I’ve got this pain right here…

I started my cardiology rotation today, as an upper level of course! I have two interns on my team, one fellow above me, and an attending that changes each week. There is a second team identical to ours. The group of us are responsible for all of the cardiology patients in the hospital, including electrophysiology patients (pacemakers) and cardiothoracic surgery patients up until the day they go to surgery.

It was a long, tiring and boring day. Filled with tedium. One attending made the comment to me once that emergency medicine residents should do hardly any emergency medicine rotations during residency. Instead, they should rotate through all subspecialties learning to do things like treat people with chest pain, etc… There is certainly merit to what he is saying, which is exactly the reason we rotate through trauma, cardiology, intensive care, ob/gyn, pediatrics, etc… each program is different. But I had to snicker at his specific example he chose of learning how to work up chest pain on cardiology. Cardiologists don’t work up chest pain (forgive me all you cardiologists out there, Dr. Bob included) … they treat people with presumed cardiac disease, then stress ‘em, squirt their hearts with dye, pop open clogged vessels, put in stents to keep ‘em open, and sometimes refer them to surgery.

Emergency Medicine physicians work up chest pain. Is it heart? Reflux? Pericarditis? Pneumonia? Gall Bladder disease? Pulmonary Embolism (blood clot to lungs)? It’s part of our job to form a differential based on presentation, risk factors, aggrevating & relieving factors. Then order appropriate lab tests, decide who to keep for observation, who we can send home to get stressed next week, who to treat with antacids… Many times we get cardiology input, but rarely are they in the ED when a paitent rolls in from the ambulance, or presents in the waiting room with 10/10 crushing chest pain. We are the ones that treat their pain, dilate their coronary arteries, push fluids for right sided infarction, diurese for heart failure…all of this occurs before the cardiologists arrive.

Some physicians refer to us as no more than triage nurses. I am not offended by that. We are triage physicians. It’s our job to figure out what’s going on and get that patient to the most appropriate care as soon as possible. (usually that means going home to follow up with their family doc.) Besides that, we have lots more fun than those floor medicine residents!

Today, my first day on cardiology, was far more boring than seeing chest pain in the ED.

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