PGY-1 HCMC ED

INTERN RESPONSIBILITIES IN THE EMERGENCY DEPARTMENT

You are expected to be present and ready to work when your shift starts. Being late is not acceptable.  If you are late by more than 10 minutes in 3 different instances, you will owe the department a shift.

You shouldn’t work if you are sick.  Call the Team Center A pit boss or faculty at least 2 hours prior to the start of your shift if you cannot work.  Expect to make up your shift if you do not call ahead.

TEAMCENTERS: You are the primary caregivers in the Emergency Department.  It is expected that you will start out slow as you familiarize yourself with how the ED works.  Within a few days however, you should be carrying at least 3 patients at any given time.

After you have performed your focused history and physical, develop a differential diagnosis and plan, and present this to the pit boss (or staff if there is no pit boss in your area).

A pit boss or staff should be present for all pelvic or ultrasound exams or any invasive procedures.

Start tying up loose ends on patients 15-25 minutes before the end of a shift.  Make sure that the patient has been staffed and that there is a plan in place.  Complete all procedures, invasive exams, admission sign-outs (if applicable) and documentation before signing out at the end of a shift. 

SPECIAL CARE:  This is an area of the ED dedicated to evaluation of intoxicated and mental health patients who require restraint and isolation.  You will be responsible for running this area of the ED, with Team Center A staff as you supervisor.  If volume allows you should be picking up patients in A or calling triage to take some fast track patients through Special Care.

A patient will be brought into SC by paramedics or police.  The will be changed into a hospital gown and restrained on the gurney or placed in one of the isolation rooms in the back.  You will need to:

• Talk to the people who brought in the patient to gather history.
• Talk to the patient to gather history.
• Examine the patient, this should include:
  • exposure and visual inspection from head to toe looking for signs of injury/deformity.
  • complete HEENT
  • CVS
  • PULMONARY
  • ROM of extremities
  • anything else indicated given hx
• Look up hx on IRIS and EMSTAT.
• Enter gathered information in EMSTAT.
  • First dx should be Altered Mental Status for all intoxicated individuals.
  • Try to enter a progress note q2h on patients during the shift.
  • Patients can be discharged to jail, detox, a sober individual/parent, to street once clinically sober or to hospital.
  • Before patient is d/c’d to street the patient must be able to walk/talk/urinate normally.
  • For abnormal pupils there is a book with a number of known individuals.

Sometimes police with accompany the patient with intent of returning to the jail after evaluation, these should be seen earlier to clear the room.

Yes most of the people are drunk and not the most charming of the patient population but remember these individuals are the most likely to have serious injuries that can be overlooked or have gone unattended for a long period.  Be on the look out for that headbleed or acidosis that could go unnoticed.  Also, do not simply sit back in SC if there is nothing to do, if everyone is tucked in you should be picking up people in TCA.

Staff comes by intermittently to round.  It is reasonable to go to them in TCA and present the newest patients and develop a plan.  Good Luck and remember your stories for your turn at the ALOHA party!

If your patients in special care have been seen and you are not busy, you are expected to help out in Team Center A.

STABILIZATION ROOM:  This is a room you’ve all heard about.   When you hear a STAB called overhead you should try to arrive in few minutes before the patient is expected to set up.  Get into a gown, gloves and face shield.  Have you IV set up as well as two syringes to draw labs.  As the intern, you are responsible for one of the most important tasks in the management of any critical patient, establishing IV access.  Practice this skill in the cubes so you are proficient when it counts. 

• Help with transfer of patient onto the cart. 
• The on the opposite side of the patient from the nurses you should start an IV and draw blood.
• Help roll the patient and palpate spines on trauma.
• Start foley if indicated, use numbing gel if indicated.
• Do the rectal/hemoccult if indicated.
• You also are the one that is often doing compressions in an arrest.
• You will do lines if there is no G2, or there are more lines that are needed quickly.
• Help where needed, with whatever you are told to do.

Take brief breaks as needed to use the restroom and sit down to eat.  Coordinate with others in the pit area so that your patients are covered.

Take advantage of ED experience.  If you don’t know how to do something, ask.

Work hard.  Have fun.