Did you catch ER episode last night?

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911_turbo

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So in the beginning of the episode a trauma comes in and one of the nurses drops a bunch of her cards. One of the residents sees them and says whats this intraoperative hypotension. She explains that she is studying to be a nurse anesthetist and has a test the next day. Then the ER resident says so you want to be pushing drugs under an anesthesiologist and her reply is she doesn't have to work under an anesthesiologist. Then ER attending says after one year you'll be all on your own. Then strangely the rest of the ER attendings and residents treat her like she is unintelligent.

Just thought I would share that in case you missed it.

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yea, it was sort of odd that illinois (read chicago for reference of ER hospital) represented this, since illinois is not part of the opt-out state list.
 
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yea, it was sort of odd that illinois (read chicago for reference of ER hospital) represented this, since illinois is not part of the opt-out state list.

And hopefully never will be
 
So in the beginning of the episode a trauma comes in and one of the nurses drops a bunch of her cards. One of the residents sees them and says whats this intraoperative hypotension. She explains that she is studying to be a nurse anesthetist and has a test the next day. Then the ER resident says so you want to be pushing drugs under an anesthesiologist and her reply is she doesn't have to work under an anesthesiologist. Then ER attending says after one year you'll be all on your own. Then strangely the rest of the ER attendings and residents treat her like she is unintelligent.

Just thought I would share that in case you missed it.


Later in the episode the nurse nails an intubation when the resident can't get it and quips back that "you can't do that with a mnemonic."

I wonder who some of the writers are affiliated with.
 
Later in the episode the nurse nails an intubation when the resident can't get it and quips back that "you can't do that with a mnemonic."

I wonder who some of the writers are affiliated with.

Despicable
 
The most important take home point is:
"Who still watches ER?"
 
ER has been promoting left wing ideals for years. It is not suprising to me that they would attempt to whittle away at the 'uppper-class' of health care providers by depicting a rather unlikely scenario, to say nothing of the falsehood regarding the future level of the nurse's supervision.
 
I have a friend who works on the set of ER- I'm gonna give her an earful about this.

I've been to some tapings of it- there's a physician "consultant" on the set, if I ever go to another taping (unlikely) I'm going to kick him in the nuts.
 
I have a friend who works on the set of ER- I'm gonna give her an earful about this.

I've been to some tapings of it- there's a physician "consultant" on the set, if I ever go to another taping (unlikely) I'm going to kick him in the nuts.


Too late. If he's allowing that drivel, he clearly doesn't have any balls.
 
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Even with a positive portrayal, it is probably to our advantage that people learn that there are nurse anesthetists working without anesthesiologist supervision.
 
I find it incredibly frustrating that they go out of their way to promote CRNAs as highly skilled professionals, yet they portray RNs as an afterthought that hardly do a thing. Of course, that's par for the course with nursing organizations lately. :cool:
 
Later in the episode the nurse nails an intubation when the resident can't get it and quips back that "you can't do that with a mnemonic."

I wonder who some of the writers are affiliated with.

Wha...?? Seriously?? Did the resident allow the nurse to step in and take over the intubation? Was the resident supposed to be an anesthesia resident or just some IM dude? I don't doubt that somewhere in some hospital this has happened but it's probably more frequently the other way around - why do they portray the less likely scenario on mainstream TV...
 
It appeared to be a relatively new ER resident.

If my resident had trouble with an intubation and the nurse (regardless of her current SRNA status) grabbed the tube, she's get an incident report in her file.
 
The resident calls respiratory, and while the nurse was busy putting on her 'big girl panties' the RT would've passed the tube, confirmed placement, drawn and ran blood gas, titrated vent settings (written by resident of course), asked the doc if they want an art-line, and finished documentation. All the while ignoring the shouts of unsolicited advice from nurse. Next say to nurse; "black 2 sugars, make it snappy". And then beg resident for permission to pimp nursey on gas laws.
 
The resident calls respiratory, and while the nurse was busy putting on her 'big girl panties' the RT would've passed the tube, confirmed placement, drawn and ran blood gas, titrated vent settings (written by resident of course), asked the doc if they want an art-line, and finished documentation. All the while ignoring the shouts of unsolicited advice from nurse. Next say to nurse; "black 2 sugars, make it snappy". And then beg resident for permission to pimp nursey on gas laws.

Why would the resident call RT?

It's great that you are able to do all that, but that in no way reflects reality in most places, particularly the academic institutions we haunt.
 
Wha...?? Seriously?? Did the resident allow the nurse to step in and take over the intubation? Was the resident supposed to be an anesthesia resident or just some IM dude? I don't doubt that somewhere in some hospital this has happened but it's probably more frequently the other way around - why do they portray the less likely scenario on mainstream TV...

It doesn't matter to the average public. The doc should of nailed the intubation even if he was an IM dude. It is TV!
 
Why would the resident call RT?

It's great that you are able to do all that, but that in no way reflects reality in most places, particularly the academic institutions we haunt.

Residents here frequently call RT when they can't get a tube, or sometimes before they even bother to try.
 
Agreed. That's very embarrassing. What the hell, we're supposed to be THE airway experts (and i guess the ENT guys, too). But I've never heard of the RT being the goto guy...at one of the hospitals we rotate, we have the option of allowing the RT to intubate if they ask nicely - unless they've already tubed the patient by the time we've arrived.
 
That's embarrassing.

-copro

No it's not, if done in the right context. When I did my ICU rotations and there was an urgent/elective (i.e. non-emergent) intubation, I would make sure Respiratory was called before I started. This way they could set up a vent, so I (or a nurse) didn't have to manually ventilate the patient forever while the RT searched for an available vent.

When I was a prelim medicine resident at Jersey City Medical Center, RT was called for the intubations. I did a bunch, but because the ICU director wouldn't credential residents in intubations, they had to be present for the intubations. I actually bailed out an RT once. Only once did we have to call anesthesia to intubate the patient.
 
Hell, some of the RTs where I trained couldnt even mask ventilate correctly. Must be different over there. Its also irritating that people still see intubation as an end all/be all life saving maneuver. Lean to use bag/mask correctly for christsake. (not directed at RTs but at ALL medical personnel who run for the laryngoscope as the first line for an airway emergency.)
 
Agreed. That's very embarrassing. What the hell, we're supposed to be THE airway experts (and i guess the ENT guys, too). But I've never heard of the RT being the goto guy...at one of the hospitals we rotate, we have the option of allowing the RT to intubate if they ask nicely - unless they've already tubed the patient by the time we've arrived.

I'm guessing (hoping) leaverus is referring to non-Anesthesia residents calling an RT.

From what I've seen, I'd rather have a well-trained RT tube my patient than most of the "other" residents at my hospital. If you're at a place where anesthesiologists are not available 24-7, I can see the need for an RT tubing someone.
 
Its also irritating that people still see intubation as an end all/be all life saving maneuver. Lean to use bag/mask correctly for christsake. (not directed at RTs but at ALL medical personnel who run for the laryngoscope as the first line for an airway emergency.)

Well, I agree with this. We emphasize this as the most important skill medical students going who're not going into anesthesia as a career can learn during a rotation.

As far as RT's routinely intubating patients... I worked at a hospital a long time ago where this was standard. I have to say that there were a lot more "bailouts" by non-RT folks because, for whatever reason, they just couldn't get the tube in. Now, a lot of the time, you can easily intubate someone with practice. But, there are those airways that someone who sees airways everyday - and appreciates what disasters can happen - should only be attempting.

I fear a system where RT's are allowed to routinely intubate or are called first will create a lot of unnecessary M&M, especially in today's morbidly obese society. I'm just not sure that an RT gets the same level of training, or has the same appreciation, of what can go wrong when they can't get the tube. And, I know for a fact that the vast majority aren't trained in alternative airway maneuvers. When this scenario arises, you gotta call for back-up. When that back-up finally gets there, you can only hope then it's not too late...

-copro
 
Well, I agree with this. We emphasize this as the most important skill medical students going who're not going into anesthesia as a career can learn during a rotation.

As far as RT's routinely intubating patients... I worked at a hospital a long time ago where this was standard. I have to say that there were a lot more "bailouts" by non-RT folks because, for whatever reason, they just couldn't get the tube in. Now, a lot of the time, you can easily intubate someone with practice. But, there are those airways that someone who sees airways everyday - and appreciates what disasters can happen - should only be attempting.

I fear a system where RT's are allowed to routinely intubate or are called first will create a lot of unnecessary M&M, especially in today's morbidly obese society. I'm just not sure that an RT gets the same level of training, or has the same appreciation, of what can go wrong when they can't get the tube. And, I know for a fact that the vast majority aren't trained in alternative airway maneuvers. When this scenario arises, you gotta call for back-up. When that back-up finally gets there, you can only hope then it's not too late...

-copro
Hey copro

Just to clarify, I am referring to RTs putting in tubes on the med/surg floors for NON-anesthesia residents. These include interns who have maybe put in a cuppla tubes in medical school and are now alone with a patient and ****ting their pants.

Before med school I was training to be an RT, so I did see it happen a few times. Maybe RT training is different in your neck of the woods, but up here it is a 4 year BSc. program including plenty of OR time and plenty of practice placing tubes, alternative airways, art. lines, etc. The RTs on occasion will teach the residents how to properly bag-mask patients, how to use the ventilators, among other things.
 
............that in no way reflects reality in most places, particularly the academic institutions we haunt.
>
I agree completly, I was goofing about a fictional TV show, hence the globs of sarcasm.:D I do get a kick out of hearing nurses, with all thier "extensive ICU experience", when they decide to persue their CRNA and then sweat the curriculum like gas laws, alveolar-air equation, ect. I mentioned this in an earlier post, but the thread was closed.
 
Well, I agree with this. We emphasize this as the most important skill medical students going who're not going into anesthesia as a career can learn during a rotation.

As far as RT's routinely intubating patients... I worked at a hospital a long time ago where this was standard. I have to say that there were a lot more "bailouts" by non-RT folks because, for whatever reason, they just couldn't get the tube in. Now, a lot of the time, you can easily intubate someone with practice. But, there are those airways that someone who sees airways everyday - and appreciates what disasters can happen - should only be attempting.

I fear a system where RT's are allowed to routinely intubate or are called first will create a lot of unnecessary M&M, especially in today's morbidly obese society. I'm just not sure that an RT gets the same level of training, or has the same appreciation, of what can go wrong when they can't get the tube. And, I know for a fact that the vast majority aren't trained in alternative airway maneuvers. When this scenario arises, you gotta call for back-up. When that back-up finally gets there, you can only hope then it's not too late...

-copro
>
I'm not disagreeing with you here, but fundamentaly speaking, isn't experience the factor that matters?.......regardless of the alphabet soop that follows ones name? Here's the thing, it's up to you (anesthesiologists) to train us (RT) in those alternative maneuvers, my profession was born from yours. I've never worked in an RT dept. that did'nt hold anesthesia in the highest regard, we know you guys are the gold standard in AW managment......we want to learn from you. I did most of my training, and worked in a huge 1200 bed teachng hospital outside NYC, I now work in one of those little ****bird critical access places some of you love to complain about, guess what? now I am the go-to guy whe anes is not in house (they are usually gone by 6PM)


ETA - I whole heartedly agree that BLS goes a long way, and is many times the better option until a more experienced provider arrives.
 
Well, what happens when you can't get the tube in?

-copro, MD, LMFAO
>
On noc's there is one RT and one PA in house, if neither of us can pass the tube, after unsuccessfully attempting to establish a BLS AW, (anes has already been paged at home by this point) The PA will perform a cricothyrotomy, since I have no experience at that procedure. But perhaps one of our anesthesiologists would teach me.
 
Hell, some of the RTs where I trained couldnt even mask ventilate correctly..........
>
Holy Crap!.....now THATS embarrassing! I mean jeez, I learned that when I was a Jr. EMT boy at 16 y/o.
 
yup, it was pretty sad. The RTs were excellent when I did my internship so I assumed the same for residency.....nope. About 2/3 of them had the idea that smashing the mask to the patients face somehow created better ventilation and if not then push down harder.
 
Until I read this thread I had no idea RTs anywhere could intubate anyone.

I was definitely aware of their face-smashing abilities, however.

Glad to hear that's a regional thing.
 
>
On noc's there is one RT and one PA in house, if neither of us can pass the tube, after unsuccessfully attempting to establish a BLS AW, (anes has already been paged at home by this point) The PA will perform a cricothyrotomy, since I have no experience at that procedure. But perhaps one of our anesthesiologists would teach me.

:eek::eek::eek:
 
Until I read this thread I had no idea RTs anywhere could intubate anyone.

I was definitely aware of their face-smashing abilities, however.

Glad to hear that's a regional thing.
>
Seriously?.....In the 20ish hospitals I've been at, the teaching place being the exception, RT was the first line emergency intubaters. And in all those places, anesthesia did the competency examination. As far as face mashing goes, I've had more luck after a quick reposition, but some people seem to adopt this 'when encountering resistance...push harder' aproach to life.
 
>
In all seriousness, aside from waiting for anes to show up while the Pt dies, whats our options? I've suggested LMA's or perhaps combitubes, but no one in the ED seems to like those options.
 
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