Emergency Medicine
Intro to Clinics Night
Evan Suzuki
Mike Abboud
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
Getting Ready for the First Shift
 Learn and practice reading EKGs
in a methodical way
 EKG books
 Sample EKGs http://ecg.bidmc.harvard.edu/m
aven/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!
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!!!
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!
Type your notes
under this tab so
you can edit
them.
Brings you to their
clinical overview –
use “cardiology”
to look at previous
EKGS
These tabs are all
really useful,
especially “Prev” … is
this patient always
having back pain??
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
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/
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.
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