--Josh--
This is certainly one of the most daunting rotations during PA school, however, with just a few quick tips you can crush the rotation and impress your preceptor.
If you see a patient, TAKE OWNERSHIP. This does not mean you are going to be the one making all the decisions (you will not have to), but try and follow the patient all the way through their ED course. For example, it can be as simple as a patient was given Zofran for nausea/vomiting. Follow up with the patient and see how they are feeling, it is much better to come back to your preceptor after 30-40 minutes and say “ Ms. Smith in bed 4 nausea has resolved, she has been able to tolerate fluids without any further vomiting, her repeat abdominal exam is without tenderness.” This is in contrast to your preceptor asking you how Ms. Smith is doing and you sitting there with a blank stare as you have not been back in the room once (we have all been in that boat...many times). I personally will take a few minutes and make a quick round on all my patient’s to see how they are doing; Are the medications working? Are there any other labs or imaging that need to be ordered? Can I discharge or admit the patient? Then update the nurses.
I know it’s cliche, but BE NICE TO THE NURSES. They can make or break your rotation. This does not mean be overly nice (we all know this person and it can just be annoying), but make sure you introduce yourself at the beginning of every shift and ask them for advice. Many of them have been doing emergency medicine for many years and know the ins and outs of the department. After you go see the patient, you will present your patient to either the PA or MD. Once you have a plan in place try and find the nurse to update them. Let them know if the patient needs labs, CT, IV fluids, medications, etc. This will not only keep you involved in the patient care, but also help with the flow of the department.
KNOW THE DISPOSITION. This is one one of the most difficult tasks in emergency medicine for practicing PAs and MDs. As you leave the patient’s room you should try to have a general idea if the patient is someone who can be discharged or will they need to be admitted. Sometimes this is straightforward; patient with a small laceration - discharged, patient with an MI- admit. However, a majority of the time things are not that simple and learning the sick from not sick is a skill that is developed over many years of experience. Is is not uncommon that your preceptor will ask you, “So what do you want to do with this patient?”. If you have already started brainstorming the differential diagnosis, workup, and possible disposition then you will be way ahead of the game.
PICK TWO TOPICS on each shift to read about. After every shift I would take two topics and go home and read about them (more realistically I watched youtube on these topics). It was much easier for me to take a patient with diverticulitis that I just saw on a shift and then go read about, rather than just picking random topics out of a textbook. Then you have a patient in mind when thinking about epidemiology, risk factors, presenting complaint, physical exam, workup, imaging, labs, antibiotics, and disposition. The next time you see a patient with a similar disease process, you will be surprised at how much easier it is to recall information.
BE INVOLVED with as many cases at possible. Even if you are not going to be seeing the patient, try to be be exposed to as many different patient cases and procedures as possible. For example, if a cardiac arrest comes in and you are not busy doing something else then just go stand in the corner and observe (of course make sure you are not in the way). I would always try to let the docs and PAs know that I was interested in emergency medicine and if they had any interesting cases or procedures if they could come get me. You would be surprised how often they will come find you to suture or perform an I&D.