WELCOME TO THE ED

EM Chiefs

Welcome to Residency

We’re glad you are here

This purpose of this presentation is to provide helpful information for your new role as an emergency medicine resident

Your Schedule

There is a list outside Laura’s door of everyone’s rotations by month

Your schedule is available in Tangier (www.tangierweb.com)

You can click on location schedule to find out who you will be working with

Your Schedule:

Shifts/Scheduling:

Each intern will work 18 shifts in the one month period

Interns with scheduled vacation will work 14 shifts

We will typically make the schedule 3 weeks to 1 month in advance and will email the schedule out

When should I be there?

AM shifts: Be there by checkout, 6:45am

PM shifts: Be there by checkout, 6:45 p,

Mid shifts: Show up at noon, be available for checkout, try to dispo each of your patients by midnight

Shifts/Scheduling:

Notes about trading shifts after the schedule is published: You MAY trade a shift for a shift with another

intern if they agree The preference is for switches with another EM

intern Ask one of the chiefs if you want to switch

with an off service If you are sick, injured, etc, let someone

know immediately

ED Schedule:

Check OUT:

Checkout is in the South (front) fish bowl each day at 6:45 am and 6:45 pm. All residents working are expected to be present.

If you are working the Noon to Midnight (mid) shift, please be available at the 6:45pm check out to update the team on your patient’s status and treatment plan

The check out presentation should include a brief/succint summary of presenting complaint and findings, pertinent labs/study findings and planned disposition

Prior to leaving, (ffs) be sure that your documentation is complete

Check Out Presentation

Example: Mr. Smith is a 67 year old male with h/o

diabetes, hypertension, and smoking with no past cardiac workup who presented complaining of chest pain that was relieved by nitroglycerin x 3. His labs, including cardiac biomarkers, are all normal and there are some lateral T wave changes on his EKG. He has received an aspirin. He will be admitted to the medicine team for further workup. I have already spoken to the admitting team. He is still chest pain free and there should be nothing else to do or check.”

Check Out Presentation

Example Ms. Johnson is a 36 y/o woman whose

pelvic exam is consistent with PID. I have just ordered Rocephin IM and she can leave as soon as she receives it. Her discharge instructions and antibiotics are on the chart.

The Front

The Back

The Back

Fast Track

Room 8: OB/GYN

Room 14: Eye Room

Surge Unit

PACS

PACS

Seeing Patients:

You may see patients on either the North (back) or South (front) section

Feel free to bounce back and forth as needed Patients should be seen in the order the charts

are placed in the chart regardless of chief complaint (unless someone is critically ill)

Patients are triaged by their level of illness (1-5) Feel free to pick up sick patients (level 2), but if

you walk into a room and notice that someone appears ill, grab your attending or an upper level resident prior to performing a history and physical. The patient may require time-critical interventions!

ED Tracker Board:

The Rack

Documentation:

All documentation in the ED is done on pre-made T-sheets.

The T-sheets are listed by chief complaint and are located just outside the front and back fish bowls.

If you cannot find a T-sheet that properly matches the complaint, a “General Medicine” T-sheet is available.

All portions of the T-sheet should be completed, including filling in labs and xray results.

Be sure to sign the T-sheet legibly. (Be sure your attending signs it too)

T Sheets:

T-Sheets

Procedures

Procedures:

Get as many procedures as you can See as many new procedures as you can For now, talk to the attending before

doing a procedure. A procedure note should be written for

any procedure performed, there are specific procedure notes in the T-sheet racks.

Don’t forget to log your procedureshttp://www.new-innov.com

Get an Upper Level to Help

Procedure Logs

Presenting to the Attending

Presenting to the Attending:

If you see a patient that you are concerned about, let the attending know right away. If you can’t find an attending, notify an upper level for help until the attending is available.

Each attending has a different personality and different preferences. Talk with the upper levels when you arrive about tips for presenting to the attending for that day/night.

There are typically two attendings on each day. One takes the front section, the other takes the back. Present to the attending who is covering the section your patient is roomed in.

A Note on Safety

Illness and injury do not discriminate on the basis of mental stability or desire to obey the laws of society

Please be cognizant of your personal safety at all times

If you ever feel uncomfortable or threatened, remove yourself immediately from the situation

Security and LRPD are always available and can be called for assistance

Conferences:

Conferences are on Thursday from 7am to Noon. You are required to have at least 70% attendance.

You are only excused if you are working the night before and after.

If you are one an off service rotation, you should be allowed to go to conference

If you are scheduled from 7a-7p on Thursday, you had better be at conference.

The money shift: AM shift on a conference day

The shaft: Conference then a mid shift; we will try not to do this to you.

Important Dates

Other important Dates

7/12/12: Cadaver Lab

7/19/12: Splint Lab

2/21/13: In Service Review

3/28/13: Cadaver Lab

Other Helpful Hints:

Communication with the nursing staff will get you very far. Most of our nurses are very experienced and want to help you if you will allow them.

You must call radiology for US at night and on weekends (681-1812).

Radiology will put prelim reads in for CTs, these are available on PACS.

Discuss plain film x-rays with the attending prior to acting on them and prior to patient discharge.

If you have any questions or concerns, just ask! We are happy to help however we can.

Ask Your Friendly RN

Helpful Hints for Sunrise:

When you pick up a patient chart, place your name in the resident box on the ED dashboard.

For lab orders, if you type “ed.superset” you will have a order set with many typical ED stat orders.

When you consult another service, type “ed.consults” and select the service.

Make sure all orders are STAT

Traumas

Trauma Roles

Trauma Roles

Trauma Room

Code Cart

Where the &#$% is ____?

Blanket Warmer, Blood Fridge

FAST

CVLs, Art Lines

Important Places

PPEs & Scrubs

Consultant Room

Water, Ice, Other Equipment

CT Scanner

Lounge