Procedures interns should be comfortable with?

[PirateHotel]

I am at a European med school, planning on starting IM residency in the States next year.

At my school, students don't get much procedural experience beyond taking bloods, ABGs, the occasional intubation etc. From my US clinical experience I understand that some students have done paracentesis and other bedside procedures like putting lines in (which I have not).

This being my final year, I want a list of procedures that I should actively try and get experience in before starting internship. I'd rather not be the guy who hasn't done something all the AMGs have done 15 times already!

My question: which procedures should interns be comfortable with?

Thank you kindly for the advice

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[Frugal Traveler]

I've done these as a medical student:
ACLS (CPR, etc)
Intubation/airway management with various devices
Arthrocentesis
Placing lines (make sure you know how to properly suture so the line does not fall out!).
Lumbar puncture
ABG
NGT placement
I&D
Fluorescein eye testing
Cardioversion/ cardiac defib
Pap smear/ reading a secretion slide (fibronectin) - Pap smear is essential for primary care
Anoscopy (good for anal fissure detection and hemorrhoids.. simple to learn).
Microscopic UA (looking for RBCs, trich, etc)

I wish to do: Paracentesis, placing a chest tube or needle decompression, Code cool protocol
Code situations (more practice)...Hope to get better at code situations overall.

I personally think internists are poor at managing airway and overbagging... so I think airway management is the most important thing you can learn (follow an anesthesiologist for a week)


NEJM has videos of bread and butter procedures:
http://content.nejm.org/misc/videos.dtl

 

[ResidentMD]

I've done these as a medical student:
ACLS (CPR, etc)
Intubation/airway management with various devices
Arthrocentesis
Placing lines (make sure you know how to properly suture so the line does not fall out!).
Lumbar puncture
ABG
NGT placement
I&D
Fluorescein eye testing
Cardioversion/ cardiac defib
Pap smear/ reading a secretion slide (fibronectin) - Pap smear is essential for primary care
Anoscopy (good for anal fissure detection and hemorrhoids.. simple to learn).
Microscopic UA (looking for RBCs, trich, etc)

I wish to do: Paracentesis, placing a chest tube or needle decompression, Code cool protocol
Code situations (more practice)...Hope to get better at code situations overall.

I personally think internists are poor at managing airway and overbagging... so I think airway management is the most important thing you can learn (follow an anesthesiologist for a week)


NEJM has videos of bread and butter procedures:
http://content.nejm.org/misc/videos.dtl

Paracentesis is not that big a deal (unless the patient is really low on albumin or something and has massive ascites). I would say an ABG is more thrilling than a paracentesis. It was a big let down for me when i first did it. I agree on the intubation thing...following an anesthesiologist around sounds like a great idea.

 

[w a n g]

most interns i've worked with havent had much experience in things other than what you've mentioned OP..

 

[bunbury]

I went to a European school as well. The lack of experience in procedures was a big source of anxiety for many of us coming to the US for residency.

In the end it was a total non-issue. Most procedures are easy enough to learn with a little guidance and I had plenty of support from senior residents whenever I felt uncomfortable. I did not feel at a disadvantage when compared to my AMG colleagues.

In fact, I felt that the (almost excessive!) emphasis on history taking and clinical examination that I had during my medical education in the British system actually put me at an advantage when assessing patients on the Internal medicine wards.

 

[jdh71]

I personally think internists are poor at managing airway and overbagging... so I think airway management is the most important thing you can learn (follow an anesthesiologist for a week)

I don't know about "overbagging" . . . but the reality of our modern medical world is that the gas trolls (and then the guys in the ED) have the most experience with the airways and always will. As an intern outside of isolated situations, at a university hospital, I doubt you do many intubations - not enough to become "good" at them your first year. Even many pulmonary fellowships don't aggressively manage the airway first hand with the fellows - all depends on how busy you are - and policy of MOST hospitals is that if you want to use rapid induction agents the gas trolls have to be there anyway.

And then to confound things even further, emergency airways are done by ENT (maybe gen surg, maybe ER).

And I don't see the above changing too much with time (unfortunately). Bottom line, if you want to throw a bunch of tubes, apply to gas or ER, because most of what medicine does will not allow you much chance to get good at intubations (as an intern)

 

[ResidentMD]

I don't know about "overbagging" . . . but the reality of our modern medical world is that the gas trolls (and then the guys in the ED) have the most experience with the airways and always will. As an intern outside of isolated situations, at a university hospital, I doubt you do many intubations - not enough to become "good" at them your first year. Even many pulmonary fellowships don't aggressively manage the airway first hand with the fellows - all depends on how busy you are - and policy of MOST hospitals is that if you want to use rapid induction agents the gas trolls have to be there anyway.

And then to confound things even further, emergency airways are done by ENT (maybe gen surg, maybe ER).

And I don't see the above changing too much with time (unfortunately). Bottom line, if you want to throw a bunch of tubes, apply to gas or ER, because most of what medicine does will not allow you much chance to get good at intubations (as an intern)

There was a discussion on another thread touching a bit on this issue, but do programs allow you, either using elective time or your own free time for getting experience in procedures? I mean, is there a way to work with an anesthesiologist for a week or more during residency (if not in internship, then on an easy rotation during R2/R3) to get good at intubations?

 

[jdh71]

There was a discussion on another thread touching a bit on this issue, but do programs allow you, either using elective time or your own free time for getting experience in procedures? I mean, is there a way to work with an anesthesiologist for a week or more during residency (if not in internship, then on an easy rotation during R2/R3) to get good at intubations?

You can probably get a gas elective at most university programs if you want it, but probably not 1st year. But then, merely doing a month of intubations, is helpful, but probably still not enough to get "good" at them. You do your best.

 

[drfunktacular]

Considering that many decent-sized hospitals are implementing Rapid Response Teams with ACLS-trained nurses, anesthetists and anesthesiologists, I can't imagine that there are many situations in which internists should be trying to put down tubes anyway . . .

 

[Frugal Traveler]

Considering that many decent-sized hospitals are implementing Rapid Response Teams with ACLS-trained nurses, anesthetists and anesthesiologists, I can't imagine that there are many situations in which internists should be trying to put down tubes anyway . . .

This is true... but remember who owns the MICU... IM does and not anesthesia. I think we should be able to do elective intubation if the airway is not predicted to be difficult or anesthesia is unavailable for multiple reasons (fell asleep secondary to crossword puzzle-itis in the OR or a gas leak).

Usually university programs have procedure electives during which you can follow anesthesia around and intubate and do lines. Depending on the state you reside, many patients are not going to have a favorable Mallampati score and you can really mess up their grill with the blade if you are not careful... all these obese people tend to have sub-optimal thyromental distances in addition to all the other issues they have!

 

[docdaname]

I've done these as a medical student:
ACLS (CPR, etc)
Intubation/airway management with various devices
Arthrocentesis
Placing lines (make sure you know how to properly suture so the line does not fall out!).
Lumbar puncture
ABG
NGT placement
I&D
Fluorescein eye testing
Cardioversion/ cardiac defib
Pap smear/ reading a secretion slide (fibronectin) - Pap smear is essential for primary care
Anoscopy (good for anal fissure detection and hemorrhoids.. simple to learn).
Microscopic UA (looking for RBCs, trich, etc)

I wish to do: Paracentesis, placing a chest tube or needle decompression, Code cool protocol
Code situations (more practice)...Hope to get better at code situations overall.

I personally think internists are poor at managing airway and overbagging... so I think airway management is the most important thing you can learn (follow an anesthesiologist for a week)


NEJM has videos of bread and butter procedures:
http://content.nejm.org/misc/videos.dtl

first off....let me just say the above post makes me hate you. secondly, to the OP. you do not need to know how to do any of the above mentioned procedures, except for a pelvic/pap. but i consider that part of the physical exam.
yes, as a med student, **some** people get to do central lines/intubations, but a lot of people dont. as an intern (which i currently am), you will not be expected to know how to do any of these, nor will you even be ALLOWED to do any of the above procedures without supervision until you have done 5 of them. OP, relax, and enjoy your last year.
and to the above poster. i highly doubt you played any significant role in cardioversion. And for the record, no internist (or anyone other than an anesthia resident/attnd) will ever be intubating any patient on the floor, with the exception of in the ICU, and only under the direct supervision of the intesivist/anesthesiologist.

 

[PirateHotel]

Thanks for the helpful and reassuring replies.


@Frugal Traveler: That is an impressive list. I think from an intern's perspective regarding airway management the most important thing is bag-mask skill (while waiting for the rest of the code team to come)... I wouldn't expect to intubate much at all. Beyond PGY1, I agree one should be prepared to do what the patient needs in the MICU (within reason).

@WANG, bunbury and docdaname: very reassuring. I had a sense that it wasn't going to be a major issue, but with all the other stresses of starting somewhere new I'm looking for ways to prepare for the transition into residency.

 

[jdh71]

And for the record, no internist (or anyone other than an anesthia resident/attnd) will ever be intubating any patient on the floor, with the exception of in the ICU, and only under the direct supervision of the intesivist/anesthesiologist.

This isn't necessarily true.

 

[randomedstudent]

first off....let me just say the above post makes me hate you. secondly, to the OP. you do not need to know how to do any of the above mentioned procedures, except for a pelvic/pap. but i consider that part of the physical exam.
yes, as a med student, **some** people get to do central lines/intubations, but a lot of people dont. as an intern (which i currently am), you will not be expected to know how to do any of these, nor will you even be ALLOWED to do any of the above procedures without supervision until you have done 5 of them. OP, relax, and enjoy your last year.
and to the above poster. i highly doubt you played any significant role in cardioversion. And for the record, no internist (or anyone other than an anesthia resident/attnd) will ever be intubating any patient on the floor, with the exception of in the ICU, and only under the direct supervision of the intesivist/anesthesiologist.

I mostly agree with this, but did want to point out that guidelines about procedures are often program specific. At our program we are *supposed* to be observed while doing the first 3 of a given procedure, however, that is not absolute b/c times often arise when there is no more senior person in house and a procedure must done, so you either call in a fellow at 2 am or you just do it yourself, provided you've seen enough and feel comfortable enough to do so. And I assume the last line was in reference to a private hospital and not a university setting during residency. Because I can assure you that during residency at a university hospital or a VA which is affiliated with a university hospital patients will get intubated on the floor by internal medicine residents and interns. At least this is true for my program. Esp. at the VA where surgery residents are not in house overnight, the only physicians in house are the IM residents/interns and the ONE ER physician who is usually not EM trained (although they are required to be certified in intubation), so if someone crashes at night guess who intubates...

 

[NDESTRUKT]

As an intern, I was at the VA and a patient coded whilst I was on call. My resident was asleep and anesthesia didn't come for five minutes and we kept bagging. Being my second month as an intern and overly nervous, I went ahead and intubated the guy anyways. It wasn't that difficult and I only had one month of anesthesia rotation from my MS-3 year. If I were to relive it again, I would have just waited for gas to come by and do it.

 

[docdaname]

I mostly agree with this, but did want to point out that guidelines about procedures are often program specific. At our program we are *supposed* to be observed while doing the first 3 of a given procedure, however, that is not absolute b/c times often arise when there is no more senior person in house and a procedure must done, so you either call in a fellow at 2 am or you just do it yourself, provided you've seen enough and feel comfortable enough to do so. And I assume the last line was in reference to a private hospital and not a university setting during residency. Because I can assure you that during residency at a university hospital or a VA which is affiliated with a university hospital patients will get intubated on the floor by internal medicine residents and interns. At least this is true for my program. Esp. at the VA where surgery residents are not in house overnight, the only physicians in house are the IM residents/interns and the ONE ER physician who is usually not EM trained (although they are required to be certified in intubation), so if someone crashes at night guess who intubates...

I went to medical school at a large, academic institution and rotated through a VA. I am now an intern (but going into anesthesia) at a large, academic institution, where I have rotated through a VA. I have never met a single medicine intern or resident who has intubated a patient, outside and anesthesia or ICU rotation. Im sorry, but it just doesnt happen. It would be in only THE MOST extreme circumstance. You can always bag. And im sure the RT would intubate before an intern would. I can only imagine what would happen after try to explain how you threw it in the esophagus and didnt realize it to your attending on rounds the next morning.

 

[ResidentMD]

I went to medical school at a large, academic institution and rotated through a VA. I am now an intern (but going into anesthesia) at a large, academic institution, where I have rotated through a VA. I have never met a single medicine intern or resident who has intubated a patient, outside and anesthesia or ICU rotation. Im sorry, but it just doesnt happen. It would be in only THE MOST extreme circumstance. You can always bag. And im sure the RT would intubate before an intern would. I can only imagine what would happen after try to explain how you threw it in the esophagus and didnt realize it to your attending on rounds the next morning.

I think there are quite a few ways to find out that its not in the esophagus, arent there?

 

[jdh71]

I went to medical school at a large, academic institution and rotated through a VA. I am now an intern (but going into anesthesia) at a large, academic institution, where I have rotated through a VA. I have never met a single medicine intern or resident who has intubated a patient, outside and anesthesia or ICU rotation. Im sorry, but it just doesnt happen. It would be in only THE MOST extreme circumstance. You can always bag. And im sure the RT would intubate before an intern would. I can only imagine what would happen after try to explain how you threw it in the esophagus and didnt realize it to your attending on rounds the next morning.

oh

you are a gas troll, this explains your attitude

I went to med school at a large university medical school and I'm in residency at one - if a patient needs a tube, you give it to them, including on the floor. I intubated two patient's last year, on the floor.

 

[jdh71]

I think there are quite a few ways to find out that its not in the esophagus, arent there?

generally yes

 

[Tigerz_Fan]

This may be off topic from the OP's original question, but intubating is an important skill to at least have tried. Never, ever just wait for gas people to show up. Never just assume someone will be running to the code behind you that will save the day. There may be a day when you are working, moonlighting, whatever, in a small community hospital and there will be no one else but you to do the job.

Furthermore, when I was in residency, there was a code on the floors and the senior resident decided just to bag and wait for the gas peeps. The reason was that he had never intubated someone before. He was eventually pulled into a meeting with our PD, the GME dean, and the hospital CMO. Their reasoning? If you are ACLS certified, then you were trained on intubations and therefore are expected to attempt an airway.

Docdaname, it is simply not true that no internist will ever intubate a patient on the floors. I know many that do in every code they attend.

JDH, by airway emergencies, I assume you mean a patient that needs an urgent surgical airway. In the ER that is done by ER, trauma, GS, and ENT (if present in the room). In the ICU, it can be done by CCM, GS, or ENT.

Drfunktacular, our RRTs do not intubate our patients, it may be different in your hospital. It would be a nice idea to have them trained as well.

To the OP, I have had several interns that never even placed a line or tried an ABG. And they have managed residency just fine.

 

[randomedstudent]

I went to medical school at a large, academic institution and rotated through a VA. I am now an intern (but going into anesthesia) at a large, academic institution, where I have rotated through a VA. I have never met a single medicine intern or resident who has intubated a patient, outside and anesthesia or ICU rotation. Im sorry, but it just doesnt happen. It would be in only THE MOST extreme circumstance. You can always bag. And im sure the RT would intubate before an intern would. I can only imagine what would happen after try to explain how you threw it in the esophagus and didnt realize it to your attending on rounds the next morning.

Hmmmm...your VA is very different from mine. Anesthesia is never seen outside the OR and they leave by 4pm on weekdays, are no where to be found on weekends. RT's do not intubate at our VA or at our university hospital, they are not allowed to. At night at our VA surgery residents are not required to be in house (I think this is BS personally, but I don't make the rules), so the only physicians guaranteed to be in the hospital after say 7 pm is the 1 or 2 ER docs (and like I said before the majority are not EM trained) and the 5 IM residents/interns (2 MICU, 1 for cards and 2 for wards). In a code, the ER doc is not required to respond, we have to call down if we need them to try to intubate and they come when they can (once it took 15 minutes for the doc to come). So that is how it comes about that medicine interns and residents intubate patients.

 

[Tigerz_Fan]

I went to medical school at a large, academic institution and rotated through a VA. I am now an intern (but going into anesthesia) at a large, academic institution, where I have rotated through a VA. I have never met a single medicine intern or resident who has intubated a patient, outside and anesthesia or ICU rotation. Im sorry, but it just doesnt happen. It would be in only THE MOST extreme circumstance. You can always bag. And im sure the RT would intubate before an intern would. I can only imagine what would happen after try to explain how you threw it in the esophagus and didnt realize it to your attending on rounds the next morning.

I'm sure the person would realize before morning rounds. The first clue might be gastric juices spurting into the resident's face when he tried to bag the stomach with a tube placed. And then the CO2 detector wouldn't change color. Then I imagine the patient's O2 sats would start to fall. And if that didn't get his attention, then hopefully the resident would get the picture when the patient started coding.

Sorry, but we medicine folks are not that dumb.

 

[Tigerz_Fan]

I and policy of MOST hospitals is that if you want to use rapid induction agents the gas trolls have to be there anyway.

Really? I've rotated through 4 different hospitals now, and I have never seen a policy that requires gas to be present for RSI. An attending present (like CCM, ED, gas) yes, but not strictly gas.

 

[jdh71]

Furthermore, when I was in residency, there was a code on the floors and the senior resident decided just to bag and wait for the gas peeps. The reason was that he had never intubated someone before. He was eventually pulled into a meeting with our PD, the GME dean, and the hospital CMO. Their reasoning? If you are ACLS certified, then you were trained on intubations and therefore are expected to attempt an airway.

Interestingly enough the newest ACLS essentially recommends deferring permanent airway during a code until after stabilization if O2 sats are fine with bag-mask.

JDH, by airway emergencies, I assume you mean a patient that needs an urgent surgical airway. In the ER that is done by ER, trauma, GS, and ENT (if present in the room). In the ICU, it can be done by CCM, GS, or ENT.

I know ER, surg, and ENT do them, silly. I've never seen nor heard of a CCM person doing one. Your program train you in surgical airway?

Really? I've rotated through 4 different hospitals now, and I have never seen a policy that requires gas to be present for RSI. An attending present (like CCM, ED, gas) yes, but not strictly gas.

That's been what I've been told. We don't even have succ's in the code carts. The gas trolls have them in their tackle boxes. Plus, many nurses won't push the drugs you want on the floor (MD's have to) and since I don't have the luxury of walking around with vials of succ's or vec and etomidate or propofol in my pocket . . . rapid induction on the floor requires the presence of the gas trolls

 

[Tigerz_Fan]

Interestingly enough the newest ACLS essentially recommends deferring permanent airway during a code until after stabilization if O2 sats are fine with bag-mask.

I know ER, surg, and ENT do them, silly.

I've never seen nor heard of a CCM person doing one. Your program train you in surgical airway?

That's been what I've been told. We don't even have succ's in the code carts. The gas trolls have them in their tackle boxes. Plus, many nurses won't push the drugs you want on the floor (MD's have to) and since I don't have the luxury of walking around with vials of succ's or vec and etomidate or propofol in my pocket . . . rapid induction on the floor requires the presence of the gas trolls

I was referring to situations where there may not be any backup to perform the intubation for you. I have friends who moonlight, and especially if you moonlight in the ER, you are the one to tube the patient. BVM may be fine for a time, but chances are that the patient who just coded will need a definitive airway at some point. And the go-to person will be you.

No need for RSI kits in the crash carts because a pulseless patient is already relaxed for you. We keep tackle boxes of our own for the unit. I do remember the ER having them as well. I have gone out to the floors to perform RSI on a patient prior to moving them to the unit. In my hospital the airways are ours. The gas peeps stay in the OR.

And yes, my program trains us in emergent surgical airways. Our faculty consists of not only IM/pulm/CCM but GS/trauma/CCM as well.

 

[jdh71]

I was referring to situations where there may not be any backup to perform the intubation for you. I have friends who moonlight, and especially if you moonlight in the ER, you are the one to tube the patient. BVM may be fine for a time, but chances are that the patient who just coded will need a definitive airway at some point. And the go-to person will be you.

No need for RSI kits in the crash carts because a pulseless patient is already relaxed for you. We keep tackle boxes of our own for the unit. I do remember the ER having them as well. I have gone out to the floors to perform RSI on a patient prior to moving them to the unit. In my hospital the airways are ours. The gas peeps stay in the OR.

And yes, my program trains us in emergent surgical airways. Our faculty consists of not only IM/pulm/CCM but GS/trauma/CCM as well.

I'd like to know which program that is, please send me a PM. I'm applying this year.

EDIT: And I can appreciate that the Pulm/CC fellow has her own tackle box for these situation, but medicine interns on the floor do not.

 

[drfunktacular]

This may be off topic from the OP's original question, but intubating is an important skill to at least have tried. Never, ever just wait for gas people to show up. Never just assume someone will be running to the code behind you that will save the day. There may be a day when you are working, moonlighting, whatever, in a small community hospital and there will be no one else but you to do the job.

Furthermore, when I was in residency, there was a code on the floors and the senior resident decided just to bag and wait for the gas peeps. The reason was that he had never intubated someone before. He was eventually pulled into a meeting with our PD, the GME dean, and the hospital CMO. Their reasoning? If you are ACLS certified, then you were trained on intubations and therefore are expected to attempt an airway.

Docdaname, it is simply not true that no internist will ever intubate a patient on the floors. I know many that do in every code they attend.

JDH, by airway emergencies, I assume you mean a patient that needs an urgent surgical airway. In the ER that is done by ER, trauma, GS, and ENT (if present in the room). In the ICU, it can be done by CCM, GS, or ENT.

Drfunktacular, our RRTs do not intubate our patients, it may be different in your hospital. It would be a nice idea to have them trained as well.

To the OP, I have had several interns that never even placed a line or tried an ABG. And they have managed residency just fine.

ACLS does not teach intubation nor imply that you were trained in it...?

 

[docdaname]

ACLS does not teach intubation nor imply that you were trained in it...?

ACLS does not teach intubation. In fact, it teaches minimalizing interruptions in chest compressions. In other words, intubation needs to be done quickly. Im doubtful any intern or resident could quickly get a tube in during a code. I agree that in a coding patient you dont need drugs to intubate. But I just dont believe an R2 got a talking to by the PD for not intubating. Its just not a skill thats taught. Im calling shenanegans on any intern or R2 that claims to have intubated a patient on the floor.

 

[jdh71]

Im calling shenanegans on any intern or R2 that claims to have intubated a patient on the floor.

Oh? You are calling me a liar then? Just so we are clear . . .

 

[adam6]

ACLS does not teach intubation. In fact, it teaches minimalizing interruptions in chest compressions. In other words, intubation needs to be done quickly. Im doubtful any intern or resident could quickly get a tube in during a code. I agree that in a coding patient you dont need drugs to intubate. But I just dont believe an R2 got a talking to by the PD for not intubating. Its just not a skill thats taught. Im calling shenanegans on any intern or R2 that claims to have intubated a patient on the floor.

Each time I've taken ACLS, we've gone over intubations. My residency program also set up procedure days so that you could practice intubations in the Sim Lab. Additionally, I have been to a number of codes (especially as a med student at resource-poor hospitals) where the R2 or R3 intubated the patient. And as a resident, our ICU was PCM-run and our attendings encouraged us to intubate. I don't think you can extrapolate from your personal experience to say that IM residents do not ever intubate.

 

[Tigerz_Fan]

Each time I've taken ACLS, we've gone over intubations.

Same here. Each time we have also reviewed combitubes (which no one uses) and LMAs.

And docdaname, I am very sorry to disappoint you, but IM residents do intubate. Your own personal experience cannot speak for the entire IM population. I intubated as a resident, and have since that time.

 

[gutonc]

My question: which procedures should interns be comfortable with?

Grabbing your ankles every time the ER pages you!

 

[docdaname]

Same here. Each time we have also reviewed combitubes (which no one uses) and LMAs.

And docdaname, I am very sorry to disappoint you, but IM residents do intubate. Your own personal experience cannot speak for the entire IM population. I intubated as a resident, and have since that time.

so when you were an R1 or R2 you intubated a patient without any supervision? I am impressed.

 

[PirateHotel]

I think this thread proves that there is marked variability in the experience IM residents have depending on their hospital / attending situation.

-It'll give me something to talk to the residents about.


Gutonc:

 

[ResidentMD]

so when you were an R1 or R2 you intubated a patient without any supervision? I am impressed.

Whats the point of your question? There are people here that have intubated during their residency, and there are people that havent. Lets move on to better discussions rather than nitpicking.

 

[Tigerz_Fan]

so when you were an R1 or R2 you intubated a patient without any supervision? I am impressed.

Yes. In each situation, the patient needed an airway, end of story. You guys talk about bagging forever, but can also end in badness. But that is a discussion for another day.

ResidentMD, totally agree. Let's move on.

 

[Ariee]

docdaname
so when you were an R1 or R2 you intubated a patient without any supervision? I am impressed.

My IM R2 intubated a coding patient in the ICU by himself. This was at a university affiliated community hospital. Gas showed up half-way through and they stood aside while R2 put in the airway. Intubation is not too difficult of a task, once you've done several in a controlled OR. Although, I'm sure the edematous larynx after several failed intubations is a different story...

I don't get what is so impressive about intubating...isn't that why gas gets a lot of crap about being glorified nurses, big money for not very impressive procedures...

 

[PirateHotel]

Either way, it sounds like it pays to be comfortable with intubating in an emergent situation... some places (read; ivory towers) a resident would most likely not intubate b/c there are 30 people that show up to codes..other places it might be a necessity.

Do most programs have elective rotations in procedures?
What sort of procedures would one be exposed to?
-For example, would it be only bedside stuff, or could you also spend a week in the cath lab?

 

[drfunktacular]

Either way, it sounds like it pays to be comfortable with intubating in an emergent situation... some places (read; ivory towers) a resident would most likely not intubate b/c there are 30 people that show up to codes..other places it might be a necessity.

Do most programs have elective rotations in procedures?
What sort of procedures would one be exposed to?
-For example, would it be only bedside stuff, or could you also spend a week in the cath lab?

Are there R2's out there cath-ing their patients with ACS now instead of waiting for Cards??

 

[PirateHotel]

Only if you have X-Ray vision

 

[jdh71]

Are there R2's out there cath-ing their patients with ACS now instead of waiting for Cards??

I did like a 100 last year!

 

[Tigerz_Fan]

Are there R2's out there cath-ing their patients with ACS now instead of waiting for Cards??

Not in my hospital, but we do right heart caths to eval pulm hypertension

And Xray vision would totally be awesome!