During my emergency medicine rotation at Metropolitan Hospital from August 26 to September 27, 2024, I participated in a comprehensive site visit evaluation conducted by PA Sajid Mohamed. The evaluation consisted of two key meetings: a midpoint review and a final assessment, each lasting about an hour and a half. These sessions included three other classmates, and we were required to present two complete History and Physical (H&P) reports, a pharmacological drug card discussion, a patient management discussion, and a journal article.
PA Mohamed provided detailed and constructive feedback aimed at enhancing our clinical skills, particularly in areas of patient assessment, medical management, and pharmacological knowledge. In my case presentation, I discussed a patient who presented with weakness, fatigue, and vomiting over four days, experiencing multiple episodes of yellow emesis, nausea, abdominal discomfort, and bloating. This patient was diagnosed with acute liver failure. One of my classmates presented a case of appendicitis, leading to an in-depth discussion about its acute management, appropriate antibiotics, admission criteria, and indications for ordering a CT scan.
As part of the evaluation, I also discussed the mechanisms of action, indications, and clinical applications of ten medications, including Indomethacin, Labetalol, Clindamycin, Empagliflozin, Spironolactone, Misoprostol, Apixaban, Diazepam, Rosuvastatin, and Entresto. For instance, I highlighted Misoprostol’s various applications, such as its role in second-trimester pregnancy termination (alone or with methotrexate), expectant management of missed and incomplete abortions, cervical ripening and induction of labor, treatment of postpartum hemorrhage, and the prevention and treatment of NSAID-induced gastric ulcers in high-risk patients.
Additionally, I presented a journal article on barosinusitis, emphasizing its prevalence among airline pilots, flight attendants, and scuba divers, with an incidence rate as high as 40% among divers. The article covered the common symptoms such as nasal congestion, facial pain, headaches, and in severe cases, epistaxis. Management strategies included nasal decongestants, saline irrigation, steroid therapy, and pain management for mild cases. Functional endoscopic sinus surgery was recommended for refractory cases. We also discussed preventive measures, such as the use of decongestants before activities involving pressure changes, avoiding such activities during upper respiratory infections, and employing equalization techniques to manage pressure differences.
Overall, the site visit evaluation was an invaluable learning experience that provided me with constructive feedback and enhanced my clinical knowledge, presentation skills, and understanding of patient management.
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