Can we stop w necrobumping program review threads
Started by WhatJobDoIPick
YEPPPP.
Need more TEE thoughts.
Is there really a use for TEE in CPR? I mean... who's really taking time to sink a probe, little less have a probe immediately available, for cardiac arrest?
It's like the entire thing with trying to introduce REBOA to medical cardiac arrest protocols...
But ZOMG guys, it might... g u i i i i d e ... t r e a t m e n n n n t ....
EGDT didn't work out... but actually paying a minimum amount of attention to septic patients... does work.
I like using bedside ultrasound for my pulse checks. I’m not sure why I would want to do TEE vs a simple TTE when I’m just trying to see squeeze vs no squeeze.
TEE is supposed to take the place of TTE looking for effusion/tamponde and signs of PE with the added benefit of looking for dissection and perfecting hand placement.
Granted, I have a big enough issue just getting people to slow down to 100-120 BPM instead of 200+, so I'm not going to waste time going, "Can you move your hand to the left slightly... thanks!"
TEE in the ED: Role of Transesophageal Echocardiography in Cardiac Arrest
Cardiac arrest is one of the most demanding presentations for emergency physicians to manage. Focused transesophageal echocardiography (TEE) has emerged as a valuable aid.
www.emra.org
Dead people often stay dead.
In cardiopulmonary arrest, pulse checks and fiddling around with bedside POCUS TTE usually doesn’t contribute to ROSC. It just allows you to move on to the inevitable. A quick arterial line beats pulse checks. A LUCAS device beats TEE evaluation of human CPR.
ED TEE in cardiac arrest can add value, but is of limited value to the vast majority of EDs.
Our EM/CC faculty occasionally did in residency particularly in the setting of ED ECMO. I found beneficial and novel even if not widely applicable to my current or most practice settings. Not something I’ve seen in the community since residency. Academic centers should still keep pushing the boundaries of resuscitation though.
TEE should not be a consideration when picking a residency program.
You also shouldn’t be going on close to 20 EM interviews all at fairly popular programs/locations. It’s a poor awareness of the state of EM and your own competitiveness.
In cardiopulmonary arrest, pulse checks and fiddling around with bedside POCUS TTE usually doesn’t contribute to ROSC. It just allows you to move on to the inevitable. A quick arterial line beats pulse checks. A LUCAS device beats TEE evaluation of human CPR.
ED TEE in cardiac arrest can add value, but is of limited value to the vast majority of EDs.
Our EM/CC faculty occasionally did in residency particularly in the setting of ED ECMO. I found beneficial and novel even if not widely applicable to my current or most practice settings. Not something I’ve seen in the community since residency. Academic centers should still keep pushing the boundaries of resuscitation though.
TEE should not be a consideration when picking a residency program.
You also shouldn’t be going on close to 20 EM interviews all at fairly popular programs/locations. It’s a poor awareness of the state of EM and your own competitiveness.
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United 1K milage run?
We've had a few "kids" come in here like that these days. I've gotten PMs from them asking me questions like: "What do you MEAN you can't/have to [insert any facet of actual EM that their academic nonsense centers completely ignore]?!"
They have no clue. ZERO.
The review threads used to be a really useful part of this forum before it became emergency medicine's version of a VFW.
I had the same thought. But 20 reviews all back to back is spammy - and we reserve the right to say things like: "Kid; listen to us - those things that you think are shiny and cool.... stop that."
It’s interesting that it kinda died right around the time there was an explosion of residencies of dubious quality.
The thought of doing a TEE on a coding patient sounds like the dumbest idea I’ve ever heard.
Obviously ruling out tamponade is 1000x easier with a TTE. Sure.. maybe you diagnose a dissection one time out of a thousand.. in which case that guy is dead regardless
Just because you can doesn’t mean you should. Find other ways to get your names on papers.
I did TEE in residency during codes. It takes a few seconds to drop a probe and get an adequate view and I could subsequently just glance at the screen whenever I wanted during pulse checks and it was hands free. I don’t do it now as an attending in the community, just like I do not do my own transvaginal ultrasounds even though I was forced to in residency. But who cares, let them be excited to practice. And also who gives a **** what a cardiologist thinks about EM training lol
Is perpetually tying up an ultrasound machine and a TEE probe in the ED on the off chance you might identify a dissection during a code (which, let's be real, if they're dissecting and coding do you expect to have a meaningful outcome) worth it?
The only good thing about identifying a dissection on a code is that you can call the code and go see the guy who has been waiting in room 8 for his medication refill who immediately asks what took so long.
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I wait for this so I can look them straight in the eye and come back with
Yep, it’s inconvenient for me too when people die, probably worse for him and his family though.
Very few people can maintain indignation or even eye contact for this 🤣 then we can move on with that super STAT med refill of their 5mg Norvasc they ran out of 6 months ago
