Emergency Care Observation

Minutes have passed and to my surprise, after shocking the patient multiple times, we had return of spontaneous circulation. A sense of excitement, and relief, poured over me. From my past experiences, I assumed that there was a small probability that this man would live; however, that day I learned that every patient is different. As a Physician Assistant (PA) I want to consider the entire combination of factors that make each person unique, analyzing all aspects of their life – physically and emotionally. Ultimately, this experience motivated me to channel all of my energy towards pursuing a career as a PA.

Bedside reporting involves giving information or a report to the oncoming nurse in the presence of a patient. This method gives the patient an opportunity to ask questions and get clarification regarding his or her care. Bedside reporting increases patient satisfaction, quality of healthcare and nurse-to-nurse responsibility. Hospitals need to design a better handoff process that can easily reduce patient risks and increase patients’ involvement in their care. Emergency rooms shift reports usually take place at the nursing station of every patient care area. The departing nurse gives information verbally to the oncoming shift. Therefore,

S (situation): Hi, my name Kelsey and I am a nurse in the emergency department. I am calling about Shannon O’Reilly’s most recent laboratory results.

Clipboard and stethoscope in hand, I walked toward the double doors that flashed emergency in bright red letters above. It was my first clinical shift as an EMT student, and first day jitters flittered around in my stomach, I had no idea what to expect. However, I was not expecting to witness the fragility of life. About a half an hour into my shift the rapid response alarm blared through the emergency room. I turned to my preceptor and quizzically asked what this meant. “A rapid response is a patient who is in need of immediate medical care and intervention. As an EMT who is part of the rapid response team you will be expected to assist with vitals and chest compressions. Let’s head toward the recess room, and I’ll explain more there.” Eventually, we reached the recess room, and the rapid response team was already there preparing for the arrival of the patient. A nurse was on the phone with the firefighters that were bringing the patient in. Seconds later she announced “It’s a STEMI”. Then fright ran through my veins. A STEMI is medical jargon for a segment elevation on an EKG. In other words the patient’s coronary artery is completely occluded. The patient is suffering from a heart attack. Prior to this, I had never seen someone who was having a heart attack. However, the thing that terrified me the most was that I knew I would be expected to perform chest compressions. I had only ever performed chest compressions on a dummy.

For my mentor project, I chose to shadow Dr. Kristen James, D.O., a young emergency room Physician (approximately 33-34) who works in the E.R. at Tenova North Knoxville Medical Center. The length of all emergency room shifts are twelve hours—7:00 a.m. to 7:00 p.m., 7:00 p.m. to 7:00 a.m., or 11:00 a.m. to 11:00 p.m.— but for the sake of the well being of my mind and body, I only shadowed for a half of a shift (11:00 a.m. to 5:00 p.m.). I had previously shadowed my father in the same emergency room for a twelve hour shift and I knew that I definitely did not have the stamina to make it through another one with a clear mind or comfortable feet. During this essay, I will be tying in some useful comparisons between shadowing my father vs. shadowing

Shortly after enrolling in college I obtained a job as an emergency department (ED) scribe. Working as a scribe challenged me to think harder about what I wanted to do in health care. It was what I witnessed during my first code that inspired me to pursue a career in medicine. A patient had come into the ER with hypertension and bradycardia. Shortly after the doctor and I had finished completing his assessment, the patient went into cardiac arrest. While I was impressed by the responsiveness and intervention of the nursing staff, my eyes, like many others in the room, were fixed on Dr. Crowder. With an unusual calmness he systematically called out orders “defibrillate…. okay, continue chest

I stood with a look of wonderment as I watched the beehive of physicians, radiologists, nurses, and paramedics collaboratively save a man’s life. The scene initially appeared chaotic with scrubs flying around and doctors swarming all over, but in actuality the team was extremely single-minded—as if driven by instinct. I was amazed by the speed and conviction with which the attending doctor made his decisions; his training and experience was evident with every move. Seeing the tearful wife thank the doctor highlighted the impact of his work—his actions had saved a husband and a father. I left admiring both the competency of emergency physicians and their ability to touch lives in such a dramatic way. While my enjoyment of high school biology sparked my original inclination towards medicine, my first hand experiences in the hospital deepened my motivation and left me steadfast in my decision to become a doctor.

Pulling off the ramp, we turned onto Church Hill Road responding on a priority one for the cardiac arrest. I tried to review my field guide en-route to the call, but all I could see were flashing lights reflecting off the guide’s pages and crowds of cars moving over for our wailing sirens. Within three minutes we had arrived on-scene and it was clear that our patient was not in cardiac arrest; however, his 12-Lead EKG and oxygen saturation were marginally reassuring and pointed to an active heart attack. At this point in my EMS training I was a BLS provider, but had adequate knowledge to assist Kathy. Instinctively, I went right to work and loved every second of it. The concept of formulating a differential diagnosis in the field and testing that theory is one of the principle factors that kept drawing my back to EMS. In addition, I developed an unparalleled appetite for knowledge, stemming from my desire to get every differential diagnoses right. Coming to this realization early in my EMS career, we [healthcare providers] frequently forget that patients often lack the medical knowledge provided to us through years of training. Behind CT Scans and MRIs are patients with questions. Having the ability to provide compassion, sympathy and reassurance to a patient is a central part to their recovery and survival; therefore, we [healthcare providers] need to be able to care for our patients on a holistic level, focusing less on the disease and more on the

The emergency lights light up the hallway as the ambulance pulls in, everybody's hearts are racing but composure is held, that bay door opens and the EMT’s rush in doing chest compressions while steering the stretcher with precision the patient is safely transferred to another bed, the CPR continues and another team takes over all with the intent to save this life. This is a brief description of the teamwork involved in emergency medicine. This is the typical thoughts one may have about an emergency situation, but what they don’t realize is all the teamwork involved in medicine in general. I chose to do my career investigation project on becoming a Physicians Assistant.

In the near future I aspire to embark on a career as a qualified professional Paramedic with a successful degree. I want to aid people in threatening and non-threating life situations at my extreme personal best. My curiosity and willingness to help others arose due to a personal loss, thus wanting to study paramedic science at university level and be part of the NHS; a place where life, love and loss unfolds every single day.

After completing my bachelor’s degree at Florida State University in the fall of 1997, I began my career at a small hospital in Largo, Florida. I started on a thirty eight bed cardiac/telemetry unit. I had the fortunate opportunity to orient with a seasoned nurse who loved her career in nursing. She was an enthusiastic preceptor that not only educated me on the tasks of nursing but inspired and introduced me to critical care and critical thinking. I spent the next three years at this hospital working in the Coronary Care Unit until deciding to become a travel nurse and see the country. I began travel nursing with my best friend and we worked in Florida, Washington D.C., New York and Denver. At all of these locations we worked in the intensive care unit. Each experience provided a different population and vast new experiences.

The experience I gained at the cardiology clinic and the hours shadowing at the Methodist Hospital emergency room are a pillar for the career of my choice. I want to be able to help those in need in my local community hospital. I feel the urge to give a hand to those that have guided me through the right path, from teaching me right from wrong to encouraging me to strive to be the best in life. At the Methodist hospital, I learned how to obtain patient’s medical history and entered data into Cerner, and I obtained consent from patients before procedures such as diagnostic imaging and casting. I observed physical examinations being performed by the physician assistant and it taught me that it is necessary to have knowledge to be able to diagnose and treat conditions and that interpersonal skills are essential for this career. Currently, I work for the department of health where I triage and register patients, assist physicians and nurse practitioner in the examination of patients, and assist with maintenance of inventory supplies and

The Path of Paramedics Caring for patients in the EMS environment is like riding a motorcycle: The moment you get comfortable and think you’ve seen everything, you become dangerous(David Persse)! Just one day in the life of a paramedic and you will second think anything you thought you knew. They must be prepared or any and everything that could possibly happen. They can hold your life in their hands and they have to have the skills to sustain in until the hospital is reached. Becoming a paramedic is the right choice because, everyday seems like an adventure, the schedule is as set as stone, and you have the chance to save lives without eight years or more in medical school(Devantier, Alecia T., and Carol A. Turkington).

My supervisor, one of the head nurses, hurriedly pulled me to the corner of the bleach white hospital room and directed me to put on gloves, an eye mask, and a face mask. I felt as if I was preparing for war as I put on all of the required gear. The sound of expensive shoes click-clacked down the hallway indicating the arrival of two doctors who rushed into the room and shouted out orders to the staff while pulling the doors to the room shut along with the curtains. Two doctors, eight nurses, an intern, and a dying patient squeezed into the already claustrophobic ten by fifteen-foot room. The machine monitoring the patient’s vital signs continued to beep incessantly as my heart rate accelerated. Throughout my internship, I had never seen a patient in critical condition until that moment. I remembered my teacher’s advice if we were ever in a situation such as this: take a few deep breaths and sit down if you feel like you’re going to pass out. In that

I recently decided to ensure that the skills that were developed during my week’s placement and referring were continually built upon in a suitable high pressure environment. I subsequently attained the National Pool Lifeguard Qualification allowing me to volunteer as a lifeguard at Keetch Cottage Hospice for two years. This has not only reinforced the previously mentioned abilities but my training and serious responsibility I carry has improved my organisation as well as my ability to make rapid decisions under pressure, whilst remaining