My fifth rotation was Emergency Medicine at Metropolitan Hospital. This was my favorite rotation yet! The environment was fast-paced and exciting, all the PAs, residents and attendings were welcoming and eager to teach and both the providers and nurses happily allowed me to do procedures. This rotation was very different from my last where I was on the medicine floor, following patients. It took me a day or two to adjust to the nature of the ED and what they’re goal is – to rule out diagnoses that will kill the patient and just treat what is acute. I had …

MINI-CAT Scenario: A patient is rushed into the emergency room at 4:00 pm c/o dizziness, headache and right sided weakness for 1 hour. Code stroke is activated and the team rushes to call neuro, get a history and all her labs as quickly as possible. The patient states she’s a “hard stick” and after the first failed attempt at obtaining an IV line, they grab the ultrasound to perform an ultrasound-guided peripheral line placement. The resident has seen the other providers mostly using short-axis technique but asks the attending what he prefers, short-axis or long-axis technique for ultrasound-guided IV placement. …

Site Evaluator: Professor Rachwalski I presented the following case at my first site evaluation: LJ is a 58 y/o F with a PMHx including asthma, DM, GERD, HTN and former smoker (10 cig/d/30 years) presents to the ED complaining of shortness of breath x1 day. Patient reports she was watching a movie last night at 2 am when she got L sided chest pain sudden in onset, sharp, 9/10, radiates from anterior axillary line around the L breast, constant and worse with movement. The pain lasted for 30 minutes, patient couldn’t move for duration of episode, went away spontaneously, she …

A patient I saw in the ED presented with an acute myocardial infarction. He presented with shortness of breath and chest pressure that woke him up in the middle of the night, however once in the ED he wasn’t experiencing any chest pain. His EKG showed ST elevations and was having an acute STEMI although he didn’t seem like he was having an MI due to his largely asymptomatic presentation. Therefore, I presented a journal article on typical and atypical symptoms of acute coronary syndrome. The article explained how many times women are underdiagnosed or misdiagnosed because they tend to …

Identifying data: Name: LJ Sex: Female Date of birth: 7/13/1963, 58 y/o Date & Time: 7/14/21, 2:30 pm Location: Metropolitan Hospital Marital status: single     Religion: Catholic Race: Caucasian    Source of information: Self, reliable Mode of transport: Self   Chief Complaint: shortness of breath x1 day HPI: 58 y/o F with a PMHx including asthma, DM, GERD, HTN and former smoker (10 cig/d/30 years) presents to the ED complaining of shortness of breath x1 day. Patient reports she was watching a movie last night at 2 am when she got L sided chest pain sudden in onset, sharp, 9/10, …

My fourth rotation was Long Term Care at Queens Hospital Center. Due to the restrictions with Geriatric clinic at QHC since COVID-19, I was placed in the medicine unit. This was my first inpatient rotation and so it brought a very new and different experience from my previous outpatient rotations. I really enjoyed getting to follow patients and see their progression which I hadn’t gotten to see in an outpatient setting. It was so helpful to be part of a team of an attending, residents and medical students to be able to learn from everyone and their various styles, knowledge …

Site Evaluator: Dr. Davidson I presented the following case at my first site evaluation: FS is a 91 y/o female with a PMHx of HTN, HLD and osteoporosis who presented to Queens Hospital Center ED last night after a fall. At baseline, she lives alone, is ambulatory – walks without any assistive devices at home and uses a cane when outside, is completely independent in her activities of daily living and independent activities of daily living including driving, and has full cognitive capacity – she states she is able to care for herself. Pt was standing near her kitchen when …

RT is a 54 y/o male with a PMHx of HTN, HLD and depression who presents with abdominal pain x1 day History Elements: Onset: pain began suddenly and rapidly around 1:00 pm yesterday while patient was sitting on his couch Location: epigastric abdominal pain Duration: pain is constant and persistent Character: sharp, severe pain  Alleviating/Exacerbating: sitting up and bending forward helps slightly but only temporarily. Patient took advil for the pain but his sx were barely alleviated Radiating: pain is mainly in the upper abdomen and radiates around to the back Timing: pain came on yesterday and has gradually gotten …

I presented an article titled “Considerations of Elderly Factors to Manage the Complication of Liver Cirrhosis in Elderly Patients” which discussed management and treatment of cirrhosis in the elderly, keeping in mind how dosing and administration of medication/tx differs in this population. It also discussed various complications of liver cirrhosis including hepatic encephalopathy, which I focused on as this related to my patient who was an elderly, non-alcoholic woman presenting with AMS from her baseline and was diagnosed with HE.