Louisiana state university health science center new orleans emergency medicine residency program policies to supplement lsuhsc house officer manual



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SLIDELL ED

You are assigned to Slidell Memorial Hospital for the month:


Orientation: There is no formal orientation for this rotation. Dr. Eddie Lirette and Kumar Amaraneni are the Directors of the Emergency Department at SMH.
Scheduling: You will do sixteen 10-hour shifts each month from 11am to 9pm.  Your default schedule is: Monday, Tuesday and Friday, and the first and third Saturday and Sunday of each month. If the aforementioned shifts involve more than sixteen dates in a month, then cap your work hours with the sixteenth shift. If you would like to deviate from this schedule, then you must obtain permission at least two weeks prior to starting the rotation from Dr. Lirette (edlirette@cox.net) and submit the approved schedule to Kathy Whittington. (klwhit@lsuhsc.edu
Responsibilities: the daily management of all patients in the ED while on shift.
Directions: Take I-10 East towards Slidell and exit at Gause Blvd (exit #266), the third Slidell exit. Turn left at the light on Gause Blvd. and go approximately 2 miles. The entrance to the ED will be on the left after you pass the red light at the end of the hospital.
Conference: you must attend conference and journal club.
Extras: All procedures must be recorded and turned in at the end of the month.
Supervision: you will work side by side with an Emergency Medicine board certified physician.
Evaluations: Pooled and compiled by Dr. Kumar and Dr. Stafford.
Meals: Provided by SMH.
Slidell Memorial Hospital Emergency Department Rotation
GOALS and OBJECTIVES
What follows are the goals and objectives for the Slidell ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the Slidell ED. The year of training may include PGY 1-5.
The educational goals and objectives for the Slidell ED rotation are to provide residents with an opportunity to experience and learn about the initial evaluation and management of emergency patients in the community setting as well as the following:
1)      Perform basic assessment of patients with a variety of moderate and major traumatic conditions.
2)      Formulate a differential diagnosis for patients with various kinds of traumatic conditions and mechanisms of injury.
3)      Order and interpret appropriate diagnostic laboratory and imaging studies for trauma patients.
4)      Competently perform minor procedures such as suturing of lacerations, incision and drainage of the abscesses, insertion of nasogastric tubes and urinary catheters, venipuncture, insertion of peripheral intravenous catheters, lumbar puncture, splinting of fractures and sprains, spinal immobilization.
5)      Demonstrate basic understanding of the principles of ACLS resuscitation as applied to persons in cardio-respiratory arrest.
6)      Achieve ability to perform an adequate history and physical exam, prioritize conditions, and form a differential diagnosis in adults with acute and chronic medical problems of varying severity presenting to the ED for care.
7)      Learn proper methods for stabilization of patients with life threatening conditions such as sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac arrhythmias, severe GI bleeds, and overdose.
8)      Learn to evaluate, diagnose and initiate any needed therapy for a variety of specific medical problems such as asthma, seizures, anemia, stroke, GI disorders, urinary tract infections, pneumonias, and other respiratory illness.
9)      Learn to evaluate and appropriately manage a variety of patient complaints such as chest pain, abdominal pain, dizziness, headache, syncope, etc.
10)  Learn to perform an adequate history and physical exam in female patients with gynecologic problems or problems related to early pregnancy including abdominal bleeding, infection, threatened abortion, and ectopic pregnancy.
11)  Learn appropriate use of diagnostic lab and imaging studies for emergency patients and to have basic competence in their interpretations.
12)  Learn to use the following diagnostic aids: central venous pressures, pulse oximetry, arterial blood gases, EKG’s.
13)  Perform the following procedures with basic competency and to know indications and contraindications: venipuncture, starting an IV or heparin lock, arterial puncture, insertion of a Foley catheter, placement of a central venous line, thoracentesis, paracentesis, lumbar puncture, urinalysis with microscopic, wet prep of vaginal secretions.
14)  Become familiar with common medico-legal problems which present in emergency medical practice such as: consent, desertion, AMA, restraints, impaired patients, child or adult abuse or neglect.
15)  Be able to arrange appropriate follow-up for discharged patients and give adequate discharge instructions.
16)  Learn and use the available contributions of the Social Services Dept. to patient care in the ED and for discharge planning.
17)  Learn appropriate medical evaluation of mentally disturbed patients including techniques for restraint and control of violent patients.
18)  Learn about billing as it pertains to ED patients.
The clinical and didactic experiences used to meet those objectives included daily patient care in the Slidell ED, along with bedside teaching. This rotation experience is part of the greater emergency medicine curriculum, also including PALS/ACLS/ATLS provider and instructor certification and weekly didactics (part of the overall didactic curriculum).
The feedback mechanisms and methods used to evaluate the performance of the resident include an end of rotation global evaluation. Immediate feedback may also be given to the resident, and any significant problems will be discussed during the rotation with the LSU EM administration.
The resources and facilities in the institution that will be available to each resident include computer access to Up To Date and the LSU Library services, including current texts in emergency medicine. The residents will have access to the resources of the hospital including medical texts, medical records, doctor’s lounge and cafeteria.
The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Emergency Medicine team in a community hospital under the supervision of a staff physician. The residents will participate in the initial management of emergency department patients, to include trauma, psychiatric, obgyn, pediatric and general medical patients.
The relationship that will exist between emergency medicine residents and faculty on the service: The overall goals of resident education and patient care will govern the relationship between faculty and residents. Residents will receive 24 hour supervision while on the rotation. All patient care and medical charts will be reviewed and signed by the ED faculty prior to patient discharge.
Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7 days off.

This rotation summary has been reviewed and agreed to by the service director and LSU Program Director.



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