Emergency Medicine Residency Handbook 2009 Edition table of contents chapter page
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- INTERNAL MEDICINE at the VA
- PGY-2 OFF SERVICE ROTATIONS
ED-BASED TRAUMAMeeting Place: KCH ED Contact Number: EM Chiefs Daily Rounds: ED morning report Schedule: The EM Trauma intern will be expected to function the same as our regular EM interns but will have a different shift distribution. You will also be scheduled for an intensive 2 day session of Trauma skills-stations and lectures. EM Faculty Liaison: Dr. Bonny J. Baron pager: 917-760-1344 Description of rotation: During the Trauma rotation, the PGY-1 Emergency Medicine Residents will rotate through the KCH ED for a 2 week time period. During that time, they will be responsible for 5 CCT shifts and 4 Pod A shifts. They should try to focus on traumatized/injured patients but can and should see any patient that presents to their area that needs to be cared for. In addition to this 2 week block, each PGY 1 will be assigned a 2 day slot when they attend a “Focused Trauma Workshop.” Please make sure you look at your yearly schedule and you know when you are supposed to attend this workshop. It will run the better part of a Thursday and subsequent Friday so make sure you are free on those days. If you are in an EM month, you may need to request these 2 days off to ensure that you are free to attend this workshop. Please do not forget this. During this time period, the resident will have multiple activities to complete. The days will begin with a number of trauma-oriented lectures. They will then participate in multiple hands-on small group learning sessions involving critical trauma skill sets and will be exposed to multiple simulation cases involving traumatized patients. Lastly, there will be a reading list made available on the KCH EM web site where a number of trauma-oriented PDF papers can be downloaded. The resident is responsible for reading these papers prior to the completion of their PGY 1 residency year. The Emergency Medicine Resident will have direct patient care responsibility: In the Emergency Room, they will be doing what all of the other PGY 1’s are doing that month with the exception being that they are supposed to be concentrating on traumatized patients. Just like the other PGY 1’s in the ED that month, the resident rotating on trauma will have to attend regular Wednesday EM Conference and morning reports according to the usual rules for absence. During the shifts in the Main ED, the resident will focus on injured patients. If no injured patients are waiting to be seen, then the resident will see normal ED patients At the completion of this rotation the resident will demonstrate competence in the following: MEDICAL KNOWLEDGE, PATIENT CARE
-Crystalloid volume replacement -Colloidal volume replacement -Blood volume replacement -Inotropic support
-Physical exam -Diagnostic peritoneal lavage -Abdominal CT scanning -Abdominal sonography -Laparoscopy -Non-operative management
-external fixation -angiography
Educational Expectations: The following topics should be covered in the resident’s reading during this rotation: ATLS Hemodynamic monitoring Volume resuscitation (crystalloid and colloid) Neuro-intubation Resuscitation with blood products Rapid sequence intubation Inotropic support Intubation with cervical spine trauma SVO2 as a guide to resuscitation Intubation with facial trauma Lactate and base deficit to monitor perfusion deficit Mechanical ventilation Shock(hemorrhagic,neurogenic,cardiogenic) Spinal trauma Physiologic scoring Spinal shock Tissue ballistics Penetrating and blunt thoracic trauma Trauma in pregnancy Penetrating and blunt abdominal trauma Trauma in the elderly Penetrating and blunt neck trauma Pediatric trauma Head trauma Glasgow Coma Scale Pelvic trauma Facial trauma Long bone fractures (open and closed) Vascular injury OBSTETRICS Meeting Place: S building 5th floor Daily Rounds: 9am Schedule: Contact Ms. Stephanie Goeloe (OB residency coordinator) (718) 270-3320. If unable to reach Ms. Goeloe, the Chief resident of OB at KCH should be able to help. You can reach the OB Chief Resident through the KCHC operator at (718) 245- 3141 Educational Objectives: PGY-1 Emergency Medicine residents will spend a two-week block on the Obstetrics in-patient service at Kings County Hospital. Residents will also rotate through the outpatient clinics. The Emergency Medicine Residents will be under the direct supervision of an Obstetrics/Gynecology Senior or Chief Resident and Attending Physician. They will act in the role of a PGY-1 OB/GYN Resident, providing direct patient care, and assisting with in-patient and Emergency Department consultation. They will also assist in the operating rooms. The Emergency Residents will attend the Department of Gynecology’s daily conferences and monthly Grand Rounds, as well as Emergency Department Educational events, if patient care requirements allow. The purpose of this rotation to perform at minimum the 10 deliveries required by the RRC for graduation. All deliveries are to be documented in New Innovations for credit. At the completion of this rotation, the resident will demonstrate competence in and be able to: · Evaluate and treat the patient with pre-eclampsia/eclampsia (PC,MK) · Make admission, transfer and discharge decisions on OB patients (PC,MK,C,SBP,P) · Utilize laboratory data and ancillary studies appropriately in the care of OB patients (PC,MK) · Utilize in-patient consultation appropriately (PC,MK,C,P,SBP) · Compassionately interact with patients and their families during the stress of illness and death (PC,C,P) Description of clinical experiences: Residents will have experience in and demonstrate competence in the following procedures:
Description of didactic experiences: The residents will participate in the daily, weekly, and monthly OB/GYN conferences as well as the Emergency Medicine conferences if it is does not interfere with patient care requirements. The following topics should be covered in the Resident’s reading during this rotation: Pelvic and abdominal pain Abnormal vaginal bleeding Ovarian cysts and rupture thereof Tubo-ovarian abscess Spontaneous abortion Threatened abortion Endometriosis Pelvic inflammatory disease Ectopic pregnancy Uterine incarceration Ovarian torsion Mittelschmerz Vaginitis/vaginosis/vulvitis Urinary tract infection Sexually transmitted disease Atrophic vaginitis Infertility Vaginal foreign bodies Sexual assault Contraception Drug and radiation exposure in pregnancy Diagnosis of pregnancy Nausea and hyperemesis gravidarum Premature rupture of membranes Vaginal bleeding in early pregnancy Molar pregnancy Contraception Hysterectomy Pelvic relaxation Amenorrhea
MICUMeeting Place: KCH MICU D building Contact Number: (718) 245-3774 (KCH) or (718) 270-1566 (SUNY) Daily Rounds: Contact KCH Medical Chief Resident for the block Schedule: Contact the KCH Medical Chief Resident at least 2-3 weeks before the start of the rotation. EM Faculty Liaison: Dr. Ian DeSouza Cell: 917.903.1765 Special Considerations: The Medical Intensive Care Unit at Kings County Hospital is a four week rotation for PGY-1 Emergency Medicine Residents. The Emergency Medicine Resident will function as a PGY-1 Internal Medicine Resident, providing direct patient care. The Emergency Medicine Resident will be supervised by a Senior Medical Resident, Critical Care Fellow and the Intensive Care Unit Attending Physician. The Emergency Medicine Resident will attend daily Attending Rounds, daily lectures with the Department of Internal Medicine, weekly Critical Care Conferences, monthly Internal Medicine Grand Rounds, and participate actively in the monthly Emergency Medicine / MICU interdisciplinary conference. The resident must attend the weekly Emergency Medicine Departmental conference. At the completion of this rotation, the resident will demonstrate competence in and be able to: · Perform a comprehensive history and physical examination on critically ill patients(MK,PC) · Develop differential diagnoses for life-threatening problems, and create cohesive care plans based on these diagnoses(MK,PC,PBL) · Manage critically ill patients in an intensive care unit setting(MK,PC,PBL) · Make admission, transfer and discharge decisions for patients with life-threatening and potentially life-threatening illness(MK,PC,C) · Appropriately utilize and interpret invasive monitoring(MK,PC) · Appropriately utilize and interpret culturing techniques, results and use of antibiotics(MK,PC) · Utilize laboratory data and ancillary studies appropriately in the care of critically ill patients(MK,PC,SBP) · Utilize in-patient consultation appropriately(MK,PC,C,P,SBP) · Compassionately interact with patients and their families during the stress of illness and death(PC,P,C) Description of clinical experiences: Residents should have experience with and demonstrate competence in the following procedures on this rotation: (MK,PC) · Airway management and endotracheal intubation · Placement and care of central venous catheters · Placement and care of arterial catheters · Placement and care of pulmonary artery catheters · Interpretation of Swan-Ganz-catheter readings · Utilization of oxygen delivery devices and mechanical ventilators · Lumbar puncture · Arterial blood gas sampling and analysis · Abdominal paracentesis · Thoracentesis · Chest tube placement · Placement of esophageal/gastric balloons Description of didactic experiences: (MK,PC) The Emergency Medical resident will actively participate in the interdepartmental conferences. The following topics should be covered in the resident’s reading during this rotation:
Mechanical ventilation ACLS Interpretation of invasive monitoring Drug induced paralysis ARDS Asthma/COPD Pneumonia Meningitis Opportunistic infection Super-infection Broad spectrum antibiotics Acute renal failure Hemodialysis/peritoneal dialysis Gastrointestinal hemorrhage Intracerebral bleeding/CVA Hepatic encephalopathy Shock Sepsis Uremic encephalopathy Anticoagulant therapy Pulmonary embolism Coma/brain death examination Cardiogenic pulmonary edema Dysrhythmias Fever Acid base derangements Electrolyte abnormality Nutrition: parenteral and enteral Disseminated intravascular coagulation Hemolysis INTERNAL MEDICINE at the VAMeeting Place: VA Hospital 9th floor chief resident office on the 1st day of the rotation Daily Rounds: Contact the Medical Chief Resident, 718-836-6600 ext. 6514, before first day of rotation Schedule: Contact medicine chief resident at least 2-3 weeks before the start of the rotation. EM Faculty Liaison: Dr. Antonio Saliba Antonio J. Saliba MD, MPH Chief Emergency Department Brooklyn VA Campus O (718) 630-3607 F (718) 630-2821 C (347) 831-5346 Educational Objectives: PGY-1 Emergency Medicine Residents will rotate for a four-week block on the in-patient Medical Services at the Brooklyn VA. The Emergency Medicine Residents will be integrated into the schedule of the Department of Medicine by the respective Chief Medical Residents. The Emergency Medicine Residents will function in the role of a PGY-1 Internal Medicine Resident, and will have direct patient care responsibility. They will be under the direct supervision of a PGY-3 Medical Resident and Internal Medicine Attending Physician. Residents will also attend daily attending rounds, daily educational conference, weekly Medicine Department Grand Rounds and the monthly Morbidity and Mortality Review. At the completion of this rotation the resident will be familiar with and demonstrate competence in:
Medical Knowledge and Patient Care:
Description of clinical experiences: Residents should have experience and demonstrate competence in the following procedures on this rotation:
Description of didactic experiences: The resident will attend all lectures offered by the Internal Medicine department. The following topics should be covered in the resident’s reading during this rotation:
Diabetes insipidus Deep vein thrombosis Diabetes mellitus Malignancy Diabetic ketoacidosis Paraneoplastic syndromes Diabetic hyperosmolar state Lymphoma/leukemia Electrolyte disturbances Metabolic acidosis Acute and chronic renal failure Asthma/COPD Anemia Pneumonia Hemolysis Sepsis AIDS TB
Brain abscess Infectious diarrhea Connective tissue disorders Vasculitis TTP ITP Acid-peptic disorders Spinal cord compression Pancreatitis Hepatitis Upper GI bleeding Lower GI bleeding Congestive heart failure Myocardial ischemia Atrial fibrillation Atrial tachycardias Sarcoidosis
Airway Management/ENT Research CCU at SIUH NICU at UHB SICU at KCHC Neurology at SIUH Orthopedics/FT at KCH AIRWAY MANAGEMENT Location: KCHC OR Faculty Liaison: Dr. Christopher Doty Contact: Ms. Wharton, LRNA 245-4398 or 245 4408 Structure: The rotation takes place during a two-week block during the second year. During this time the residents will report to the clinical instructor at 7 a.m. every weekday. The resident will have the opportunity to develop his/her airway management skills under close supervision in the controlled setting of the OR. The rotation is embedded with the ENT rotation. When not in the OR the resident will participate in scheduled ENT clinic. One Thursday at 11am during month, the resident will participate in a combined Emergency Medicine/Trauma Service simulation session in the simulation lab. Contact Dr. Gillet for further information the month prior to the start of the rotation. Goals and Objectives:
Reading Suggestions:
Evaluation: At the end of each rotation, the supervising faculty will complete the evaluation form provided by the Department of EM and will discuss it with the resident. An evaluation of the rotation from the resident will also be solicited. Both of these will be placed in the resident’s folder and reviewed by the residency directors. CCU Meeting Place: Emergency Department at SIUH 7:30AM. On the first day of the rotation go directly to the CCU, which is located in the Heart Tower on the second floor. Schedule: Contact the Luane Shaleesh (ext. 6205) (lshaleesh@siuh.edu with requests as soon as possible. Then contact the Internal Medicine Chief Resident at least 2-3 weeks before the start of the rotation to confirm your call schedule. Overnight call will occur approximately every 3rd night. Chief resident office: 718-226-9523 In-house page 1295 Lastly, please see Jennifer Cohen (ext. 1548) (jennifer_cohen@siuh.edu) in the Emergency Department prior to the start of you rotation. She will help you with acquisition of an SIUH ID that will allow you to park as well as get around the hospital. For directions to SIUH (driving or ferry) consult the SIUH ED section of the resident handbook. EM Faculty Liaison: Christopher Doty pager: 917-760-2005 Educational Objectives: The Coronary Care Unit at SIUH will be the PGY-2 Emergency Medicine Resident’s introduction to the cardiac patient. In this four week rotation the Emergency Medicine Residents will act in the role of a PGY-1 Internal Medicine Resident. They will be providing direct patient care in the CCU. Emergency medicine residents will be supervised by either a senior resident (PGY-3), chief resident, cardiac fellow, pulmonary fellow, pulmonary critical care fellow, hospitalist, intensivist, or a cardiology attending. The Emergency Medicine Resident will attend daily Attending Rounds and all daily lectures with the Department of Internal Medicine. Day-to-Day Assignments:
On-Call: Residents are on call for a 24-hour period, at which point the rest of the team will take over their patients’ care. The on-call residents should finish their work by 7:30 am and must complete their sign-out within three hours and leave the hospital by 10:30 am. Conferences: The department of critical care medicine provides the residents with its own assortment of lectures that are prepared by the attending faculty members. This occurs at 12 pm Monday through Friday in the ICU conference room. The lectures span a multitude of important topics related to critically ill patients. Important Telephone Numbers: 1. ICU 718-226-9250 2. CCU 718-226-9240 3. ER 718-226-9140 / 41 / 42 4. Dr. Maniatis (ICU Director) 718 980 5700
Description of clinical experiences: (MK,PC) Residents should have experience and demonstrate competence in the following procedures on this rotation:
End of Rotation Requirement: Over the course of your CCU rotation, you will encounter many interesting or novel EKG’s. It is your responsibility to find one interesting EKG and either make a copy of it or scan it electronically and submit it to your residency directors. This EKG will go up on the department’s web site as an “EKG of the Month.” In addition to submitting this EKG, you must also submit a short paragraph discussing the reading of the EKG and why it is interesting or novel. This should not be more than 3 or 4 sentences just stating what the rate, rhythm and axis are plus any other interesting findings noted on the EKG. Description of didactic experiences: (MK,PC, PBL, SBP) The following topics should be covered in the Resident’s reading during this rotation: Chest pain (differential diagnosis of) Coronary artery disease Hypertensive crisis Dissecting aortic aneurysm Coronary artery spasm Cardiogenic pulmonary edema Acute myocardial infarction-diagnosis Treatment of AMI Myocarditis Pericarditis Pericardial tamponade Congestive heart failure Restrictive cardiomyopathy Hypertrophic cardiomyopathy Congenital heart disease Nitrates/Beta-blockers /Digoxin Calcium channel blockers Heparin/coumadin Thrombolytic therapy Pacemakers Dysrhythmias-supraventricular Dysrhythmias & Anti-dysrhythmics ACLS protocol Cardiac catheterization Echocardiography Electrophysiologic studies Stress testing Nuclear cardiology Invasive pressure monitoring Intra-aortic assist devices Heart blocks Wolff-Parkinson-White syndrome All residents completing an Off-service rotation are required to meet with that rotation’s EM faculty liaison/coordinator for an exit interview in oral exam type format. This shall serve as an evaluation of the rotation and the fulfillment of the educational expectations. NICU Meeting Place: 7 am NS35, NICU, 3rd Floor UHB EM Faculty Liaison: Dr. Antonia Quinn Contact : Dr. Gloria Valencia, Director NICU, Vice Chair UHB Clinical Services Schedule: Email requests to Pediatrics Chief Residents (pedschiefs@hotmail.com) and Dr. Valencia who makes the NICU schedule (2 months ahead of time) Educational Objectives: As a PGY-2, the resident will rotate for four weeks in the NICU in the role of a junior resident. The resident will work under the supervision of an Attending Neonatologist. The resident will also be present at “difficult” or complicated deliveries and gain experience in neonatal resuscitation and stabilization.
Clinical Experience: The resident will demonstrate competence in the evaluation and management of the following neonatal disorders:
The resident will understand and demonstrate competence in the mechanics of assisted ventilation and the proper methods for monitoring adequate oxygenation:
The resident will demonstrate competence in the following procedures:
Description of didactic experiences: The resident will attend all educational conferences and meetings while on the NICU Service. The resident will be responsible for the list of suggested readings for the NICU Rotation in addition to any provided by the NICU Service. The resident will be fully incorporated into the NICU Care Team and participate in all rounds, conferences and didactics including Perinatology Conference and Neonatal Morning Report weekly. Attendance at the Wednesday Emergency Department Conferences will be at the discretion of and with the permission of the NICU attending on service if patient care needs allow. Please see attached rotation description. ENT Meeting place: ENT Clinic – U Building 2nd floor Contact Number: (718) 245-3470 Schedule: 1:00pm until clinic ends (usually 4pm), weekdays except Thursdays EM Faculty Liaison: Mark Silverberg Educational Objectives for ENT rotation: PGY-2 Emergency Medicine Residents will rotate for two weeks on the Otolaryngology service at Kings County Hospital. (These are the same two weeks you will rotate on the Airway service.) The Emergency Medicine Residents will be integrated into the clinic schedule of the Department of Otolaryngology by the Chairman of the Department of Otolaryngology. The EM Resident will function in the capacity of an Otolaryngology Resident. The resident will see patients in the clinic, in the operating room, as a consultant to the Emergency Department, on the general floors and in the critical care units of the hospital. The Resident will be under the direct supervision of an Otolaryngology Attending Physician, and senior Otolaryngology residents. Residents will attend daily attending rounds, daily educational conferences, and weekly Otolaryngology Grand Rounds. They will also attend all Emergency Medicine Department Conferences and educational events as their patient care schedule allows. At the completion of this rotation the resident will be familiar with and demonstrate competence in the following concepts: · Examination of the head, ears, nose, throat and neck (PC)(MK) · Normal and abnormal anatomy (MK) · Management of nasal bleeding (PC) · Management of trauma to the face (PC)(MK) · Management of trauma to the ears (PC)(MK) · Management of trauma to the nose (PC)(MK) · Management of trauma to the mouth (PC)(MK) · Management of trauma to the neck (PC)(MK) · Recognition, identification and management of tumors of the head and neck (PC) · The evaluation and treatment of hoarseness (PC) · Management of airway emergencies (PBL, PC, MK) · Evaluation of acute and chronic hearing loss (MK) · Evaluation and treatment of the patient with extra-cranial infection of the head including: sinusitis, otitis externa, otitis media, facial cellulitis, Ludwig’s angina, pharyngitis, retropharyngeal abscess, and acute epiglotitis (PBL, MK, PC) · Evaluation and treatment of infections of the neck (PC, MK) · Care of the tracheostomy patient (PC, MK, SBP) · The role of an Otolaryngology Consultant on both emergent and non-emergent patients (SBP, COM, PROF) · Appropriate admission of patients to the hospital on the Otolaryngology service (SBP, PC, COM) · Develop the Doctor-Patient relationship as the resident interacts with patients and their families (PROF, COM, PBL)
Residents should have experience and demonstrate competence in the following procedures on this rotation: · Control of epistaxis, including anterior cauterization · Anterior and posterior nasal packing · Topical anesthesia · Laryngoscopy: indirect (mirror) · Laryngoscopy: direct (fiberoptic nasopharyngolaryngoscopy) · Management of nasal lacerations · Management of nasal fractures and other nasal trauma · Management of injuries to the external ear · Management of injuries to the middle and inner ear · Management of common neck wounds · Incision and drainage of oral, pharyngeal and cervical abscesses
The following topics should be covered in the resident’s reading during this rotation:
Otitis Media Facial Cellulitis Otitis Externa Ludwig’s Angina Ear Foreign bodies Salivary Gland Problems Epistaxis Maxillofacial fractures Nasal Fractures Odontogenic Infections Rhinitis Epiglottis Acute Upper Airway Obstruction Cricothyrotomy Emergency Tracheostomy Endotracheal Intubation Post adenotonsillectomy Bleeding Peritonsillar Abscess Retropharyngeal Abscess Parapharyngeal Abscess Pharyngitis Upper Airway Foreign Bodies Ruptured Tympanum Vertigo Tracheostomy Tracheostomy Tube Placement Cholesteotoma Mastoiditis Tumors of the head and neck SICU Meeting Place: SICU D3 Contact Number: (718) 245-4522/3982 Daily Rounds: 6:30 am daily Schedule: The on-call schedule is made by the Department of Surgery. EM residents will have similar call responsibilities as surgical residents Residents will NOT be required to attend the weekly ED educational conferences EM Faculty Liaison: Dr. Bonny Baron Educational Objectives: PGY-2 Emergency Medicine Residents will spend four weeks in the SICU at Kings County Hospital. The Emergency Medicine PGY-2 resident will function as PGY-2 Surgical Residents. They will have critical care patient responsibilities under the direct supervision of a PGY-4 general surgery resident and general surgery/trauma/critical care attending physicians. While on rotation they will attend daily patient care work rounds and attend daily educational rounds. They will attend the weekly trauma conference. At the completion of this rotation, the Resident will demonstrate competence in and will be able to:
Description of clinical experiences: Residents demonstrate competence in the following procedures on this rotation:
Description of didactic experiences: The residents will attend daily, weekly and monthly surgical/critical care/ trauma conferences. The following topics should be covered in the resident’s reading during this rotation:
Mechanical ventilation High frequency ventilation Interpretation of invasive monitoring ARDS Post-operative management Wound management Pneumonia A-V hemofiltration Blood product usage Super-infection Broad spectrum antibiotics Acute renal failure Hemodialysis/peritoneal dialysis Gastrointestinal hemorrhage Intracerebral bleeding/CVA Hepatic encephalopathy Shock Sepsis Uremic encephalopathy Anticoagulant therapy Pulmonary embolism Coma/brain death examination Cardiogenic pulmonary edema Dysrhythmias Fever Acid base derangements Electrolyte abnormalities Nutrition: parenteral and enteral Disseminated intravascular coagulation Hemolysis Sedation Drug induced paralysis
Medical Knowledge
Interpersonal and Communication Skills
Professionalism
Systems-Based practice
Practice Based Learning and Improvement
NEUROLOGY Meeting place: SIUH hospital, Third floor, East side (3E). The “Neuro floor” Contact Number: (718) 683-3766 Daily Rounds: 8 am Responsibilities: Morning report with Dr. Najjar or one of the neurology faculty. Go to see the daily neurology consults for all in house and emergency department patients. EM Faculty Liaison: Dr. Mark Silverberg Cell: 917-822-4510 Educational Objectives: PGY-2 Emergency Medicine Residents will rotate for two weeks on the Neurology service at SIUH. They should be there at 8am on Monday, Tuesday, Thursday and Friday. Wednesdays they are to show up for the regular EM conference at Kings County Hospital at 7am. While rotating at SIUH, residents will work under the direction of the Neurology Attending staff as part of the Neurology consultant team. Each day that the residents are at SIUH on the neurology service, they should attend the interactive morning report conducted by the Neurology Attending Staff. In addition, the EM resident will attend all Department of Neurology conferences and educational events. At the completion of this rotation the resident will demonstrate competence in the following concepts:
Description of clinical experiences: Residents should demonstrate competence in the following procedures on this rotation: · Lumbar puncture · Electroencephalography · Electromyography
The following topics should be covered in the resident’s reading during this rotation: Cerebral aneurysm Arteriovenous malformation Hemorrhagic stroke Ischemic stroke Vertebro-basilar insufficiency Transient ischemic attack Subarachnoid hemorrhage Bell’s palsy Trigeminal neuralgia Amyotrophic lateral sclerosis Neuro-intubation Multiple sclerosis CNS abscess Meningitis/encephalitis Myelitis Neuritis Guillain-Barré Syndrome Myasthenia gravis Peripheral neuropathy Spinal cord compression V-P shunts Headache Pseudotumor cerebri Normal pressure hydrocephalus Seizure disorders Anti-seizure medication EMG EEG
Head CT and MRI evaluation Brain death and its examination Emergency Orthopedic/Fast Track Rotation - Handbook Orthopedics is a major component of the daily cases seen by Emergency Medicine physicians. The goal of this rotation is to increase orthopedic exposure to the emergency medicine residents so that they feel comfortable managing various orthopedic emergencies. The rotation is 4 weeks spent in the fast track emergency department at Kings County Hospital. The resident is to evaluate every orthopedic emergency case that comes through the emergency department in addition to seeing fast track cases. Residents are allowed to cherry pick orthopedic cases from the call to treatment list. When orthopedic cases are identified in Suite A and B, Fast track by other ED attendings or residents, the ED orthopedic resident will be paged (there is an orthopedic pager – pick it up from Stephanie or the previous resident on Ortho). If there are no orthopedic cases (fractures/sprains), the resident should see musculoskeletal cases. If there are no orthopedic or musculoskeletal cases the resident should see regular fast track cases. Every orthopedic case and procedure must be placed in the residents’ personal logbook, which will be collected at the end of the rotation and must be turned in prior to the exam. If the orthopedic case requires surgical intervention, admission, requires additional assistance or is beyond the scope or comfort of the Emergency Medicine attending, the orthopedic resident should be called. When able to, the ED orthopedic resident should be the one calling the orthopedic resident for the consult. Emergency Medicine residents should also see pediatric orthopedic cases; however, the orthopedic resident should be called to see these cases as well. On days when the emergency medicine resident is working during the day, the resident is to also go to morning orthopedic surgery resident rounds to go over the patients that were formally consulted the previous day. Be prepared. The resident work schedule is the following: Monday and Tuesday 6a-6p (Morning report is at 6am in C – 3 and you are required to be there) Thursday and Friday 11a-11p (no morning report on these 2 days) Contact Dr. Gore prior to the start of your rotation – Robert.gore@downstate.edu or 312-399-3451 Orthopedic Examination Required Reading
On the last Wed conference of the block (before you switch) at 7am, the residents will have a closed book examination. A passing grade will be 80% or above. The exam will consist of multiple-choice questions and five essays. The essays will consist of interpretation of orthopedic x-rays, including injury complications, correct orthopedic fracture nomenclature and management of these various injuries. It should take ~1 hour to 1 ½ hours to complete the entire exam. PGY-3 OFF SERVICE ROTATIONS EMS
Toxicology Ultrasound Research EMS Contact:
Educational Objectives: The EMS rotation will provide a general exposure to the medical, regulatory, legislative, administrative, political, and organizational aspects of pre-hospital care. By completion of this rotation, the resident will have developed the basic groundwork for understanding the structure and function of Emergency Medical Services. The resident will spend two weeks on this rotation. The base for the rotation will be the Fire Department of the City of New York. The Emergency Medicine Resident will accompany EMTs and Paramedics on ambulance runs. This will be supplemented with experience at the FDNY on-line medical control center and at the EMS academy where residents will participate in Paramedic and EMT training. Residents will be under the direct supervision of the Medical Directors at the Fire Department’s Office of Medical Affairs. At the completion of this rotation the Resident will demonstrate competence in the following concepts:
Description of clinical experiences(MK,PC) Residents should have experience and demonstrate competence in the following procedures on this rotation:
Description of didactic experiences: (MK,PC,SBP) The following topics should be covered in lectures or readings during this rotation: A. Overview 1. History of EMS 2. National, state, and local 3. Various types of service 4. Level of care 5. Volunteer vs. hospital based vs. city/county based vs. commercial B. Fiscal Aspects of EMS 1. Costs and resources, billing C. Organizational Aspects of EMS 1. Levels of EMT training and skills; fire, police, MD, administrators 2. Equipment and vehicles 3. Local, state, and federal regulations 4. EMS Medical Director 5. Development of 911 6. Receiving and dispatch 7. Communications and telemetry systems 8. Field triage 9. Interface with other services (police and fire) D. Categorization and designation of hospitals and hospital services E. Medical Control 1. Centralized vs. decentralized 2. The role of the Medical Director 3. The role of the Emergency Physician 4. Development and implementation of protocols 5. On-line and off-line medical control 6. Call review and CME for the prehospital provider F. Air Transport Systems G. Disaster Planning and Management 1. Planning for prehospital disasters a. The EMS role b. The hospital role 2. Special disasters a. Biological b. Chemical c. Radiation H. Education 1. CPR 2. EMT
3. AEMT 4. EMT-P
5. First aid and first responder training 6. Public education I. The Role of EMS in Public Education 1. Issues of organization 2. Issues of medical treatment and level of care
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