ED Procedures

[pugsly]

Hi,

i am wondering what is the biggest procedure (major) that an ED physician can do on their own without calling the surgeons or cardiologits?? thanks

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[BADMD]

Your question is not answerable in its current form as I can't define "big procedure." Please clarify exactly what you mean and what you are trying to figure out.

Also, the only time a cardiologist gets involved for a procedure is if I need an emergent cardiac cath.

 

[EM2BE]

and I'm pretty sure there was a similar thread w/in the last year. do a search, and I'm sure you'll get some answers

 

[pseudoknot]

I assume the ED thoracotomy is what the OP was after.

 

[USCDiver]

or the peri-mortem C-section

 

[waterski232002]

Transvenous pacing is fun too... but there are more invasive procedures we do like chest tubes, cricothyrotomy, intubation, pericardiocentesis. But in general, ED Thoracotomy & Peri-mortem C-sections are the 2 most invasive procedures that are done in the ED by an Emergency Medicine Physician.

 

[southerndoc]

Transvenous pacing is fun too... but there are more invasive procedures we do like chest tubes, cricothyrotomy, intubation, pericardiocentesis. But in general, ED Thoracotomy & Peri-mortem C-sections are the 2 most invasive procedures that are done in the ED by an Emergency Medicine Physician.

Even then, the surgeon is getting a call when the chest gets cracked. Getting them to the OR quickly if you get a pulse back is required, so a nurse, tech, or secretary should be calling the surgeon anytime an emergent thoracotomy is being performed in the ED.

 

[beyond all hope]

I love thoracotomies, but I trained at two big trauma centers and currently work in one and I´ve never seen anyone survive. I´ve seen at least fifty, probably closer to a hundred. Good way to get cut with HIV-HepC blood by a nervous intern. (still love ´em)

Never done or even seen a perimortem CS. Terrified that I might have to do one some day, although in theory it´s really quite simple. Low Trans incision, cut uterus, tear like crazy, deliver baby.

The best procedures are the simple, elegant ones. FB from kid´s nose by having mom blow in mouth. Reducing nursemaids, or reducing a shoulder with good technique.

I still love tubing people and putting lines in them, but I find as an attending I´m always trying NOT to do this to patients unless absolutely necessary.

 

[12R34Y]

I love thoracotomies, but I trained at two big trauma centers and currently work in one and I´ve never seen anyone survive. I´ve seen at least fifty, probably closer to a hundred. Good way to get cut with HIV-HepC blood by a nervous intern. (still love ´em)

Never done or even seen a perimortem CS. Terrified that I might have to do one some day, although in theory it´s really quite simple. Low Trans incision, cut uterus, tear like crazy, deliver baby.

The best procedures are the simple, elegant ones. FB from kid´s nose by having mom blow in mouth. Reducing nursemaids, or reducing a shoulder with good technique.

I still love tubing people and putting lines in them, but I find as an attending I´m always trying NOT to do this to patients unless absolutely necessary.

I though Low transverse C-sections were the typical in the OR c-sections (ie the kind my wife had).

The crash c-sections we do in the ED would be vertical midline big incision. did they change this recently?

later

 

[BADMD]

The crash c-sections we do in the ED would be vertical midline big incision. did they change this recently?

Those untrained in doing C-sections should do the midline incision. We need as much exposure as we can get if we are going to be successful in this rescue procedure.

An OB or MFM might do a LTCS in an emergency because that is the approach they are accustom to performing. In that case, deviating might actually slow them down.

 

[beyond all hope]

BADMD made an excellent point.

I just described the procedure as I've seen it done. Just got back from doing some fieldwork in Guatemala and got involved in a fair amount of OB. This is the way I'd do it if I were standing over a patient with a jittery hand.

Might as well do a big X on the belly.

PS. anyone out here ever done a perimortem C?

 

[WallowaWanderer]

The biggest procedures are getting really big people in and out of bed.

 

[roja]

BADMD made an excellent point.

I just described the procedure as I've seen it done. Just got back from doing some fieldwork in Guatemala and got involved in a fair amount of OB. This is the way I'd do it if I were standing over a patient with a jittery hand.

Might as well do a big X on the belly.

PS. anyone out here ever done a perimortem C?

The one procedure I hope to never do.

I have done a number of thoracotomies (although not a big fan of them) and emergent surgical airways, etc etc and I hope I never have to do a perimortem c.

 

[Rendar5]

The one procedure I hope to never do.

I have done a number of thoracotomies (although not a big fan of them) and emergent surgical airways, etc etc and I hope I never have to do a perimortem c.

Saw my first "exciting" C-section saturday. Luckily baby and mom were alright. The ob's hand was shaking for a bit when he started to suture the uterus together. After seeing that, I honestly don't think I would be able to handle a perimortem C/S very well.

 

[canjosh]

PS. anyone out here ever done a perimortem C?

have seen one...at a medium sized community hospital...s/p mvc. midline incision, baby seizing upon delivery...died within a day or so. Not pretty.

 

[waterski232002]

PS. anyone out here ever done a perimortem C?

We did one last year at UofC (not me personally)...

25 yo F called in by EMS as SOB. When they rolled through the door, they were doing CPR b/c she arrested afterwards en-route. Intubated mom, and opened immediately. OB & NICU were paged immediately. By the time they got into the ER it was a blood bath. They literally said "holy ****". Both underwent prolonged codes, but neither survived.

 

[mountebank]

A good handy book on procedures "Essential Emergency Procedures"

http://www.amazon.com/Essential-Eme...=sr_1_8?ie=UTF8&s=books&qid=1210923608&sr=8-8

check it out.

 

[roja]

*applaud*

You should really check out the chapter on ED thoracotamies. Its AWESOME!

 

[pseudoknot]

A good handy book on procedures "Essential Emergency Procedures"

http://www.amazon.com/Essential-Eme...=sr_1_8?ie=UTF8&s=books&qid=1210923608&sr=8-8

check it out.

What's the overlap between that book and Roberts & Hedges?

 

[roja]

The chapter on ED thoracotamies is better.

 

[jbar]

Any chance a green fairy from New York wrote that chapter?

 

[pseudoknot]

Haha, I'm a little slow sometimes. I checked out the table of contents on Amazon. I'll have to take a look one of these days. Plus it has a chapter on bedside burr holes (!).

 

[roja]

Any chance a green fairy from New York wrote that chapter?

*looks innocent*

 

[docB]

I've always been a Roberts and Hedges guy but they've just gotta change all of their pictures. When you have that many pictures with ground glass syringes, people not wearing gloves, leeches, docs smoking at the bedside, injuries sustained while hand cranking a Model T Ford and so on it really detracts from the info.

 

[southerndoc]

I've always been a Roberts and Hedges guy but they've just gotta change all of their pictures. When you have that many pictures with ground glass syringes, people not wearing gloves, leeches, docs smoking at the bedside, injuries sustained while hand cranking a Model T Ford and so on it really detracts from the info.

They should add some color as well.

 

[docB]

They should add some color as well.

Yeah. I always though every procedure was bloodless when I was reading about them.

 

[southerndoc]

Yeah. I always though every procedure was bloodless when I was reading about them.

Imagine my surprise when I did my first thoracotomy and became covered in blood.

 

[deleted109597]

Imagine my surprise when I did my first thoracotomy and became covered in blood.

Wait, there is blood involved? I'm out then. These shoes cost like, $150!!!

 

[jbar]

http://g-ec2.images-amazon.com/imag...-vendor-play-shuttle-off,BottomLeft,0,43_.jpg

 

[Rendar5]

*applaud*

You should really check out the chapter on ED thoracotamies. Its AWESOME!

Lol, never made the connect between Shah and SLR til I looked at that table of contents. Nice job

 

[roja]

Lol, never made the connect between Shah and SLR til I looked at that table of contents. Nice job

Shah is a tiny little machine.