Emergency medicine is what I want to practice first after graduating PA school so I was really looking forward to having this rotation (in other words, saving the best for last). Because I had this rotation last, I was able to use all the knowledge and skills that I have gained throughout this year and put them to use. Rotating at Woodhull’s emergency department was amazing since I was able to evaluate and manage very sick patients that are part of the underserved community, many of which do not have insurance or are homeless. I was also required to think fast on my feet and come up with differentials, assessments, and plans relatively quickly. I learned how to manage many acute patients at once since the ED requires prompt follow up when labs or imaging studies become available, which may change the treatment plan. In addition, it is important to gauge who to observe for longer, who to admit, and who to discharge since there is always a constant flow of patients that need to be seen.
An important skill I refined in this rotation was how to calm patients down. I find that many of the patients are unhappy after waiting hours in the ED (which is to be expected). The initial approach when talking to the patient is very important since you can de-escalate patients before they become agitated or problematic. I also helped patients with getting food or water, going to the bathroom, or with their other needs if I saw that anyone needed help to provide the best quality of care that I could. Another skill I learned was the importance of consults and when they were or were not indicated. If a consult will not contribute to the management of a patient, it delays discharge time. Additionally, I was able to practice skills such as IVs and laceration repairs. Most of the PAs and nurses in the ED were willing to teach and allowed me to see and evaluate the patients, practice writing notes, order labs and imaging, follow up with the patient throughout their visit, and perform procedures. Unfortunately, Woodhull is not a trauma 1 center so although we had a trauma unit, they did not consist of “true” trauma patients. However, I was proactive in involving myself fully into the ED experience and still learned a lot. I decided to work several night shifts since there are more opportunities to learn and less competition for procedures and was happy with that decision.
Overall, I really enjoyed working in the ED. Being able to combine what I learned during didactic year with my experience throughout clinical year prepared me for what I was looking forward to most, managing patients in a high volume and acute setting.
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