1. Emergency Medicine Intro to Clinics Night Evan Suzuki Mike Abboud Emergency Medicine

2. The Structure • 4-5 approximately 10 hour shifts per week • Expect to work a few overnights and weekends • At HUP you will be paired with and present to a resident • At Presby,Pennsy, and Reading you will present directly to the attending • Weekly 5 hour HUP conferences on Wednesdays • Occasional roughly 3 hour CHOP conferences on Fridays

3. Getting Ready for the First Shift • Learn and practice reading EKGs in a methodical way • EKG books • Sample EKGs - http://ecg.bidmc.harvard.edu/maven/mavenmain.asp • Review the DDx of COMMON and DEADLY causes of… • Chest Pain, Shortness of Breath, Abdominal Pain, • Dizziness,Nausea/Vomiting, Pregnant and Bleeding, • Altered mental status, Syncope, Joint/Back Pain • Review the EM booklet on VC2000 (hard copy given during orientation) I am really helpful!

4. EMTRAK • HUP’s easiest and most intuitive EMR • During orientation make sure you have EMTRAK access and ask Janae and/or HUP IT how to link to Medview • Before seeing a patient • Click “Reports” then “Print Triage Report” to get a sheet with the vitals, chief complaint, and triage notes • Click the “prev” tab to see check out previous ED visit records • Check MedView for an overview of their past EKGs, problem list, hospital discharge summaries, and outpatient notes • “Chart biopsies” are important but don’t get too lost in the EMR before seeing the patient!!!

6. Need to call a Consult?? Here is where you can look up the number for it! Under “Reports” you can find “print Triage Report” – this lets you have a sheet with the vitals and triage notes… all the residents use this!

7. Type your notes under this tab so you can edit them. These tabs are all really useful, especially “Prev” … is this patient always having back pain?? Brings you to their clinical overview – use “cardiology” to look at previous EKGS

8. Doing H&Ps and Presentations • Enter the room with a BASIC DDx, the info you gathered from the EMR, and a mental or written list of questions to ask. For chest pain… • Deadly DDx: dissection, MI, esophageal rupture, PE, tension PTX • Common DDx: costochondritis, muscle strain, trauma, asthma, panic attack, angina • EMR info examples • Recent admission for NSTEMI and previous EKGs • Frequent visits for chest pain without any • OPQRS questions • Focused but thorough H&P…don’t forget to ask about sex and drugs! • Be concise while presenting • We care if a 60yo male patient’s father died of an MI • We don’t care if a 20yo female’s grandfather died of prostate cancer • Know more than you tell the residents and/or attending

9. The Perfect H&P • Chief complaint • History of present illness with pertinent positive and negatives • Brief review of systems • Focused Past medical and surgical history • Focused pertinent medications and allergies • Very focused social history and family history if required • Vitals- highlight any abnormal vital signs • Focused and pertinent physical exam • Differential diagnosis • 3 life threatening things, 3 more likely things • Which do you think is the correct diagnosis and why? • Plan: Remember, both diagnostics AND therapeutics! • http://embasic.org/2012/03/27/how-to-give-a-good-ed-patient-presentation/

10. What else should I do? • Sometimes it’s helpful to obtain records from OSH and other EDs: offer to make those calls • Get involved with procedures! Blood draws, A-lines, LPs • Always offer to gather supplies & clean up (see a map of supplies in the HUP pocket-guide) • If at HUP: watch any traumas or resuscitations • If at Presby/Pennsy: go to any codes, STEMI alerts, intubations. Get involved in chest compressions if you have the chance.

11. Studying for the Shelf • Departmental exam and NOT a standardized shelf • Modified in the middle of last year • All multiple choice questions (some poorly worded) • Short vignettes or straightforward fact questions • Most material covered on a circulating review sheet • Study no more than 3-5 days leading up to the exam and pay attention during didactics