Rotation Summary

My experience on my emergency rotation was overall a positive experience.  I really enjoyed working in a fast-pace environment and seeing what it is like to think on your toes as a practitioner. I got a lot of practice presenting to attendings and residents in a concise and direct way and believe I am improving on being able to flesh out the important details to communicate to give someone a full picture of the patient story.  This definitely came as a challenge at the start of the rotation, as the expectation in the medical emergency room setting was different than my past rotations.  I felt like I had to take a few minutes to organize my thoughts and findings before presenting, however as time went on this skill developed.   In addition, it was helpful to be around residents and PAs who were always presenting to attendings as it gave me a better idea about what was expected of me.  I’ve realized how important this skill is to have in my career and will be cognizant to make a continued to improve in my presentations this year.

One thing I am very proud of over this rotation is that I was eager to volunteer to do procedures.  Thankfully, I had a lot of supportive residents and attendings around to teach me techniques.  Sometimes it was hard to push myself to volunteer to do a procedure I hadn’t done before but there were a lot of people happy to help and teach so I felt comfortable doing so.  I regret not having more time to practice blood draws and IVs and hope to do more on my next rotation.

Although it was hard to work with a different team every day as it created a challenge in having a routine and having to get comfortable with a new group ever day, I felt like I had the chance to learn each practitioner’s different style.  Whether if it was how they took a history or how they held the IV catheter, I got to see how everyone has a different style and approach and they can be equally effective.  One thing I would like to gain going forward is becoming confident in my own approach while being able to respect and learn from one that is different from mine.

Here are a log of the patients I saw over the rotation Case Logs3

Site Evaluation

Overall my site evaluations were a positive and enjoyable experience.  On my first visit, I presented a case of 26-year-old female G2P1001 27 weeks pregnant no PMHx with right lower abdominal pain x 1 day.  Pain was associated with loss of appetite but denies nausea, vomiting, diarrhea. Physical exam was significant for normoactive bowel sounds, gravid abdomen.  Right lower quadrant tender to palpations at mcburney’s point, obturator sign positive.  MRI revealed Non visualization of a normal appendix however anterior to right ovary is a 6-7 mm tubular structure with minimal associated fluid an inflamed appendix is not excluded and should be evaluated clinically.  The patient was diagnosed with appendicitis and admitted by surgery.  I thought it was an interesting case because of the different diagnostic modalities necessary for a pregnant patient.  My feedback for this presentation was I needed to improve on my patient education section, unfortunately I did not get the feed back until after my final evaluation.  At my final site evaluation, I presented a 92-year-old female PMHx of HTN, HLD, DM II, inflammatory colitis and a PSHx of a colon resection (1998) and a torn meniscus repair (2017 with 4 days of vomiting, abdominal pain, constipation and obstipation.  Patient stated pain was in the epigastric region and comes and goes. Patient stated she was vomiting 6-7 times a day.  Physical exam of abdomen revealed hypoactive bowel sounds, slightly distended, tender to palpation in right and left lower quadrants and tympany to percussion. This patient was diagnosed with a small bowel obstruction based on CT imagining, in which there was visualization of small bowel obstruction with transition point within the lower mid abdomen.  On my next site evaluation, I will try hard to come up with a broader list of differentials.  I really enjoyed having the opportunity to discuss the case more at length as that’s not often possible in the emergency room.

Here is a history and physical I presented HP Rotation 3.

Journal Article

Summary

Implementations of phospholipids as pharmacological modalities for postoperative adhesion prevention

The article I chose was centered around the use of phospholipids in the prevention of postoperative adhesions.  The case I presents was the occurrence of a small bowel obstruction in a patient with prior abdominal surgeries, a common risk factor for small bowel obstruction.  Phospholipids are employed for the reason they are surfactant-like substances and protect the serosal defects temporarily.  Their use in preventing adhesions was studied in 24 publications, all but 2 supported its efficacy.  An intraperitoneal dose of 75 mg/kg of phosphatidylcholine for 30-min exposure time was effective in both surgical and peritonitis settings. No adverse effects or impeding healing of laparotomy wounds or anastomosis were recorded.  In addition, the use of phospholipids were found do inhibit bacterial growth.  These results suggest that phospholipids can be used to forestall adhesion formation,  reduce posttraumatic inflammation, inhibit intraperitoneal tumor cell adhesion

Attached is the original article Adhesions