EM Chiefs
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We’re glad you are here
This purpose of this presentation is to provide
helpful information for your new role as an
emergency medicine resident
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There is a list outside Laura’s door of
everyone’s rotations by month
Your schedule is available in Tangier
(www.tangierweb.com)
You can click on location schedule to find out
who you will be working with
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Each intern will work 18 shifts in the one
month period
Interns with scheduled vacation will work 14
shifts
We will typically make the schedule 3 weeks to
1 month in advance and will email the
schedule out
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AM shifts: Be there by checkout, 6:45am
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PM shifts: Be there by checkout, 6:45 p,
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Mid shifts: Show up at noon, be available for
checkout, try to dispo each of your patients by
midnight
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Notes about trading shifts after the schedule is
published:
You MAY trade a shift for a shift with another intern
if they agree
 The preference is for switches with another EM
intern
 Ask one of the chiefs if you want to switch with an
off service
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If you are sick, injured, etc, let someone know
immediately
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Checkout is in the South (front) fish bowl each
day at 6:45 am and 6:45 pm. All residents
working are expected to be present.
If you are working the Noon to Midnight
(mid) shift, please be available at the 6:45pm
check out to update the team on your patient’s
status and treatment plan
The check out presentation should include a
brief/succint summary of presenting
complaint and findings, pertinent labs/study
findings and planned disposition
Prior to leaving, (ffs) be sure that your
documentation is complete
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Example:
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Mr. Smith is a 67 year old male with h/o diabetes,
hypertension, and smoking with no past cardiac
workup who presented complaining of chest pain
that was relieved by nitroglycerin x 3. His labs,
including cardiac biomarkers, are all normal and
there are some lateral T wave changes on his EKG.
He has received an aspirin. He will be admitted to
the medicine team for further workup. I have
already spoken to the admitting team. He is still
chest pain free and there should be nothing else to
do or check.”
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Example
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Ms. Johnson is a 36 y/o woman whose pelvic
exam is consistent with PID. I have just ordered
Rocephin IM and she can leave as soon as she
receives it. Her discharge instructions and
antibiotics are on the chart.
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You may see patients on either the North
(back) or South (front) section
Feel free to bounce back and forth as needed
Patients should be seen in the order the charts
are placed in the chart regardless of chief
complaint (unless someone is critically ill)
Patients are triaged by their level of illness (15)
Feel free to pick up sick patients (level 2), but
if you walk into a room and notice that
someone appears ill, grab your attending or an
upper level resident prior to performing a
history and physical. The patient may require
time-critical interventions!
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All documentation in the ED is done on pre-made
T-sheets.
The T-sheets are listed by chief complaint and are
located just outside the front and back fish bowls.
If you cannot find a T-sheet that properly matches
the complaint, a “General Medicine” T-sheet is
available.
All portions of the T-sheet should be completed,
including filling in labs and xray results.
Be sure to sign the T-sheet legibly.
(Be sure your attending signs it too)
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Get as many procedures as you can
See as many new procedures as you can
For now, talk to the attending before doing a
procedure.
A procedure note should be written for any
procedure performed, there are specific
procedure notes in the T-sheet racks.
Don’t forget to log your procedures
http://www.new-innov.com
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If you see a patient that you are concerned about,
let the attending know right away. If you can’t
find an attending, notify an upper level for help
until the attending is available.
Each attending has a different personality and
different preferences. Talk with the upper levels
when you arrive about tips for presenting to the
attending for that day/night.
There are typically two attendings on each day.
One takes the front section, the other takes the
back. Present to the attending who is covering the
section your patient is roomed in.
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Illness and injury do not discriminate on the
basis of mental stability or desire to obey the
laws of society
Please be cognizant of your personal safety at
all times
If you ever feel uncomfortable or threatened,
remove yourself immediately from the
situation
Security and LRPD are always available and
can be called for assistance
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Conferences are on Thursday from 7am to
Noon. You are required to have at least 70%
attendance.
You are only excused if you are working the
night before and after.
If you are one an off service rotation, you
should be allowed to go to conference
If you are scheduled from 7a-7p on Thursday,
you had better be at conference.
The money shift: AM shift on a conference day
The shaft: Conference then a mid shift; we will
try not to do this to you.
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7/12/12: Cadaver Lab
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7/19/12: Splint Lab
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2/21/13: In Service Review
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3/28/13: Cadaver Lab
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Communication with the nursing staff will get you
very far. Most of our nurses are very experienced
and want to help you if you will allow them.
You must call radiology for US at night and on
weekends (681-1812).
Radiology will put prelim reads in for CTs, these
are available on PACS.
Discuss plain film x-rays with the attending prior
to acting on them and prior to patient discharge.
If you have any questions or concerns, just ask! We
are happy to help however we can.
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When you pick up a patient chart, place your
name in the resident box on the ED dashboard.
For lab orders, if you type “ed.superset” you
will have a order set with many typical ED stat
orders.
When you consult another service, type
“ed.consults” and select the service.
Make sure all orders are STAT