Jacobi’s Emergency Department is the main Trauma center for much of the North Bronx as well as some areas of Westchester. While it is a public HHC hospital, most consulting services are available and you will see a wide variety of both medically and surgically acute patients. Jacobi also has a specialized burn center as well as a hyperbaric chamber that receive patients from all over New York and surrounding areas.
Jacobi Medical Center
1400 Pelham Parkway South
Bronx, NY 10461
Medical Student Director
Dr. Joshua Silverberg
Elizabeth is essential in helping students with IDs, computer access passwords and many other logistical issues. Her office is at Jacobi and her email is Elizabeth.email@example.com
Layout of the ER
East/Medical Side: This is composed of the pink and blue zones and will be staffed by one attending. Patients with medically managed problems such as chest pain and stroke symptoms will be triaged here, although this is not a hard and fast rule. In addition, the staff on the medical side will take care of “medical notes” which include emergencies such as cardiac arrests, septic patients, and severe CHF, status asthmaticus, status epilepticus, and other time critical patients. The blue zone of the medical side also has an asthma room where the respiratory therapist will initiate the care of most Asthma Exacerbation.
West/Surgical Side: This area is composed of the green and yellow zones and is staffed by another attending. Patients with surgically managed problems such as abdominal pain, GYN complaints, lacerations, and fractures and dislocations will be managed here. The “surgical notes” will include unstable trauma patients and sometimes OB patients that are very close to delivering. The yellow zone of the surgical side also has 3 GYN rooms for anybody with GYN related complaints, including all pregnant patients <20 weeks.
Urgent Care/Fast Track: Although you will rarely see this side of the ER, this area manages patients with simple complaints and quick dispositions such as trips and falls, ankle sprains, back pain, and minor motor vehicle accidents. Your patients who need to follow up for wound checks or suture removal will also come back to Urgent Care. Fast track is open 8am to 9pm on weekdays, 11am to 7pm on weekends.
Important People to Know
Attending: There will be one attending for each side of the ER, medical or surgical, and you will be presenting your patients to them. They are responsible for your student evaluations, so try to keep track of who is on and how long they are on for (they will often switch after 4 or 8 hours). The attending is ultimately responsible for all the patients on their side of the ER and will make the final decisions on their care.
Pre-attending: This is the PGY4 who is on duty. There is only one pre-attending for any 12-hour shift and they will be either on the medical or surgical side (this alternates by the day of the week). The pre-attending will act as the attending and make decisions regarding treatment and disposition of patients. The pre-attending will also run all medical and surgical notes. While all junior residents will present their patients to the pre-attending, you will most likely be presenting your patients to the attending. However, you can always ask the pre-attending for advice on what to do with a certain patient.
Chief: This is the PGY3 on duty. There is one chief for the medical side and one chief for the surgical side. When a patient first presents to the ER, the chief will be the first to see the patient, enter specific orders for labs or medications, and triage the patient to be assigned to a certain junior resident. The chief will be the one assigning you your patients. They will often touch base with you to see what progress has been made and whether your patients have been admitted or discharged.
Junior Residents: These are the PGY1s or PGY2s on duty. On any given shift, there may be 2-4 junior residents on duty, as well as surgery or medicine rotators. The junior residents are your best resources for information about where to find certain equipment and how to get things done.
Medical and Surgical Notes
When you are in the ER, even if you are in a room with a patient, always be attentive to “Medical Note” or “Surgical Note” announced overhead by the clerk. Please excuse yourself from the patient’s room if this is announced and come to the Trauma Bay. As a medical student, you may not be primarily assigned to the unstable patient. However, here are some things you can do to stay involved.
– Perform chest compressions in cardiac arrests.
– Cut the clothes off the trauma patient.
– Bring in the ultrasound machine (for trauma FAST’s)
– Put cardiac monitoring leads, blood pressure cuffs, etc on patients.
– Start peripheral IV’s.
– Grab extra supplies that may be needed by the residents (extra gauze, gowns, IV’s, etc)
Feel free to go over the resuscitation with the attending or resident when time permits.
“Getting a Patient”
You will be assigned a patient by the PGY3 chief who will give you the name, MRN, and the location of the patient. They may also tell you some brief information about the patient. Do not hesitate to walk by the room to “eyeball” the patient first. While you will most likely be given stable patients, this is a good habit to get into so that you do not ignore a patient who is sick or in pain. Afterwards, you should briefly look up the patient’s triage vitals, triage information, and any other medical history and information on the computer. While it is good to be thorough, do not spend too much time getting bogged down with medical history that may not be relevant to the patient’s chief complaint.
Obtain a good history and physical from the patient.
Style points- Introduce yourself, never examine a patient in street clothes.
Kathy L. Chuang, MD 2011 (modified by @em_stevemcguire)