From the beginning of didactic, I was always looking forward to my emergency medicine rotation. I knew that I would learn a lot and experience a lot and I was not disappointed. In my emergency medicine rotation I had shifts in several different parts of the department: pediatrics, trauma, main emergency room, and urgent care. I also was assigned several overnight shifts, which allowed me to get a real feel for how it is to work in the emergency department (ED) as a PA.
I saw a wide variety of cases including: chronic back pain, altered mental status, TB rule out, breast abscess, third degree AV block, pneumothorax, SVT, massive hematemesis with esophageal varices, ectopic pregnancy, trauma, alcohol withdrawal, liver abscess, headaches, UTIs, facial and hand lacerations, anal abscess and fistula, hyperemesis gravidarum and fetal demise. This wide variety of cases meant I got practice with different focused histories, exams, differentials and plans. I got to interview patients on my own and perform a physical exam. I would then form a plan for the patient with the differential diagnosis in mind. I presented this to a resident, PA or attending that I was working with. I then went with the provider to see the patient again. This was really educational because I got to see how a lot of different providers worked. The saying “everyone does it differently but everyone does it right” is very true. I also got to see ways I could have improved in my history taking and physical exam of a patient. I think this method helped me improve throughout the rotation, and the feedback I received from the providers I was working with toward the end of my rotation reflected that.
A few things that I was not comfortable with at the beginning of my rotation I now feel comfortable with. I had only done a neurological exam once or twice prior to this rotation. In this rotation I did a neurological exam on nearly every patient who I saw, especially those presenting with dizziness, headache, high blood pressure and syncope. I am now comfortable performing a neurological exam and interpreting the results. Additionally, prior to this rotation I was not comfortable identifying abnormal lung sounds since I had no frame of reference. I listened to every patients’ lungs on this rotation and by the end was able to identify adventitious lung sounds correctly.
On my previous rotation I got to do a few IV insertions, nasopharyngeal and pharyngeal swabs. On this rotation I got to do several more IV insertions, and nasopharyngeal swabs. Even though those were not new skills for me I appreciated the chance to practice and improve with them. I was able to learn new skills on this rotation as well. I was able to suture several lacerations, do several intradermal and intramuscular injections, assist with drainage of an abscess and a knee joint aspiration. I got to practice interpreting ECGs and using the same method each time, I was successfully able to identify abnormalities on ECG.
On future rotations I am looking forward to using the feedback I received from my preceptors to become an even better PA student and future PA-C. I will work on my differential diagnosis, I was given several tools to help me develop my differentials, one I particularly liked for the ED was the SPIT mnemonic. I will frame my differentials in terms of: serious, probable, interesting and the treatment for all of them. Using this method I will be able to come up with a long list of differentials, but it will also help me to come up with a better plan for my patients, which is something I need to continue to improve with. For my future rotations I would like to learn additional clinical skills, practice skills and procedures I have done already because there can never be enough practice, improve my differentials and plan.
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