ultrasound & FAST exam, reading and interpreting EKG and imaging, interpreting labs, staple placement, staple removal, suturing, suture removal. A few patients stood out. One in particular was a person who came in with a suprapubic abscess. I was able to do the bulk of the procedure for the incision and drainage. I’ll never forget the odor, but the rest of the procedure went well and a few days later when the patient returned for follow up they reported great relief.

My week in the fast track was a lot like my ambulatory medicine rotation in an urgent care. Patients with level 4 or 5 complaints would be sent to the fast track in order to ease the load from the main ED. One patient that stood out was an elderly person who came in with a rash on their back. When the patient revealed the rash on their back I felt that I knew exactly what the rash was. The provider came in and confirmed my suspected diagnosis of shingles, I felt proud that I knew the diagnosis and had a treatment plan ready to present to the provider. It felt like a small culmination of some of the skills I had been working on over the previous 3 weeks.

Overall I really enjoyed my time in the ED and can see myself working in this environment after graduation. I hope everyone I worked with could see the effort I was putting in to improve my skills and knowledge every shift. I appreciated the effort put in by the providers I worked with to teach me how to improve. My next rotation is psych at QHC. I was exposed to some psych patients throughout past rotations and in the ED and I am looking forward to learning more about this specialty.

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