Rotation: Adult Emergency Department
Location: Both sites
Faculty Liaison: Individual preceptors
Contact Person: Your preceptor, EM chief residents
Description
See general description given above in the Adult ED section for EM-1's.
Goals
The EM-2 goals are to become more knowledgeable and proficient in EM, including generating and working through more complete differential diagnoses, and taking more initiative in planning patient work-ups and disposition, with less reliance on attendings and senior residents (although all cases will be presented to them). Development of efficient habits to expedite patient flow through the ED and acquisition of a sense of the big picture in the department at any one time also begins in the second year.
Procedures/skills
The procedure list remains the same; the goal is to improve technique and efficiency, as well
acquiring experience with uncommon procedures you may not have had an opportunity to do as an EM-1. Teaching certain procedures to medical students and EM-1's is also part of the second year role.
Schedule
EM-2 residents work 17 shifts/28 days, at both sites.
Tips
(see ED in EM-1 section) In addition, disposition of patients become paramount. You will see many more patients than you were used to, especially overnights at St. Luke's. A good idea is to try to make a plan and probable disposition decision before leaving each patient's room.
Pitfalls to avoid
(see ED in EM-1 section)
Useful texts , etc.
Rosen, Roberts and Hedges, Tintinalli, Goldfrank, The EM journals.
Rotation: Pediatric Emergency Department
Location: St. Luke's
Contact person: EM Chief Residents
Description
An outpatient rotation in the Peds ED seeing cases of varying acuity. There is usually a high volume of patients with a wide array of pathology. You will see patients and present them to the attending, who will guide you in management.
Goals
Become comfortable in the evaluation and management of acutely injured or sick infants, children and adolescents.
Procedures/skills
Pediatric venous access, phlebotomy
Urinary bladder catheterization
Lumbar puncture
Pediatric sedation and analgesia
Wound management
Reduction of simple dislocations
Schedule
See Peds E.D. in EM-1 section of manual; 17 shifts per block.
Useful texts , etc.
Harriet Lane Manual, Barkin (EM Peds), Ludwig/Fleischer (EM Peds), Crain.
Rotation: Orthopedics/Hand
Location: Roosevelt
Contact Person: Orthopedic chief residents at Roosevelt
Description
This rotation will ground you in basic principles of bone and soft tissue injuries. Responsibilities
include seeing orthopedic and hand cases with the Ortho 3rd year or chief resident in the ED and Ortho and Hand Clinics, and taking call with the chief. Call averages 9 nights over 28 days, but the pattern is variable. The weekend call begins on Friday 7a.m. until 10 p.m., Saturday from 11 a.m. to 11 p.m., Sunday from 11 a.m. to11 p.m., then your usual Monday responsibilities begin again from 7 a.m. to 5 p.m. This is a recent change from the previous 72-hour call. You are not expected to cover Ortho/Hand floor patients nor floor consults. However, you should scrub in to a few (probably two) short, ED applicable cases (like pinning a hip with a Richard's screw or applying external fixators to a Colles' fracture). While on call, you see all ortho or hand consults in the ED. This rotation is exceptional and focuses specifically on what EM residents need to know.
Goals
Become comfortable in the early management of common fractures, dislocations and sprains.
Procedures/skills
Immobilization techniques (casting and splinting)
Reduction methods for various common dislocations and fractures
Regional anesthesia techniques, e.g. the Bier block, hematoma block.
Tips
Make sure to sign out beeper 8001 to your coverage every 7 AM so they know to call you first for ortho and hand cases. Sign out to the resident on call at 5pm (unless its you).
The ortho office is on the second floor, between the chapel and the general surgery office. It is locked at all times; the key code for the door is 5132. Residents who live near the hospital have found it convenient to take call from home. Be aggressive, the ortho residents will let you do most procedures if you ask them. Clinic is a new experience for ED residents. When seeing patients there, read the note from their previous visit. It will usually already include a long-term plan for the patient. Knowing this will help focus in on the patient's problem and avoid wasting time.
Texts
The Roosevelt library has several very helpful texts: Emergency Orthopedics, The Extremities, several emergency radiology texts, (eg.Harris), the ortho sections in Rosen, and Hoppenfeld's Physical Examination of the Spine and Extremities are all excellent. Rockwood and Green is the orthopedists' bible. Use the photographic anatomy book in our residency library for review.
Useful hand texts include: The Hand Examination and Diagnosis, American Society for Surgery of the Hand; The Hand: Primary Care of Common Problems, American Society for Surgery of the Hand;``The Hand In Emergency Medicine'', Emergency Clinics of North America, D.Uehara, guest editor-Aug 1993. Carter's text
A particularly helpful website is The Wheeless Textbook of Orthopedics, Also typing the name of a particular fracture into Google images will give you a quick representation of relevant radiographs.
Additional Requirements:
Monday 6:30-7am X-ray rounds with chiefs and Dr. Unis (2nd fl ortho conf room)
Discuss x-rays and patients from over the weekend
Tuesday 6:30-7a Anatomy Rounds at CV Hand Center with cadavers
7- 8am Hand Surgery Conference
Wednesday 7:30 - 12n EM conference
Thursday 8 - 10am Grand Rounds (alternating weeks at SL and RH)
10am- 4pm Ortho clinic (Winston 2N)
Rotation: Toxicology
Location: NYC Poison Center ground floor conference room
Dept. of Health, Bureau of Laboratories
455 First Ave (Between 26th and 27th Streets)
Faculty liaison: Tod Bania, M.D. Page # 1036
Contact person: Robert Hoffman, M.D., Medical Director NYC Poison Control Center
Lewis Nelson, M.D., Assoc. Medical Dir., NYC Poison Control Center
Goals
To develop a working knowledge of the common toxidromes and a basic familiarity with the most common toxic ingestions and exposures.
Schedule
On Day 1 of the rotation, report to the Bellevue ED, adult side, at 8:15 A.M., and ask for morning report. At 9 A.M., after morning report, go across the street to the Poison Control Center and ask for one of the Toxicology fellows. They will have a handout and all the information you will need for the rotation.
General schedule:
Weekdays, 8:15 A.M. - 4 P.M. You will spend the mornings making call-backs for cases that were called in to the Poison Center. There will be plenty of time to read about the cases, and then you present them to the Tox fellow on call. After lunch, there will be attending rounds during which the most interesting cases of the day are discussed.
Most Thursday mornings there is Journal Club, except for the first Thursday of every month, when there is a Consultants' Conference at 2 P.M. in the ground floor lecture hall.
Tips
You will be asked to present at Journal Club, and to speak on a topic at some point during your rotation, so take note of interesting clinical cases in which you've been involved.
To get to the Poison Center (455 First Ave, between 26th and 27th), you can take the1, 2, 3, or 9 train to 42st, take the S shuttle to Grand Central, and then take the 6 train to 28th street. If you prefer a bus, you can take a cross-town bus and transfer to a downtown bus at 2nd Ave. Get off at the 26th St. stop. If you plan to drive, you need to pick up a parking pass from Vicki in the ECI (room 345 Bellevue Administration Building). If you drive, plan on getting there early (by 7:45am) because the garage fills up very early.
Useful texts , etc.
Goldfrank's; Ellenhorn/Barceloux; Gosselin.
Poison Center Toxicology Review Book (Available from one of the Tox Fellows for $25, cash)
Rotation: Ultrasound
Location: Emergency Department at SLRHC
Contact Person: David Riley, MD and Richard Lanoix, M.D.
Goals
· Developing proficiency in performing and the interpretation of ultrasound examinations in the ED.
· Developing a basic understanding of ultrasound principles and techniques.
· Achieve credentialling in Emergency Ultrasound.
Methods
This rotation will take place for 2 weeks from 9 A.M. to 5 P.M. Monday through Friday. Under the supervision of David Riley, MD and Richard Lanoix, M.D. and the two ultrasound fellows, you will accomplish the above-mentioned goals. The rotation will begin with a written and hands-on ultrasound examination to determine your needs. This will be followed by a course structured to address any deficiencies noted. Then, you will serve as an integral member of the Ultrasound Division. This entails spending time in the ED performing, and recording on videotape, as many ultrasound examinations as possible. Many of these examinations will be performed under direct supervision. You will review and interpret the examinations performed and recorded by everyone else in the department. These examinations and interpretations will then be reviewed with you at first by the fellows for accuracy, and then subsequently with either Dr. Riley or myself to verify your accuracy and that of the fellows. Consequently, you will receive continual feedback on your manual and interpretation skills. Furthermore, if the Ultrasound Division is scheduled to teach a course at an outside institution, or is performing a research project, you will participate.
Tips
You are expected to attend every EM conference, Trauma Conference & Journal Club.
Useful Texts
Heller & Jehle: Ultrasound in Emergency Medicine
Ma & Mateer, Emergency Ultrasound
Rotation: Trauma Surgery
Location: Las Vegas
Faculty Liason:
Description
EM-2 Electives
*4 wks to pursue personal interests here or at another hospital. Here are a few SLR choices:
Rotation: Ophthalmology
Location: St. Luke's Old Building. Use entrance just east of the ED. (Ask the guard at
the entrance for directions to the optho clinic.
Faculty liaison: Dr. Lurin
Contact: Ophtho Chief Residents
Description
The primary goal of the rotation is to become skilled in slit lamp exams, and familiarize yourself with the architecture as well as pathology of the eye. Use the time to cover the appropriate chapters in Tintinalli.
Procedures/skills
Working knowledge and familiarity with the slit lamp, Dilated fundoscopic exam and tonometry.
Schedule
The workweek is Monday through Friday, with weekends and nights off. The day begins at 9am, and usually lasts through the early afternoon. Each resident is expected to join in patient exams, be well read, and stay for the majority of clinic time. You can attend the EM Wednesday conference but ask the senior Optho resident whether or not they want you to go to clinic Wednesday afternoon.
Tips
Dress well, scrubs are not appropriate. A tie or nice shirt for men and a blouse for women + white coat will help you fit in and keep up the public image of the ED. Remember; you are a representative for the program. While the clinic is a high volume work area, you can both learn and be helpful to the optho residents. Introduce yourself, don't be afraid to ask questions.
Useful texts , etc.
The Wills Eye Manual.
Rotation: ENT
Location: Roosevelt and St. Luke's ENT clinics
Contact Person: ENT Chief resident
Faculty Liaison: Dr. Lurin
Procedures/skills
Direct and indirect laryngoscopy, technique for thorough head and neck exam and evaluation and control of epistaxis.
Schedule
ENT clinics meet at the Roosevelt Site on Monday and Thursday afternoons, beginning at 1:30 P.M. in the first floor clinic space, and on Friday at St Luke's (it is an all-day clinic), in the Clark 2 clinic area. These clinics typically end at approximately 5 P.M. During this elective, you are expected to attend every EM conference, Trauma conference, and Journal Club.
Useful texts , etc. Rosen, an ENT atlas
Rotation: Dermatology
Location: Varies: St. Lukes Site: 1090 Amsterdam Ave. Suite 11D, and Roosevelt
Derm Clinic in the Brodsky building, 425 W. 59th St., Suite 5C, across the street from the Roosevelt ED.
Faculty Liaison: T.B.A.
Contact Person: Iris Afanador tel. # 305-2149
Goals
To see the widest possible variety of pathology, understand principles of treatment, and recognize dermatological emergencies.
Schedule
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Monday |
8:00 am to 11L30am |
1090 Amsterdam Ave, Suite 11D |
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Tuesday |
1pm |
Brodsky Bldg. Suite 5C |
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Wednesday |
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EM weekly conference |
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Thursday |
8:00am to 11:30 am |
1090 Amsterdam Ave, Suite 11D |
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1pm |
Brodsky Bldg. Suite 5C |
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Friday |
1pm |
Brodsky Bldg. Suite 5C |
Tips
The Derm clinics are busy, and you are an extra person. How much you see and learn will largely be determined by effort on your part to make yourself and your goals known to the residents and attendings.
Useful texts , etc.
Fitzpatrick; Dermatology Atlas.
Rotation: Radiology
Location: St Luke's Clark 3 reading room and SL ED radiology room
Contact Person: Dr. Baer
Goals
Interpretation of radiographs and CT, and understanding indications for particular studies.
Schedule
8:00 A.M. to 12 P.M., Monday through Friday. The morning begins with conference at 8am at either St. Lukes or Roosevelt, often relevant to practice in the ED. The department coordinator will hand you a schedule of all conferences on the first day. After this, you have many options. Because each attending specializes, EM residents have found it useful to divide their time between plain films, abdominal, chest and neuroradiology. A good plan is to spend your first week with the residents/attendings reading plain films from the ED. For the second week, focus on abdominal CT scans. The attending reads these alone during the day in the 3rd floor ballroom, so you will have their undivided attention as a teacher. The attending who does this changes daily so ask around. Next, spend a week in the basement in the neuroradiology suite, adjoined to the MRI. There is an extra PACS system so you can practice your radiology reading skills between reviewing Head and C-Spine CTs and MRIs. Lastly, spend a week with the Chest Attending, reading chest CT scans.
In addition to the 8 am conference, conferences are held on most days at 12pm and 4pm. As before, some are relevant to the ED while others are not so check ahead.
You are expected to attend every EM conference, Trauma conference, and Journal Club. Contact Dr. Baer ahead of time to discuss your schedule.
Tips
Feel free to float around the ballroom on any given morning, sitting with a variety of attendings, who tend to come and go, depending on their clinical duties. Some are definitely more enthusiastic that others, so don't waste your time with someone who's not interested in teaching you.
Useful texts
Harris And Harris: The Radiology Of Emergency Medicine
Rotation: Community-based Emergency Medicine
Location: Southampton Hospital Emergency Department
Contact Person: Dr. Darin Wiggins; (631) 726-8476
Goals
To become familiar with Emergency Medicine in a community hospital setting.
Schedule
Varied.
You will be assigned to a Board Certified Emergency Physician and will follow his or her schedule. The shifts are usually 12 hours.
Tips
This is an opportunity to experience how Emergency Medicine is practiced across most of the country. There are few backup specialists in the hospital and you will be involved in the stabilization of sick patients. They do not usually have residents in the hospital, so the staff is eager to teach and happy to have you there.
Spending a month in the Hamptons with plenty of free time to hit the beach is a nice benefit.
Depending on availability, you may be given a place to stay near the hospital.
