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Fourth Year Role

Start of shift:

1. Check airway equipment, including diffcicult airway supplies
2. Check difficult airway stock list (list near airway supply) against current inventory- ask tech or Resus Nurse to restock missing items
3. North zone signout
4. Confer with charge nurse, IBEX Pulsecheck, and BedBoard Overview- introduce yourself, touch base on ED bed situation, # admitted patients, # available ICU beds, etc.
5. How many patients are in for a stress test today?

During shift:

Supervise all junior residents, meaning hear cases primarily when you can, otherwise just get a bullet (assessment and plan) from the resident on cases they’ve presented to attending

When you start falling behind in hearing about cases or seeing patients you’ve heard about, defer presentations to the attending, catch up with attending afterwards

Know all North Resus pts- well enough that you would be able to speak to a MICU consult about them

Know the bare bones of the South Resus patients- who’s really sick, who could leave the Resus area if a bed is needed

• When the junior residents become saturated with patients, and the department gets busy:
1. Board round with them on their patients (have them click “My patients” in IBEX); help them determine the next few critical actions they need to perform
2. Cherry pick patients to pick up primarily- clear admissions, call-ins who need orders entered, etc.
3. Confer with attending if other options would improve department flow

Board round with attending a few times per shift (just for a few minutes each time) to get on the same page about eval and dispo for each patient- this is a good way to get the gist of patients you were previously unaware of and see the departmental ‘big picture’

At Signout:

• -Sign out to incoming senior
• -Take part in attending change of shift as needed

Notes on Resus:

• -Know the North Resus patients well- the EM-4 should be actively supervising their care (bring junior residents in to the case), or care for them primarily if no juniors are available
• -Know key issues/dispo status for South patients

Charting:

Reiterating the attending assessment and plan may not be useful; however, Seniors should write a brief progress note in the Doctors Notes section on patients they are supervising/following (ie. Response to treatment, PCP contacted, etc.)

Codes:

The EM-4 should run the codes, assigning other roles according to staffing and need (airway, central line, etc.). If an EM-3 is primarily caring for a coding patient, the EM-3 could then take on the role of running the code and assigning roles (leaving the EM-4 to assist with airway, or whatever is needed).

Night Shifts:

Depending on staffing and volume, several options are possible:

1. EM-4 supervises the North Zone, attendings focus on hearing South Zone cases directly from South junior residents and EM-4 supervises North juniors
2. EM-4 sees patients primarily, but periodically round the board with attending to keep abreast of overall department flow and cases

Know This

The fourth year should know the answers to these questions (or know how to find out quickly) on any given shift:

1. Who can come out of Resus?
2. If CT can take a patient right now, who goes next?
a. -Or- How many patients are waiting on CT and Ultrasound? In what order should they go?
3. How many admitted patients are boarding in the ED right now?
4. Which patients have been in the ED the longest without a disposition, and what are they waiting on?

Written by phil

July 27th, 2009 at 5:52 pm

Posted in Residents

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