As part of our relationship with the trauma surgery department, we spend four weeks during our 1st year and six weeks during our 2nd year as a member of the trauma team. As the “trauma junior,” we are actively involved in all level one and level two trauma resuscitations that present to the hospital, responsible for primary/secondary surveys and emergent procedures when indicated in the trauma bay. Vanderbilt is a busy trauma center, and most residents attend about 30-50 resuscitations during this month. We also work alongside surgical residents to see all trauma consults, develop plans, perform procedures, and attend trauma teaching conferences daily. We manage the trauma patients admitted to the ICU as well as the stepdown unit. This rotation is one of the highest-yield for procedures, including central lines (5-10), arterial lines (10-20), ultrasound-guided peripheral IVs (too many opportunities to count!), and chest tube placement (5-10).
Labor & Delivery
Though most residents will deliver a baby (or multiple) in the emergency department or ambulance bay during their training, we also rotate on the obstetrics service for three weeks as an intern to gain experience catching babies. We work closely with the OB/GYN residents and faculty, as well as the nurse midwives to run the labor and delivery unit. The entire department is welcoming and eager to teach us. Most residents will assist with about 10+ deliveries per week, far surpassing the required 10 deliveries to graduate. The time spent on the labor and delivery service prepares us well, and residents feel equipped to handle anything when active deliveries roll into our department. Additionally, this rotation helps foster great relationships (and friendships!) between the emergency department and the OBGYN residents.
“You, as emergency medicine physicians, need to become experts on managing the airway,” says Kevin High, the airway guru of VUMC. Interns spend three weeks with anesthesia faculty and certified registered nurse anesthetists practicing endotracheal and nasotracheal intubations, bag-valve masking, LMA placement, IV insertion and peripheral nerve blocks. This is strategically placed within the intern year to give 1st year residents practice and build their confidence with the technical skills intubation requires before proceeding with difficult airways in the emergency department. Most residents will log roughly 30-50 intubations over the course of three weeks. It’s also a vacation block, making it a resident favorite :)
The Veterans Affairs Hospital - Nashville is located on Vanderbilt’s campus directly next to Vanderbilt University Hospital. Throughout all three years, we rotate in the emergency department at the VA Hospital, but during our intern year we spend a month in the VA ICU. The VA ICU functions as both a Cardiovascular Intensive Care Unit and a Medical Intensive Care Unit, providing our residents with a chance to manage complex cardiac patients that you won’t find elsewhere in the hospital. Common presentations to the cardiac side of the ICU include STEMIs, NSTEMIs, unstable arrhythmias, pericardial effusions, patients who are s/p cardiac ablations, acute on chronic decompensated heart failure, and patients presenting for heart transplant workup. Residents learn management of Swann-Ganz catheters, observe cardioversions and perform many bedside echos. The cardiology teaching in the VA ICU is second to none. Our focus on training in resuscitations as emergency medicine physicians makes us leaders in the ICU when a patient decompensates, and often, senior level medicine residents will turn to us for guidance in these critical situations. We have right of first refusal for all procedures in the ICU as well; therefore there are plenty of opportunities to perform central lines, arterial lines, ultrasound guided IVs, paracentesis, and lumbar punctures.
As interns, we spend four weeks in the Intensive Care Unit at Vanderbilt University Medical Center caring for some of the sickest patients in the hospital with a wide range of diagnoses including multisystem organ failure, acute respiratory failure, acute decompensated liver failure, renal failure, sepsis, ingestions, GI bleeds, and end-of-life care. The day starts with a lecture led by one of the MICU fellows, followed by rounds with a senior resident, fellow and attending, pharmacists, and nurses. We are then responsible for placing consults, talking to consultants, managing patients, and performing all procedures. Similar to our rotation at the VA ICU, procedures abound. The critical care attendings at Vanderbilt are world leaders in management of respiratory failure (see Wesley Ely), and have pioneered some of the landmark developments in the field. Learning the basics (and beyond) of ventilator management in this environment is a priceless opportunity.
Orthopedic injuries are some of the most common complaints that present to the emergency department. To gain more experience, for a few weeks during our intern year we take “call” with the orthopedic surgery residents to see consults. Not only do we get hands-on experience with reductions, splinting, and casting, but we also create friendships with the orthopedic residents with whom we work closely almost every ED shift. Another valuable component of this rotation is attending the Sports Medicine Clinic with Dr. Fitch on Monday mornings. Dr. Fitch is emergency medicine trained, and subsequently completed a fellowship in Sports Medicine. He serves as the Head Vanderbilt Football Team Physician. In his clinic, we gain experience with joint injections and start to develop knowledge of the patterns of orthopedic injuries. He is an incredible educator, and through patient interactions, teaches us how to perform thorough and focused orthopedic physical exams.