When people think of the emergency department what is the first thing that comes to mind? The wait, the dreaded wait. For many, going to the ED is stressful, inconvenient, scary, and oh so time-consuming. But from the perspective of someone in scrubs, other people’s misfortune, is an ER practitioner’s excitement! For rotation 9, I was in the IU West Emergency room in Avon, IN. I worked a few day and evening shifts, but a majority night shifts. The staff there was wonderful and I can’t speak more highly of my experience. It is not a Trauma 1 Center like Eskenazi or Methodist in downtown Indy so I didn’t see a bunch of crazy trauma cases like gunshot wounds and major car accidents, but I did get to do a lot of hands-on assessments and procedures.
Like any emergency department there is a wide variety of patients and not all of them come with real emergencies. On one end of the scale are the patients who treat the ED like their primary care office and come in for a sniffly nose, a “fever” of 100F, pain medicine, or just typical aches and pains.
Then there is a large portion of people who present with abscesses, lacerations, or broken bones. I got extensive experience with local anesthesia, stapling, suturing, and I&Ds. Additionally, I got to help with reducing fractures and placing splints. These procedures kept the shifts interesting and I really enjoyed improving in these clinical skills.
Next in increasing severity are the patients who present with stroke symptoms, chest pain, abdominal pain, or shortness of breath. So, there are a lot of things that can cause subjective weakness/numbness, chest pain, abdominal pain, and shortness of breath and an exact cause is not always identified in the ED. One of the key differences between the ED compared to other areas of medicine is that, in general, practitioners think about differential diagnoses from most deadly to least deadly rather than from most likely to least likely. In other words, rule out the things that would most likely kill the patient first. It was very important that I learn to work-up and think through these big and sometimes deadly presenting symptoms and I was thankful for the opportunities I got to do just that.
On the other end of the scale are the patients who arrive in cardiac arrest. One of the most memorable moments was doing CPR on a real patient for the first time. It was surreal. I have learned and practiced the technique plenty of times on mannequins, like thousands of other people, and have maintained a CPR certification since I was a young teenager. But, being in the midst of a true code carries with it a level of intensity and palpable adrenaline that is unmatched and unable to be prepared for. Unfortunately, our patient did not make it. However, he provided me a valuable learning opportunity and I can confidently say that I feel completely comfortable starting CPR and would not hesitate to jump in if I came across someone in need.
This was probably my favorite rotation thus far! I loved the shift variety, hands-on procedures, clinical decision-making, and overall energy of the ED. It came with its challenges, the most notable being the changing of shifts and accompanying fatigue being physically hard on my body and the odd hours making it difficult to talk on the phone with my long-distance husband. But, if the right opportunity opened up, I would certainly enjoy making a PA home in the ED!
Up next is one month of thoracic surgery. I cannot believe this is my last core rotation. Wow has this clinical year passed quickly! After this rotation I take my summative practical and written exam and then focus my attention on studying for my boards while I finish up two, three-week electives.
Watch out, I am going to be a practicing PA before you know it!