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Ventil8

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Hi

I'm hoping to match into ANES in 3 weeks. I'm wondering what Anes CC lifestyle is like. Is the pay competitive? I assume you do all the trachs, but what about PEG?

Any info appreciated.

Ventil8
 

LaCirujana

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Hi

I'm hoping to match into ANES in 3 weeks. I'm wondering what Anes CC lifestyle is like. Is the pay competitive? I assume you do all the trachs, but what about PEG?

Any info appreciated.

Ventil8

Can't speak to the pay/lifestyle, but at our institution, surgeons (whether it be the primary team for the patient, surgical intensivist, or either Otolarygology or OMFS as a consultant) do ALL of the trachs. I've heard of the Brit anesthesiologists doing perc trachs, however some data suggest a bedside open procedure is equally if not more safe, and I've personally seen patients seriously mangled by pulmonary intensivists at one of my moonlighting gigs trying to do percs on inappropriate candidates. Never heard of an anesthesiologist doing a PEG; surgeons, gastroenterologists, and now interventional radiologists, do PEGs and PEG-Js here.

I'd be interested in hearing what the practice is at other big institutions.
 

Eidolon6

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The guys I know work in week blocks...pretty busy and then do OR time when not covering. They share SICU coverage with surgical critical care group and cover the neuro ICU.

As for procedures, our surgery service provides most trachs in the ICUs using a modified bedside percutaneous approach. They are generally prompt but are known for delaying trachs because "they are too busy" or perseverating about marginal and insignificant lab values.
Occasionally, we will consult ENT to place a tracheostomy in the OR if we deem the patient too high risk for our general surgeons' bedside approach.

Perc trachs are a skill that can be acquired with appropriate tutelage and proven safe in appropriate patients. The procedure is employed by intensivists of all types, with the appropriate training and careful attention to patient selection.

Echoing LaCirjuana sentiments about bad trachs...I have seen trachs placed by surgery, ENT and pulm/CCM go bad...Oft times because judgement was swayed by time constraints or inability to book OR time...which is inexcusable from my standpoint...but happens in the real world of busy, big hospitals.

Regardless of who performs this anal-sphincter tightening procedure...picking the appropriate procedure for the patient and his/her situation is of paramount importance.

As for PEGs, its shared by our surgeons and gastroenterologists with radiology available in certain situations.
 
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Eidolon6

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What do you mean by week blocks?
Any idea how many hours/week anes cc docs work? weekends too?
thanks

Week long blocks where the ICU is covered by that one person meaning that person will round every day on the ICU patients, usually for the whole week including one weekend. This may include night home call or a call rotation with other physicians.
 
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