In the Emergency Department, home sweet home

For my second rotation of residency I am in the ED (Emergency Department) in an inner-city hospital. Some may think; "You are doing a residency in emergency medicine, so why are you not always in the emergency department?" In the first year of residency I will do about 40% of my training in the ED and about 60% on off service rotations like OB, ICU, Anesthesia, Ortho, etc. During my second year I will do about 60% of my train in various ED's and 40% off service. In my third year I will be in various ED's 100% of the time.

The off service rotations are great for getting training in specialties that you have to know as an ED physician. YOu have to handle OB, Ortho, pediatric, etc patients in the emergency room. It is nice to be in the ED as I feel at home there and everything I am learning has a direct impact on my skill set as a physician. There are several different emergency departments that my residency works in and this was one of the things that attracted me to this program. Many residency programs keep their residents in 1 ED the entire residency. Unfortunately those residents only see 1 ED and 1 type of patients during their whole training time. An inner-city ED is a much different environment than a suburban ED or a small town ED or a trauma 1 ED. My residency program has us do rotations in all of these types of emergency departments.

Some residents do not like all the traveling between the different locations. You spend 1 month at 1 hospital and another month at a different hospital. I feel the different environments and different patient types makes you a much stronger, well rounded ED physician. My first ED rotation is in a very busy inner-city emergency room. It is a little crazy and you see amazing pathology and illnesses. I had a patient the other night that was bitten by his own pit bull and his leg was pretty torn up. As I explored the wound I noticed a foreign body within the bite wound. I sent the patient for an X-ray and sure enough there was something in the wound. I continued to explore the wound until I actual found the foreign body and upon extraction of it I realized it was one of the dog's teeth. Crazy. Of course the patient did not want the dog to be put down. Fortunately animal control gets to deal with the animal issues. I cleaned the wound and started the patient on antibiotics. Fortunately the dog did not have rabies so the patient did not have to get treatment for rabies.

In the ED you never know what is going to come threw the door and that is what I love!