Emergency Medicine Clerkship An Introduction Joshua Silverberg, MD Joshua.Silverberg@nychhc.org

The Website http://www.emresidency.net/ http://www.emresidency.net/em-student-faqs/

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The Requirements Be present for all the clinical shifts you are assigned If you are unable to make it please contact me Case Presentation Wednesday Conference Friday Follow up rounds Test The test covers common subjects in emergency medicine. There are more esoteric topics that may be covered. If they are not covered they will be removed from the test.

Look Good on Your Shifts Be courteous and professional to everyone Be on time Own your patients Sign out all of your patients Do your procedures (if possible) Ask the residents about the attendings style

Evaluations There are evaluation sheets in your packet and online Give them to all of the attendings (and residents if you think they have something to say) that you work with at Jacobi At Montefiore they have an app on their phone – ask them to fill it out

Resident Educational Activities Wednesday Conference Usually on the 4th floor of building one from 8a-12pm on Wednesdays Once a month it is at the SIM center (IMSAL) Intermittently at Weiler Friday follow up rounds Friday at 8a-9a in the ED conference room.

Sites Jacobi – 2 weeks Montefiore – 2 weeks Einstein (Optional) If you want to go to Einstein for a shift contact Dr Restivo at emdoc911@gmail.com

Jacobi Roles Attending – pretty self explanatory Pre-Attending Chief 4th year resident – cases are presented to the 4th year by the other residents Chief 3rd year resident - they run the side of the ED. They distribute the patients. Junior PGY1 and PGY2 – see most of the patients primarily

The Jacobi ED West - Surgical side East - Medical side Urgent Care/Fast Track The areas are color coded East- Pink/Blue West – Green/Yellow Grey – Urgent Care

The Monte ED The ED is divided by acuity West – High acuity side East- (North/South) – moderate acuity sides Fast Track – Low acuity

Montefiore Schedule Six 12 hour shifts Pair up with an attending Three attendings start at 7 Three attending start at 11 One in Urgent Care starts at 10:30

Jacobi Schedule Pick a track Go to all shifts listed on the schedule If you need to swap a shift please email me If your track lists you in urgent care and there is no student in one of the other patient care areas then you should go to the other patient care area.

Schedule Divide the group in half Half start at Montefiore Half start at Jacobi Discuss amongst yourselves which track you want If you need any special considerations talk to me

Your Grade Evaluations – the bulk of your grade will come from this because it tells me how well you do on shift. The test will help you if you do amazingly and hurt you if you do poorly. The presentation is pass/fail

Study Material Websites/Blogs/FOAMed Podcasts Books https://cdemcurriculum.com/ https://flippedemclassroom.wordpress .com/ https://lifeinthefastlane.com/ https://emcrit.org/ https://www.aliem.com/ https://emergencymedicinecases.com/ http://rebelem.com/ http://www.emdocs.net/mini-intern- bootcamp/ Podcasts Emergency Medicine for Students EM Basic Books Rosen’s Tintinalli Review books

Remember… These resources are not typically Peer reviewed There will be a lot of opinions

Suture Workshop Goals Practice your technique Learn to set up Learn when to remove sutures

History Blood Loss Mechanism Contamination Time Co-morbidities  Td

Physical Pulses ROM Strength Sensation Fully visualize the wound

Supplies Anesthesia Materials Lidocaine Syringe 18g needle – for drawing up the medication 25g needle – for administering the medication Materials Suture Kit 4x4s Suture material Antibiotic ointment Tape

Supplies Safety Irrigation Light Sterile gloves Mask Mayo Stand Flowing water or NS Light

Suture Types Name Filament Type Absorbability Ethilon (Nylon) Monofilament Non-absorbable Vicryl Polyfilament Absorbable Silk Prolene(polypropylene) Chromic Gut

Material Size Size Use 6.0 Face 5.0 Face/Neck 4.0 Head, Limbs, Neck, Trunk, Mucosa 3.0 Limbs, Trunk, 2.0 High tension wounds Chest Tubes

Duration by Anatomic Location Day Face 3-5 Limbs 7-10 Trunk 7-14 Hands and feet 10-14 Joints Scalp

Suturing Technique

Contact Information Joshua.Silverberg@nychhc.org