Emergency Medicine is a specialty that a lot of students either love or hate. Some love the fast-paced nature and all the procedures, while others hate the lack of predictability and chaos. Emergency medicine is an important clinical rotation for everyone because it teaches you skills you can use across all specialties.
As with all rotations, everyone’s emergency medicine clinical rotations experiences are different, but I hope that this guide can help you prepare to make your emergency medicine experience the best it can be.
My Emergency Medicine Experience
My emergency medicine clinical rotation was at a major trauma hospital near where I went to school. It had a huge emergency department with different pods. It was also a teaching hospital so there were many residents and medical students around as well. For my rotation, I was mainly with a PA and felt really incorporated into the medical team.
My time in the emergency room was split between a higher acuity Fast Track and a general main emergency room pod. This allowed for seeing a lot of different diagnoses and patients with conditions of different acuities.
I also felt that emergency medicine was the clinical rotation with the most hands-on experience. There are many procedures or things to be done in the emergency room that other rotations and specialties do not have. In my experience, there were a lot of lac repairs, suturing, splinting, and wound dressing. Also, since it is quick-paced, emergency medicine really helped me to hone in on a focuses history and physical, while also considering a large differential list.
Things to Review Before the Rotation
These are all things that I encountered frequently on rotation and needed to constantly review. It would have been really helpful to me if I would have reviewed these before the rotation (and maybe I wouldn’t have gotten pimping questions wrong lol).
- ACLS Algorithm
- differentials for various pains (chest pain, abdominal pain, eye pain) essentially you are ruling out the bad differentials
- suturing techniques
- lab values for acute conditions
- common fractures and injuries (Jones, Boxer’s, Scaphoid [snuff-box tenderness], posterior fat pad sign in child vs adult)
- headaches and warning signs
- IV fluid types and indications
Some Procedures that I Saw or Assisted With (that would have been helpful to review prior to rotation)
- suture techniques
- nerve blocks
- fluorescein dye administration
- the various splinting techniques (ulnar-gutter splint vs spica splint, etc)
Tips for while on the ER clinical rotation
Learn from everyone around you
There is always so much happening in the emergency room. You can learn from everyone around you, not just your preceptor. People in the ER see a lot and go through a lot, so there is much to learn. There are always labs that need drawn, people that need taken to x-ray, or wounds that need dressed. Don’t be afraid to ask to watch the nurse while she putting in an IV or to volunteer to draw the labs. Most people are happy to let you at least watch what they are doing, and you can learn from everyone’s different ways of doing things.
Consider ALL differentials
In the emergency department, people are often coming to you with worries that something big is wrong. Sometimes there is something big wrong, sometimes not, but you always have to rule the big stuff out. Really consider all of the possible differentials and rule them out one by one. This may take you longer at first, but after practice, you will be able to pull a long list of differentials and rule them out one by one. By having a comprehensive differential list, you can ask of the right questions and do the best physical exam possible.
Give people as much privacy as possible
With all the busyness and crowded nature of the emergency room, patients sometimes don’t have the same amount of privacy that they would have while in a different medical setting. Patients deserve the most privacy they can get if possible. Sometimes the situation doesn’t allow for complete privacy, but help patients by closing the curtain when you leave, talking in a quieter tone, or helping them stay covered with a blanket if needed.
Things to have in your pocket in the Emergency Department
I recommend getting a decent cheap pair, because its likely that you will lose them or someone will take them. I also recommend getting one in a unique color because everyone has a black pair, so it is much more likely to get lost if you have a plain black pair (mine was bright pink and it was always returned to me lol). I have included an Amazon link to a good pair here.
A good penlight
You will use a penlight a lot to examine all sorts of things, but often times the eyes since you’ll see a lot of falls in the ED. Some people use their phone flashlight, but its not great practice and its not a very bright light. Here is a penlight on Amazon that I recommend.
Its always important to do a full physical. Always listen to heart and lungs.
Spare alcohol swabs (or anything else you use a lot)
I always needed alcohol swabs in the emergency room, so I started keeping them in my pocket and it saved me a lot of time. If there is something you find you use a lot of, its not a bad idea to keep it in your pocket if you can.
Notebook (or folded piece of paper) and pen
Have something with you to take notes and write stuff down when you need to.
Having your phone with you can be helpful to have apps like MDCalc or UpToDate handy.
Study Materials to Use to Study Emergency Medicine
- UpToDate (if provided by your school or hospital)
- Rosh Review
- Lange Question Books
- First Line Guide
- Pance Prep Pearls
- ACLS Handbook: I have included a link to it here, but if you have taken an ACLS course before, you have this book sitting around somewhere. ER rotation is definitely a great time to review it.
- One Page ICU: While some of One Pager ICU is geared at the ICU (as the name says), there are a ton of useful resources on emergency management.
Any other rotations coming up? Check out my posts about some other rotations:
I hope that this guide helps you with prepping for your emergency medicine rotation. There is so much opportunity for learning in your emergency medicine rotation. Best of luck!
Thanks for reading!