The Apps I Use Every Shift as an Emergency Medicine Physician Assistant

It is impossible to know everything in medicine. Recognizing this simple fact will make a stronger provider. A great provider will be able to recognize that they don't know (or need a refresher) with certain medications, treatments, or even with keeping up with the most up to date recommendations for a particular disease and seek this information. Being savvy and knowing where to look for this information is not only critical in day-to-day function but will make a shift substantially easier. Pulling information from reliable sources will also allow you to sleep easier at night knowing you are practicing the most evidence based, up-to-date care for your patients.

One way I make myself the most efficient at work is utilizing apps on my cell phone. The following apps I recommend to any provider, but especially to those of us working in Emergency Medicine and Urgent care. Not only do I use these apps every day at work, but I also found them useful as a PA student on rotations, too.

I hope sharing these apps that I rely on every shift will help you in your clinical practice, too. Using these apps aid in my medical decision making and give me the confidence I need during cases where I am feeling unsure. I also use them as an everyday learning tool to be up to date on current treatments and recommendations!

Up To Date

This app is a no-brainer. By far the #1 app I use on a daily basis. Questions on medication dosing? UTD. Patient comes in with a rare autoimmune disease you've never heard of? UTD. Want to look up the most current recommendations for treating community acquired pneumonia? UTD. The list can go on, and on, but I'm sure you get the point.

Another great feature Up To Date has other than just looking up information is utilizing their calculators. I do not mean a math calculator, but medical calculators to help support your clinical decision making. Examples are Parkland formula, Endotracheal tube sizing calculators, and NIH Stroke Scale. However, one of my absolute FAVORITE features is UTD's Drug Interaction checker. I come here to look for interactions when I prescribe new medications to patients (especially when their medication list is a mile long).

UTD is something you have to pay for the subscription unless your school, employer, or institution pays for you. Through my hospital, I have access to a free subscription, and all I needed to do to access it was sign up for an account through my institution. If you have allocated CME money, a great way to spend it is through this app. With every search you earn CME. If you use it as often as I do, CME can accumulate quickly! It is worth every penny!

Epocrates

This is an app I relied on heavily in PA school, and continued to use it as I started practicing as a PA. As a student I used the free version of this app. Now, I pay for the yearly subscription and use CME money to cover it. Not only is there CME offered on Epocrates through their easy to access, quick to read articles they offer, but there's many other features that make this app beneficial as well. Honestly, I don't even use this app to it's full potential but still find it extremely useful. Mostly I use this app to look up appropriate doses and durations for medications.

There is also an option where you can search the disease itself (for example, cellulitis) and the recommended antibiotics will populate. You can search medications by bodily system, run drug interaction checks, and look at pathogen susceptibility patterns for commonly used antibiotics in the area where your patient lives (pretty cool!!). They even have information on herbs/supplements. There is so much more this app has to offer and is a great tool for ANY clinician no matter what specialty.

MD Calc

For the longest time I was logging onto the MD Calc website via desktop. The desktop version is very easy to use. When I found out that there was an app it became even easier! The reason for this is because I can favorite my most utilized strategy tools and they populate in my very own favorites tab. MD calc collects important stratification tools, medical decision-making tools and formulas needed in medicine in essentially any specialty.

The goal of these tools is to never truly tell you what to do, but to assist you in your medical decision making. Anytime I utilize a tool like this, I document it in my charting to help show my reasoning for doing or not doing something. Some of the tools currently in my favorites are: PERC/Wells score for PE, NIHSS, HEART score, Wells score for DVT, tPA contraindications, and sodium correction for hyperglycemia.

PediSTAT

I first learned about this app as a PA student in the ED. It was recommended to me essentially by almost every EM doctor I've worked with. The reason for the appeal is because this app helps you easily calculate the appropriate dose for your pediatric patient. It allows you to calculate dose based on weight, age, height or pediatric Broselow tape.

The most accurate way to calculate a pediatric dose is by weight. If you choose this option, it will prompt you to enter the child's weight immediately. Then, the app takes you to a new page where it breaks down medications by category (seizure, sedation, respiratory, etc). You can tap freely between the categories until you find the medications you are looking for. The weight you put in will be remembered as you navigate through the app. This saves a lot of time calculating the dose by hand, saves you time looking up the appropriate recommended weight-based dose (mg/kg) and gives clinician the reassurance needed that they are ordering the right dose (especially in critical situations where time is of the essence). The best part about this app? It is free!

USPSTF

I can definitely say I utilized this app a lot more as a PA student, however, I do find myself occasionally using this app in the ED. Mostly I use this app to answer patient questions in addition to keeping myself the most up to date on the screening guidelines. As we all know, some patients use the ED as their primary care office, and even though I don't agree with this, educating them on preventative measures and overall lifestyle modifications is still important.

The purpose of this app to enter a specific patient's demographics and view the most up to date USPSTF guidelines pertaining to them. You can search all guidelines separately without entering any patient information and can also search guidelines based on category. Common guidelines include breast cancer screenings, colon cancer screenings, and even lung cancer screenings.

CDC Vaccine Schedule

This app is a great tool for primary care clinicians, but also ED clinicians. This is helpful when I am seeing a child. This app has CDC recommended vaccine schedules for adults and children. It takes all thinking out of what vaccines are required and when. In the ED, it is helpful when I am questioning when a child may need a DTap vs. TDap shot. It also helps me understand what vaccines a child has received already for their age. Vaccines a child has received will be different for a 4-month-old than when I'm seeing a 2-year-old. This will matter when I see a young, sick child and need to keep certain disease usually prevented by vaccines on my radar.

In addition to the regular vaccine schedules, there are also recommended catch-up vaccine schedules as well. Super helpful for my colleagues who work in family medicine, outpatient internal medicine, pediatrics, or even my friends who work in an urgent care with some family medicine capabilities!

OB Wheels

Since we see all types of patients in the ED, this tool helps me when I am seeing a pregnant patient who is unsure how far along their pregnancy is. I can simply enter the date of their LMP, and get a general idea. This will help me with establishing appropriate differentials and be helpful in interpreting information depending on what studies I order. For example, comparing LMP estimated gestational age with the patient's US and HCG levels.

This is the app I used since I was a student, however, any OB Wheel app that you like will probably work just fine!

Ruler

This last app may seem silly, but I cannot tell you how bad I am at estimating laceration sizes accurately without a ruler! Usually, I keep a small tape measure in my pocket, but there are many times where I am in a patient room without it, or even forget it at home. It sounds silly, but having a ruler app on my phone ensures I am always able to use the ruler when needed. Because in all seriousness, when are we ever without our cell phones? This app is a personal preference and may not be for everyone! Again, this is the app I randomly downloaded, but I am sure any app that has measurements in centimeters will work!

I hope you all find these apps helpful in your clinical practice! If you don't use these apps currently, what apps do you find the most helpful? Share in the comments below! 😍

xo,

Manny