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.
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 7a-3p or 3p-11p. On Wednesday, attend the regularly scheduled EM conferences in the morning and the orthopedic clinic I in the afternoon. Any schedule changes must be arranged in advance of the rotation with Dr. Sherman. Obtain your schedule from Lolita Adams.
ED Fast Track
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 chart rack 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. For orthopedic procedures (fracture and dislocation reductions), perform these 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. Please assist them with writing notes or admission orders as needed. If the patient requires a procedure, have the orthopedic resident take you through the steps to perform the procedure. 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).
The orthopedic clinic is scheduled for Wednesday afternoon. It is located on the 2ndfloor of the hospital, Clinic I. See patients wherever you are needed or wherever you need based on your experience. Ask questions and make sure that you are getting good teaching by the orthopedic team. Spend some time with the splint techs.
On a couple of clinic days, ask the senior orthopedic resident if you can work with the splint/cast techs for a couple of hours. They can help you refine your techniques. For additional tips on splinting, click this link… http://www.med.uottawa.ca/procedures/cast/
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.
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 (ED or Clinic) in exchange.
The didactic experience during the rotation includes lectures both in person and online. Thursday afternoon is reserved for orthopedic reading, case follow-up, and lectures. Check with Dr. Sherman regarding lectures given in person. When he is not available, view his lectures online by clicking the links below.
Evaluation and Reading
Your reading from the month is from Simon’s Emergency Orthopedics Textbook. You will be tested at the end of the rotation. 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 or Estella for the password. It is NOT open book, it will be timed, and the honor code will be in effect (Don’t cheat). The evaluation from the month will be based on feedback from the ED attendings and orthopedic residents, as well as the end of rotation exam.