Interested in the ED? Tips for PAs, NPs and Students

  1. Study well and become certified in ACLS and PALS.  Learn the material, put your hands on the equipment, do the skills (and do them again).  Along with CPR, these are the basic skills necessary to save someones life.
  2. Take or at least audit an ATLS course.  This is GOOD information on managing the most seriously injured people.  Even auditors can participate in the skills labs (these use either animals or very advanced surgical skills manikens).  Performing a cricothyrotomy, chest decompression, or putting in a chest tube isn't something like a knee tap. You can't look in the procedure book before you need to do them.  Do the skills and remember.
  3. If you've never been one, try to learn to think like an EMT.  Patients can die while you're doing a comprehensive history and physicial.  This is no time to be wholistic or think about care plans. Learn what's important in the first 5 minutes.  What does a really sick or dying person look like...what's going to kill them and what can I do to save their life right now.
  4. If you're a student on rotations, make the most of you time in the ED.  Even if you're doing OB, IM, etc. spend some of your down time in the ED.  When I was doing my OB clerkship, one of the best OB emergencies I ever saw came in the ED while I was spending my downtime there.  If you don't have to do an ED clerkship in your program, make it an elective.
  5. If you can, ride on an ambulance, a helicopter if possible, and spend time learning about the ED from the people that work there. Look around, touch stuff, and know where everything is and the basics of how it works.
  6. If you're uncertain what's going on, talk to the patient.  Most patients will tell you whats going on in their own words and will lead you to a diagnosis 80+% of the time.  Be efficient. If a specific test is not going to alter the care of the patient, then it doesn't need to be ordered in the ED.
  7. Learn to read:  Chest, spine and abdominal Xrays...the important things, and the EKG.
  8. Know your limitations, ask for input as soon as you are unsure, make these cases into learning experiences, and write them down.  If you can, pass these experiences on to others.
  9. Let the nurses do their jobs and advocate for them whenever you can.  The best nurses in the hospital work in the ED.  Not only can they perform, but they can teach you things as well.
  10. Strive to make sure that every sick patient gets the care that they need.  Don't allow on-call providers to send sick patients home over the phone. The job of the ED provider is as much that of a care broker as a care provider. 
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