Educational Objectives:
The resident will develop competence in:
The initial evaluation, management, and stabilization of orthopedic conditions. This includes but is not limited to joint dislocations, fractures, soft tissue injuries, infectious conditions, and rheumatologic diseases.
The indications for ordering and performing radiographic studies. This includes plain films, CT scans, MRI scans, and fluoroscopy.
The interpretation of radiographic studies relating to orthopedic conditions.
The techniques to reduce joint dislocations.
The techniques to reduce fractures.
The techniques of immobilization. This includes casts, splints, and immobilization devices.
The appropriate disposition and follow-up of orthopedic conditions that may be safely discharged from the Emergency Department.
The indications for hospital admission for orthopedic problems.
The short-term and long-term complications associated with the management of acute orthopedic conditions.
The resident will develop competence in the technique and interpretation of ultrasound in diagnosis of extremity dislocation, fracture, tendon injury, tenosynovitis, joint effusion, bursitis, cellulitis, and necrotizing infection.
The resident will develop competence in the indications and techniques for regional anesthesia
SCHEDULE
This 28 day rotation will combine clinical shifts in the ED, orthopedic consultations, orthopedic clinics, as well as didactic lectures. You will work shifts in the ED fast track on Monday, Tuesday, Thursday and Friday. During those shifts, you will also respond to consults in the pediatric ED and trauma unit. If one resident is on the rotation, your shifts will be from 10a-6p. If two residents are on, you will work either 10a-6p or 3p-11p. On Wednesday, attend the regularly scheduled EM conferences in the morning and the afternoons can be used for independent study or lectures with Dr. Sherman. Any schedule changes must be arranged in advance of the rotation with Dr. Sherman.
You will meet with the ultrasound faculty for an introduction to MSK ultrasound the first week of the block and will attend US academic day the last Tuesday of the block. Plan to present your best MSK ultrasounds for review.
Clinical Shifts
You will work on the Green team seeing orthopedic patients primarily. If patients are already in rooms waiting to be seen, evaluate these patients first. If not, go through the waiting room and pick out patients with orthopedic complaints and call them in from the waiting room. Use the Simon Orthopedic Room as “your room” and bring your patients in and out of that as needed. If there are no patients with orthopedic complaints, see other fast track patients. Perform procedures with your ED attending’s supervision unless a formal orthopedic consult is requested.
While working in the ED, you should see all of the orthopedic consults wherever they might occur (Red, Blue, or Green). You will also take consults for the Pediatric ED and Trauma unit. Respond to consults outside of the Adult ED as a priority unless an emergency requires you to stay. Staff your consults with the on-call orthopedic resident on the plan of the day. You will NOT cover any patients on the wards for on-call related issues or spent time in the operating room. If you receive a call about a transfer, refer that individual to the orthopedic residents (no transfer is accepted without ED attending approval regardless).
ED BACK-UP CALL
You will be placed on the Adult ED back-up call schedule during the month. Check with the chiefs for this schedule. The number of back-up calls will vary from month to month based on availability of other residents. If you are called in for a shift, contact Dr. Sherman to discuss the changes to your Orthopedic schedule. If you are called in for an evening or night shift, you will skip the next day’s duties in exchange.
DIDACTICS
The didactic experience during the rotation includes lectures both in person and online. Check with Dr. Sherman regarding lectures given in person. When he is not available, independent study via the textbook or use the online lectures by clicking the links below.
Dr. Scott Sherman’s Orthopedics Online Didactics
PATIENT LOGS
EM orthopedic residents will be given forms to log their orthopedic experiences. All orthopedic patients evaluated in the adult ED, the pediatric ED, or the trauma unit must be recorded. The forms will list the date, patient name, unit number (the ER sticker gives all this information), diagnosis, procedures performed, and disposition for each consult and/or admission. The logs must be turned in promptly at the end of the rotation to Dr. Sherman. The rotation coordinator will go through the log books to document number of consults and procedures for the rotation. The patients’ radiographs will also be screened to look for addition to an ongoing database of teaching films. Please be meticulous in maintaining the log books. Click this link for a copy of the patient log.
Residents need 10 MSK scans for graduation, and you should plan to obtain these during your Ortho block.
ORTHOPEDIC BLOG POST
Identify a case from your clinical shifts that you’d like to write a brief post for our EM residency blog. The topic should be something not previously covered on the blog. It is fine to cover a different aspect of a similar topic. Cases should be original and include either a clinical picture or radiograph from the patient. No identifying features allowed. See the blog for examples, but the post should include a brief history/physical followed by the image, and then a “Why it Matters” discussion that should be a couple of paragraphs in length.
EXam
The test is a 100 question fill-in the blank and multiple choice test. It is to be taken on the intranet by using the following LINK. Check with Dr. Sherman for the password. It is NOT open book, it will be timed, and the honor code will be in effect (Don’t cheat).
EVALUATION
Your evaluation for the rotation will be based on the clinical shifts, patient log, blog post, and examination. Please take the exam and turn in the patient log and blog post by the last day of the rotation.