ER Rotation
March 2017: When it's slow on Easter, and you're working the ER. I have to say, I feel that my ER rotation was one of my favorite rotations so far. Is a great learning experience, working with multiple doctors everyday, and learning new things from each one. We thought our fair share of exciting traumas, and then the run-of-the-mill primary care complaints. Sometimes you feel like your in over your head.
One take away that found it very interesting, working in the ER in the city, find that there are many without access to health care, and regular Primary Care follow-up. Unfortunately, the resources of the emergency room are being abused, but this may be their only opportunity to get the health care they need, and you need to be able to help them. 1. It's important to do a full history on these patients, including medical history, surgical history, social history.
2. Review medications they are currently taking.
3. Make sure that they have prescription refills when discharged, so they are able to take medications as prescribed.
4. Counsel on the cessation of smoking, decrease in alcohol use and dangers of other drug use.
5. Provide education wherever, and whenever possible. Especially sex education and practicing safe sex.
6. Give patients access to free or low cost clinics for follow up, dental care, whatever they need. Use your resources!
I will admit I was a bit surprised at the amount of young adults coming into the ER with complaints of possible STIs concerned pregnancy. And they were unknowing to the normal function of their bodies. Such as menstrual cycles should occur "monthly". Another area of surprise was that the high rates of ectopic pregnancy and past medical history is many women in the city. This was brought to my attention by one of my preceptors, who made note that one cause can be history of sexually transmitted infections, or untreated sexual transmitted infections. Providing some information and education could help in one area to decrease this.
As students, your assistance with resuscitation, and traumas may be limited. Don't just stand back and watch, do whatever you can to help. This is helpful to the residents and attending school and a great way for you to take everything in. Put the patient in the monitor, put blood pressure cuff on, pulse ox, help get the patient out of clothes (always have scissors handy) and jewelry. While there are many things going on at once, one of the first things being done in an emergent resuscitation is getting vitals. Try to maintain composure and most importantly stay calm, you will see frightening things, but you need to remind yourself to stay calm.
Finally, be active, be forward. Take any opportunity you can for procedures, be it pap smears, ultrasound, suturing, I & D. And don't be nervous about doing it. Ask questions if you have any, research the procedure quickly before hand. Once they saw me throw a suture (nervously I might add), they kept coming to me with more lacerations. I got great experience, more than with my surgery rotation actually. I developed so much confidence in my self and abilities.
