Do you control which procedures you do in the ED?

[DeadCactus]

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Once you're out in the community, how much control do you have over which procedures you do in the ED? Can you still do basically any procedure you're trained in? Or can you find yourself in a place where GS does all I&Ds or central lines, Ortho does all the reductions or splinting/casting, etc. and you're forced to hand those procedures over?

 

[Apollyon]

In the community, very often, all of the procedures you've named you will do, since you do not have those consultants in house.

As long as you're credentialed to do it (which means you know what you're doing, and won't butcher the patient), then it's yours.

 

[DeadCactus]

I misspoke in the original post. I meant to put "out of residency" rather than "out in the community" as I'm interested how it works both in community practices and academic centers.

 

[Apollyon]

Out of residency, my answer stays the same (of course). If one becomes an academic attending, they're still calling the consultants (because residents shouldn't independently make the decision to call a consultant).

 

[ALFI]

i think it depends on the situation. i've done Trauma observations early on in my pre-health course and a 23yr old pt came in with a pulse-less ankle with and without a doppler with a severe dislocation deformity. the RMO told him to think warm thoughts and without pain meds relocated his ankle. his justification was 'no time to call ortho, no pulse means dead tissue and dead tissue means he could lose the foot. Ortho take their sweet ass time getting down here only to say the foot has to go because its been pulse-less for to long'

so yeah our registrars are a little gung-ho but the job is done, and it's done right!

 

[southerndoc]

Even without a pulse, you can quickly sedate the patient with propofol. Any painful procedure such as an ankle reduction without sedation is inhumane and negligent IMHO.

 

[ALFI]

Even without a pulse, you can quickly sedate the patient with propofol. Any painful procedure such as an ankle reduction without sedation is inhumane and negligent IMHO.

probably but with the foot already have been without a pulse for 20mins the attending just wanted to restore bloodflow and get a pulse. i did question him after and i did descreetly talk to a few registrars and other attendings about what happened and they said although he should have called ortho, he made the right call but this particular attending enjoys looking like a hero and i shouldn't get any ideas.....i need to develop my own ways but it was good i came to them and debriefed..i have potential

 

[RustedFox]

Hey.. this ALFI character sounds pretty bright.

Sorry, don't wanna call you out, but I noticed that your post-count is low. You must be new. Welcome to SDN. *thumbs up*

 

[ALFI]

Uhh thanks *puzzled look* yeah i'm new... and also i'm female but ALFI in australia stands for Adelaide's Largest F***king Idiot!...we have many ALFI's

 

[EM6771]

probably but with the foot already have been without a pulse for 20mins the attending just wanted to restore bloodflow and get a pulse. i did question him after and i did descreetly talk to a few registrars and other attendings about what happened and they said although he should have called ortho, he made the right call but this particular attending enjoys looking like a hero and i shouldn't get any ideas.....i need to develop my own ways but it was good i came to them and debriefed..i have potential

Call ortho for reduction of a pulseless extremity? IMO there is absolutely no reason to call ortho and to do so and wait for their arrival is below the standard of care. You quickly sedate with drug of choice and reduce the Fx then call them (or have someone call them while you are doing it).