For the medical student and intern, the case presentation to the attending is how you show that you understand the basics of Emergency Medicine, think like how we think, and care about what we care about. Very few medical students and interns actually have direct observations performed by senior residence are attending taking histories and interacting with patients. So the presentation is the only evidence we have that you’re good at eliciting a history, and digesting it into a plan.
Emergency Medicine is a discipline, both thought content, but also thought process. In the reported history of present illness given to attend, attending or senior residence is not just about before transcription with the patient said, ensure reflect the active process of listening, as well as hunting for information from the patient, and the chart, delivers a simply, upfront.
Initiation of every case presentation starts with the patient’s age and their chief complaint. It should not start with some long list of their comorbidities. This is unlike internal medicine or the specialties. The first thing you should say is somebody the effect of “this is a 43 year old female here today with concern for shortness of breath. And parentheses the next few sentences should be a standard OPQRST style, because the character of six, and most importantly, the tempo, really set the differential diagnosis. After describing the symptoms, it would then be appropriate to list the patient’s abbreviated history as appropriate. For instance of the patient has a she complain of shortness of breath, it is prone to mention if she has a prior history of DVT, heart failure, for Chien, cocaine use, etc. and I think it might be considered relevant. It’s a right to leave out things that are not Jermaine, front of the patient has a remote prior history of hysterectomy or something else, that you don’t think is pertinent to put in the first two minutes of This person’s description.
The next few sentences should include pertinent positive and negatives that are relevant. For instance, if the patient has a chief complain of shortness of breath, even if they don’t mention it, and you have not mentioned in the presentation otherwise, you still need to say something to the effective, whether not this patient has any poor Cartier, well criteria, respect for CAD, etc.
And then, after that, it’s all right to cheat and include some stuff that you’ve glean from the chart that may be relevant. For instance of the patient Had a corner catheterization three years ago with no obstructive corner disease, that should be mentioned. The patient there with a chief complaint of gastrointestinal bleeding, you could include any mention of endoscopies or colonoscopies or diverticulosis seen on prior imaging.
Is then fair to report On objective findings. As in start with the vital sign, go over your physical exam for everything relevant. It’s OK to exclude for portions of the same or not Jermaine, and you can either leave them entirely, or you could say That certain elements of the physical exam were normal or unremarkable. There are always some can’t miss parts of the exam you have to mention. For instance of the patient has a neurological problem or dizziness. You need to include full exam, including gate, Ambulation, posterior signs.
You then move onto any other objective data that was obtained so far. For intense EKG was obtained on the patient’s presentation, you don’t have to pretend like you don’t know that they have any gauge, you can say one was performed and now is a perfect time to bring it up and just show it to attending and give an interpretation on yourself. If a trust history had already been performed, it’s OK to Pull it up and make comment on it.
The final part of the presentation is your assessment and plan and disposition. The difference with diagnosis for certain she complaints rather straightforward and routine in the emergency department, and you should know what our common talking points are friends for every single person who comes with a chest pain, we want to hear something whether or not you think this patient may have a pulmonary or any or dissection, or or thorax, even if you don’t think it’s likely. We are always playing three problems at once. There is what you think the patient is most likely to have, and it’s OK to lead with that, and put her chips down, and say what you’re thinking. But he also always need to address. I think we cannot miss. Even if you think they’re very unlikely, or centrally ruled out by context, a quick comment saying such is prudent. The third thing We also care about is the unknown unknowns. And someone who just doesn’t look right, or seems to have some sort of monitor to high test probability for some sort of disease, which can finger on it, you should say something so that effect.