Emergency Medicine Clinical Rotation Guide

With every new clinical rotation comes a level of excitement (and a little bit of apprehension) for PA students. This is how Manpreet and Sandeep Kaur, two sisters who are both in their clinical years of PA school, felt prior to their emergency medicine rotation.

Fast-paced, demanding, informative, and exciting — these are just a few words to describe their emergency medicine rotations. And when it was all said and done, it was one of their favorite rotations. If you are a student preparing for clinicals in the emergency department, here is some advice from Manpreet and Sandeep . . .

Although we were initially intimidated prior to starting our emergency medicine rotation, it turned out to be one of our favorites. We saw several interesting cases of trauma, Covid19, heart failure, kidney disease, and so much more. We are very grateful to have had such wonderful preceptors who allowed us to gain hands-on ED skills!

Here is some information we feel will benefit you if you are preparing for a rotation in emergency medicine:

Skills To Brush Up On Before Your Rotation Begins:

1. Suturing
2. Neuro exam
3. Abdominal exam (Murphy’s sign, McBurney’s point tenderness)
4. MSK exam (i.e. apprehension test)
5. Fluorescein eye stain

Common Chief Complaints You’ll Encounter:

• Abdominal pain
• Altered mental status
• Back pain
• Chest pain (MI vs anxiety attack)
• Diabetic ketoacidosis (DKA)
• Dizziness (vs light headedness)
• Drug overdose (acetaminophen, aspirin)
• Eye complaints
• Headaches (migraine vs tension HA)
• First trimester vaginal bleeding (normal spotting vs spontaneous abortion)
• Febrile infants (rule out fever of unknown origin)
• Pulmonary embolism
• Sepsis
• Trauma

An Important Note About Oral Presentation:

Keep it concise! ED is fast paced, and preceptors are looking for a brief summary of the patient’s chief complaint along with pertinent positives on review of systems and physical exam.

For example, “50-year-old male with past medical history of cholelithiasis complains of upper right abdominal pain that is sharp, intermittent, 8/10 in severity, and worsened after eating. He has had two episodes of vomiting this morning but denies fever, chills, diarrhea, or hematochezia. On exam, patient is moderately tender to palpation in upper right quadrant with no distension. Positive Murphy’s sign. Negative McBurney’s point tenderness.” And then go on to explain what labs and imaging you would like to order.

Resources That Are Helpful:

• MD Calc – this is a free app that is very helpful for diagnostic criteria. Save these as your favorites:
  • ASCVD Risk Calculator – 10 yr heart disease or stroke risk.
  • Centor Score – strep throat diagnosis.
  • Glasgow Coma Scale (GCS) – objective level of consciousness.
  • Ranson’s criteria – mortality in pancreatitis.
  • Ottawa rule – indication for ankle and knee X-ray.

• WikiEM — This is a free app and online website that outlines common disease processes encountered in the ED, along with specific treatment plans. Very helpful when you need quick reminders on top differentials to rule out or what suture type to use for a laceration.

• EM Basic podcast & pocket guide — This is a great podcast to listen to during your commute to work! We also highly recommend downloading the associated outlines (link attached in our IG bio on @pa.sisters). The pocket guide document covers the main chief complaints and lists pertinent history questions to ask as well as what labs and diagnostics to order. We found this resource particularly helpful during our rotation.

• EMRA – Our friends let us borrow their EMRA antibiotics and orthopedics guide from here, which was occasionally useful. Full EMRA resources, including videos and online versions of these handbooks, are offered to subscribed members. Medical students can get an annual membership for $60.

Last But Not Least

Don’t be afraid to ask to do a procedure! The ED has so much to offer in terms of learning opportunities, but you have to ask! We got to put in IVs and Foley catheters, do eFAST exams and chest compressions on trauma patients, and repair lacerations. If you don’t know how, someone will be more than willing to show you.