Peds ER halfway point

Five of eleven shifts down, one of two EMS rides down and two weeks of didactics completed. I still haven't done any procedural shifts, but I hope to fit in one or two i n next two weeks. I'm also finally beginning to get study time in. I've been reading a couple hours a day for the last few after realizing that I'm getting more training in ER than Peds.

If I'm going to pass the shelf test in a few weeks, I'm going to have to learn most of the Peds material on my own.

As for cases, I've seen a lot of interesting stuff. Here's a sampling:

Status epilepticus
Febrile seizure
Crohn's Dz
Physical abuse
Refractory SVT (finally cardioverted with defib)
Diaphragmatic hernia w/ pulmonary hypoplasia
Lots of fractures and lacerations
Lots of Asthma, Pneumo and UTIs, but less Strep and Otitis Media than I expected.

I've had a chance to do casting, sutures, lots of physicals and observe a couple codes now. Surprisingly, my EMS ride day was boring. We had two real calls, one for tachycardia and one for syncope/drop-seizure. We also got called on a fire, but it was a non-event. At least the food was great. The firefighters and paramedics seem to be pretty good cooks.

As usual, this rotation has forced me to consider whether I would like, in this case, ER. Certainly the pay and time off are very attractive. Twelve to fourteen shifts a month of eight to twelve hours with no call for over two hundred a year. But you never see much of the patient, never get to do preventative medicine and don't get closure on many patients. The burnout rate is pretty high and you almost have to work in a hospital ER.

On the balance, ER doesn't surpass Family Practice. You don't make quite as much in FP, but have so much flexibility in your career: procedures, type of practice, location, patient population, etc. Plus you get to know the community and your patients much more. While many of the ER Residents and Attendings are pretty nice, I also identify with FP docs better. The surgical and IM specialists, even ER to a lesser degree, can be pretty high strung, arrogant and worn out.

The Residents switched over yesterday, so for tonight's shift I will be with ER Residents new to the Peds ER. Should be interesting.