On-shift toolkit?

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nackbaxster

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Humor me EM docs of SDN:

  1. What essential on-shift items do you always keep on hand?
  2. Are there any items you wish you could access more easily while wearing scrubs?
  3. Do you have any creative solutions for carrying items that currently pose a challenge?
I'd REALLY appreciate any and all suggestions as I work on (what I think) is a super cool project that seeks to address problems we as docs/residents all have with modern scrubs in the demanding and pragmatic world that is the Emergency Department.

Nack, EM-PGY2
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nackbaxster said:
Humor me EM docs of SDN:

  1. What essential on-shift items do you always keep on hand?
  2. Are there any items you wish you could access more easily while wearing scrubs?
  3. Do you have any creative solutions for carrying items that currently pose a challenge?
I'd REALLY appreciate any and all suggestions as I work on (what I think) is a super cool project that seeks to address problems we as docs/residents all have with modern scrubs in the demanding and pragmatic world that is the Emergency Department.

Nack, EM-PGY2
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An automatic dispenser of work notes and turkey sandwiches.

If you could invent something that lets me sign EKGs with my eyes I would give you $10k.
 
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pocket 14 gauge pen needle just incase of emergency :D I've been holding mine for 6 years...but one day...it'll all be worth it.
 
I always keep an 11 blade scalpel on my person during shifts to ward off evil airways. Other than that, I always have a pen and stethoscope. Depending on number of pockets I have on any given day, I will also have trauma shears.
 
I’m down to my phone and a stethoscope.

Can I throw away my stethoscope?
 
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Penlight for sure. A jacket of some sort as the AC is usually set to meatlocker temperatures at my shop.
 
nackbaxster said:
Humor me EM docs of SDN:

  1. What essential on-shift items do you always keep on hand?
  2. Are there any items you wish you could access more easily while wearing scrubs?
  3. Do you have any creative solutions for carrying items that currently pose a challenge?
I'd REALLY appreciate any and all suggestions as I work on (what I think) is a super cool project that seeks to address problems we as docs/residents all have with modern scrubs in the demanding and pragmatic world that is the Emergency Department.

Nack, EM-PGY2
Click to expand...
Idk… I really only carry ID, steth, pen, highlighter, phone and keys - I have a jacket that stays at work and the keys and phones go in my jacket pocket and the pen and highlighter goes in my scrub pocket with id clipped to the pocket. I have a very lightweight steth and wear around my neck.

I expect the nurses to unwrap wounds or cut off clothes where necessary, and they generally do- I haven’t carried shears since I was a resident. And re: pharmacopoeia, I can’t order meds except at the computer anyway so I would just look them up online, also haven’t carried that since residency.

It’s actually one of the things I appreciate about EM. You could take one of us and drop us in a different department 1000 miles away with nothing and we could pretty much just plug-and-play.

My biggest complaint with (hospital provided) scrubs is that there is too much variance within any given size. If i get a top and a bottom of the size I wear there is a decent chance that the bottom will be waaaaay too big or small and I just can’t understand why they can’t do better with this.
 
The only thing I ever carry on me is my badge/steth/cell phone :)
 
Y'all carry way more stuff around with you than I do. I literally have my phone in my pocket and my id clipped to my pants. That's it.

Gloves I get in the room. Shears and steth stay in my backpack unless I think I have reason to bring them with me (maybe 1-2 patients per shift for each and that's largely only because you can't see wheezing on a cxr). Need for pen light obviated by phone flashlight. Scalpel and needle, I'm ok with not having on my person as both are easy to find quickly. Pocket pharmacopeia (or any other book for that matter) 1: I have a phone. 2: I'm not an internal medicine doc.
 
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I leave my phone on my desk. I carry my stethoscope most of the time. I have a tiny set alligator forceps that are nice for getting some objects out of ears and noses.

One of my colleagues would always ask where my stethoscope was when I’d walk around in the ED without it and I’d answer “I just get Chest X-rays”.
 
BoardingDoc said:
Y'all carry way more stuff around with you than I do. I literally have my phone in my pocket and my id clipped to my pants. That's it.

Gloves I get in the room. Shears and steth stay in my backpack unless I think I have reason to bring them with me (maybe 1-2 patients per shift for each and that's largely only because you can't see wheezing on a cxr). Need for pen light obviated by phone flashlight. Scalpel and needle, I'm ok with not having on my person as both are easy to find quickly. Pocket pharmacopeia (or any other book for that matter) 1: I have a phone. 2: I'm not an internal medicine doc.
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I need my steth bc I document heart/lungs on most pts. Very useful for bill, typically useless otherwise.
 
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emergentmd said:
I need my steth bc I document heart/lungs on most pts. Very useful for bill, typically useless otherwise.
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For bill? Like, for charting/billing? Not since Jan amigo. Prior to Jan 1st I just documented no resp distress and checked their pulse to document RRR on top of all the other unnecessary exam findings. Coding changes this year eliminated the need for all of that.
 
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emergentmd said:
The only thing I ever carry on me is my badge/steth/cell phone :)
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I've been using hospital stethoscopes for more than three years now.

My bag usually has some snacks, laptop if I'm working rural, and my keys/wallet are in there.

We don't really have any specialty equipment that we need to carry. Some hospitals have disposable endoscopes, but I'm not going to carry my own to the hospitals that don't stock them. Don't have an ultrasound? Then I won't use one. You get the idea.
 
BoardingDoc said:
For bill? Like, for charting/billing? Not since Jan amigo. Prior to Jan 1st I just documented no resp distress and checked their pulse to document RRR on top of all the other unnecessary exam findings. Coding changes this year eliminated the need for all of that.
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Yea, like 95% of patients have the same exam/normal. So no thinking clicking or canned PE. All about efficiency

Plus pts feel like I am doing a good exam.

Pts are not the brightest, if I don't touch them some start to complain.
 
TooMuchResearch said:
I've been using hospital stethoscopes for more than three years now.

My bag usually has some snacks, laptop if I'm working rural, and my keys/wallet are in there.

We don't really have any specialty equipment that we need to carry. Some hospitals have disposable endoscopes, but I'm not going to carry my own to the hospitals that don't stock them. Don't have an ultrasound? Then I won't use one. You get the idea.
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shared steth are kind of gross, uncomfortable, and risk not having one. I used to think a $150 littmann was needed to hear all of those special sounds we learned in med school. Remember those PE groups where we were looking for the faintest sounds.

I found a decent looking $20 Generic on amazon that more than does the trick.
 
I carry my phone and my AirPods. I bring my stethoscope into rooms when I feel like the chief complaint warrants it but otherwise leave it at the desk.

I'm mainly annoyed at why scrubs now have so many pockets.
 
emergentmd said:
Yea, like 95% of patients have the same exam/normal. So no thinking clicking or canned PE. All about efficiency

Plus pts feel like I am doing a good exam.

Pts are not the brightest, if I don't touch them some start to complain.
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I can't comment about EM, but in my IM subspecialty world, the physical exam is almost entirely performative for the benefit of the patient. I probably only bother with it in 50% of the people I see, and <5% of those is it necessary/informative/beneficial.
 
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emergentmd said:
Yea, like 95% of patients have the same exam/normal. So no thinking clicking or canned PE. All about efficiency

Plus pts feel like I am doing a good exam.

Pts are not the brightest, if I don't touch them some start to complain.
Click to expand...
“The doctor didn’t even listen to my heart!!”
 
You can tell that OP is a rezzie because he still thinks he needs to carry things around.
Welcome to the real world, amigo. Your eyes hurt because you've never used them before.
Don't go back to reddit. Take the red pill.
 
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gutonc said:
I can't comment about EM, but in my IM subspecialty world, the physical exam is almost entirely performative for the benefit of the patient. I probably only bother with it in 50% of the people I see, and <5% of those is it necessary/informative/beneficial.
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If I had a PA/NP who could do procedures, I could be a telemedicine ER doc easily and as effective.
 
What do I carry now?
(1) ID on a pull extension, so I can scan through the doors between our waiting-room-ER and our actual-ER a dozen times per shift. Also sometimes when patients ask for the third time who I am, I show them the badge and smile (MULTIPASS!)
(2) My phone, unless I left it at my desk playing on a Bluetooth speaker. At which point I will wish I brought it with me, mostly to confirm the address of the pharmacy a patient wants their meds eRx’d to.
(3) My stethoscope lives in my backpack, but at some point I pull it out, and from that point forward it may come with me to see patients, a prop and homage to a bygone era.
(4) An ink pen, which lives in my scrub pocket, with which I can sign EKGs. The signing of the EKG is an integral part of our religion.

What else do I keep in my backpack?
(1) Trauma shears (raptor)
(2) Coozy for monster energy drinks
(3) My little black notebook
(4) Tourniquet
(5) bougie (for good luck only)
(6) Bluetooth speaker
(7) Forms of caffeine (powdered energy drink; instant coffee)
(8) Some Tylenol
(9) Emergency hemeoccult, fluorescence, tetracaine.
(10) Good plug-in charger for iPhone and USB-C
(11) Too many ink pens


In pre-pandemic times, I tended to wear cargo pants on shift. I actually kept the pockets full of things that were convenient to have on me, or might be very useful at a floor code/airway. The things I actually used a lot which were nice to have—
(1) Gauze and tape
(2) An #11 blade (mostly for removing sutures… but theoretically for a cric)
(3) A skin marker
(4) a wound culture tube and Qtip thing

I also kept a pocket bougie, 14g long angio, and tourniquet rubber banded to some nasal narcan.

I will admit, being a walking wound cart was actually really helpful for seeing patients in WR, hallways, and unstocked spaces… didn’t have to go hunting the suture cart just to get a gauze and tape, or remove a couple stitches.

But I mostly wear scrubs now, and haven’t missed this stuff enough to get a fanny pack or something.
 
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Depends adult diaper. For those shifts you can't step away to handle essential, life-sustaining bodily functions.
 
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Apollyon said:
Dude, I gave you the link on a silver platter! No googling needed!
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I know. I clicked on your link and did "find on page" to search for the word "diaper." Lol

It took me to a link in the sources which I clicked on. So, I didn't actually google it, technically.

I just went back and it doesn't have the word "diaper" in the body of the article. Only "maximum absorbency garment." Lol

There's even a politically correct word for adult diaper now.

"MAXIMUM ABSORBACY GARMENT"

Sound worse, actually.
 
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-Ear buds to drown out the nursing gossip, random phones going off, gomer wails

- credit card for food

-invisibility cloak for hiding
 
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I carry my phone, and sometimes I even leave that at the desk. Trauma shears, stethoscopes both in the room, I stopped carrying those a month or two into my job out of residency. I also usually only listen if heart/lung oriented complaint, otherwise a radial pulse works nicely.
 
Tiger26 said:
Once had a lady complain that I didn’t listen to her heart… After I also did a CT angiogram of her chest, multiple troponins, and a stress echo
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Physical diagnosis and exam were invented thousands of years before CTs, MRIs, x-rays, labs and echo- and electrocardiograms. While physical exam still has value, its amazing the disconnect between how much value patients place on it, compared to clinicians.

You can explain all this to patients, but they still want a detailed physical exam. There's a strong emotional component to it.
 
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I wrote a personal reply to the patient via patient experience listing the accuracy of every test she had ranging from physical exam to stress test
 
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gutonc said:
Hence the performative aspect. I honestly only do a quick heart/lung exam on the ones I know will be drama llamas about it. Takes 30s and saves tons of aggravation.
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Yes, I listen to the heart and left and right lung on just about everyone because “that’s what the doc is supposed to do”. It’s not really about Press Gainey or anything like that, but when I start talking about dx and treatment plans, it’s “eff yeah, this guy knows what he’s doing”. Fair amount of critical care stuff, the stethoscope stays in the back pocket, especially if the patient is gorked.
 
Pen. Rechargeable pocket flashlight bc the wall-mounted scopes are always busted.

iPhone with EMRA MobilEM app (one subscription covers all of their apps - antibiotic guide, PressorDex, ortho guide, EKG guide, etc).

I do carry a paper copy of PressorDex, and peds/adult critical care reference cards from residency. Could probably leave these at my desk.

Stethoscope clipped to scrubs.

Don't carry shears any more, the RNs and techs always have them and mine just got dirty all the time.
 
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In scrub top pocket:
Pen
Penlight
Maxwell’s guide (mostly for visual acuity chart)
Laminated critical drug card

Raptors on belt

Stethoscope in hand when needed

On desk:
Phone
EMRA antibiotic guide
“Pocket EM” book for the weird stuff
Peripheral brain with notes, reference stuff I’ve collected
 
Birdstrike said:
Physical diagnosis and exam were invented thousands of years before CTs, MRIs, x-rays, labs and echo- and electrocardiograms. While physical exam still has value, its amazing the disconnect between how much value patients place on it, compared to clinicians.

You can explain all this to patients, but they still want a detailed physical exam. There's a strong emotional component to it.
Click to expand...
"But my primary care doctor diagnosed pneumonia by listening to my lungs."

Your primary care doctor wanted you to leave and was willing to trade you some antibiotics to get the deal signed.
 
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TooMuchResearch said:
It's a wonderful world.
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Did you hear the aortic stenosis and determine that was the cause of her syncope? I've found that precisely once in my career. And it turns out that someone else had already made the diagnosis (records unavailable to me) and the patient didn't know due to language issues and poor health / life literacy. C'est la vie.
 
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