Tag Archives: clinical

Blood, Guts, and Bones…Your ER Rotation

6 Oct

Medical research and studies

I must say that I have been working in the ER for 6 years now so I am a leeeeetle partial to this rotation.  My rotation was in a busy, level 1 trauma center.  It was an intense, mind blowing 6 weeks.   Stress levels run high and there is always a lot of action.  There is also a disproportionately large amount of bull crap complaints, which you will notice right away.

I had an interesting emotional response during my ER rotation.  We saw a few trauma patients with gun shot wounds.  These were young men who died of senseless violence.  One free Friday night my husband and I went to see the movie “Departed”.  I know, one of the best crime movies with some seriously gorgeous men.  Although I did enjoy Leonardo Dicaprio and Matt Damon, I walked out of that movie in a near panic attack.  The shoot em’ up scenes hit me in a new way.  I watched people die, in real life.  The violence and death I experienced in the ER shook me deeper than I knew.  The ER is a place where you see people at their most vulnerable and scary moments.  We are a key player in these moments and that can take a toll on you emotionally.

The following are some tips to get you through your rotation.

1.  Be on time…in fact, be early.  Shift changes are key times of sign out and you will be better prepared if you know what is going on with the current patients.  You will also likely learn something about diseases and treatments.

2.  Make your presentations succinct.  There is nothing more irritating then a long, drawn out, fumbling patient presentation.

3.  Know your differentials.  The ER is a little different than your primary care rotation in that the attending will want to know mainly the life or limb threatening possibilities.  Always have five possible diagnosis and say them with confidence!

4.  If you can be a part of an end-of-life discussion you should be there.  This is more of the “art of medicine” that we all need more practice on.

5.  Patient education takes a lot of time.  A LOT of time.  I had a patient who was scared because she thought she had “poop coming out of the wrong hole”.  It was not.  My cartoonish drawing helped clear that one up.

6.  ATLS, PALS, ACLS are all important to know.  When you are part of a code, try to think preemptively what meds and procedures should be done.  You will understand the process better if you try to think for yourself.

7.  In my ER, PAs do central lines, chest tubes, intubations, sutures, I and Ds, dental blocks, joint reductions, splint applications, among other procedures.  You will not get a hang of these in 6 weeks but its important to know the indications, instruments, and meds used.

8.  Nurses, Techs, Medics,  HUCs…They all make the ER roll along and most of them know more than you do.  Show respect.

9.  Be assertive.  There will likely be Med students, NP students, nursing students, medics in training all trying to get in on that code or procedure.  If you don’t get yourself involved no one is going to coddle you along.

10.  The ER may be the career choice for you if you enjoy fast paced, high adrenaline settings… and you don’t mind having a schedule that is opposite of all your friends’ and family’s.   PAs get to use a large skill set and it is cool to help save lives in real time.  You also see some really heart wrenching things and you have to be the type of person who can leave work at work.  Did I say that I love the ER?  Comment below if you have questions or great stories.


Slice ‘Em and Dice ‘Em: Your Surgery Rotation

2 Sep


My surgery rotation was at a busy hospital in Philadelphia.  I chose to do a more general surgery rotation to get a wider scope of what happens in the OR.  This included general surgery, colorectal, breast, and ortho.  My favorite was colorectal…not.  I never knew how they had to position a patient for rectal surgery, and let me tell you, it ain’t pretty.  Backside up, retractor in.  If you have never had a surgical experience,  be prepared for the brutality of it.  The patient is anesthetized, the music blasts, and there is no finesse necessary for getting the job done.  Mostly as a student you will be holding instruments.  You will be retracting.  You will be on your feet for 10 hours a day.  I was lucky enough to work under the chief resident who happened to look like Meg Ryan from City of Angels and she actually was pretty decent. Here are some heads up about what to expect.

1) Surgical residents get treated like pond scum….so thats the only way they know how to treat you.

2) There is a TON of pimping going on.  The attendings pimp the resident and the residents pimp you.  You should learn this phrase “I’m not sure but I will look it up and give you the answer later today.”

3) It would be helpful to get a pocket guide for the most common surgical procedures and their indications.  You will be asked about epidemiology, pathophysiology, anatomy, treatment, etc.

4)  Surgery Departments are typically boys’ clubs.  Unless things have drastically changed since I graduated, expect that it will be more difficult to be successful during this rotation if you are a woman.  There is a lot of male camaraderie and strutting going on.  “Oh hello, did you know I’m a surgeon?  Just wanted to remind the whole hospital how awesome I am” Just ignore it.  Show them your book smarts and be prepared.

5)  Go over sterile procedure.  You will scrub in so know how to it before you get there.  Know about the sterile field.  If you break the field you will be the most hated person in the OR for your entire rotation.

6) The surgical techs are gods in the OR.  They know every instrument, how to handle them and how to maintain the sterile field.  They may help you get your gown and gloves on.

7)  Expect to stay late.  Everyday.  There will always be a late, add-on, once-in-a-lifetime case that you would be a complete idiot to miss.

8) Continuing off of #7, sometimes you can’t stay late.  Its okay to say no if you have something REALLY important happening.  An example would be that you are in labor and your water breaking would contaminate the field.  If you truly have to leave on time, just be prepared to get some seriously disappointed looks.  If you can handle it, walk out the door with your head up.

9)  Bring protein bars…at least 3 or 4.  Lunch break is rare.  Breakfast and dinner breaks are even rarer.  Pretty soon, that mass you just helped remove will start to look delicious.  Gross.

10)  This may be the specialty for you if you find out that you like instant gratification.  Someone’s gall bladder turns black, you take it out.   BOOM!  The End. There is less direct patient contact, but you are in close contact with your supervising MD everyday.  In all seriousness, surgeons typically come from the top of their class.  There are many kind hearted and gifted surgeons that you can learn a great deal from.  So be prepared to work long, hard hours this rotation.  Suddenly the textbooks will be replaced by real people and so many pieces of the puzzle will fall into place for you.  I promise, retracting is not nearly as bad as it sounds 🙂

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