Eff you, you Judas.

[coffeebythelake]

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I get what you're saying, but that's not really the case. The patient doesn't need a central line and there are no expectations the patient needs IV access overnight until the PICC/midline team comes in the AM with little chance of decompensation in the meantime. It also isn't needed in the ED.

Ok, so where's the breakdown in communication? If someone upstairs is pushing back and upset about this situation, maybe the report given to the admitting service is inadequate?

As an anesthesiologist, do you expect the ED to place any central or arterial lines you'd like in the OR before they come to you?

Lets be clear. In my experience that never happens. Even in patients that I feel need it. The typical ED patient has a 20 g in the AC. In trauma bleeding patients I'm happy if they send to us pt with a single 18 g and a sprinkle of 20 g. High acuity patients either go to the ICU first where the surgical ICU resident / fellow lines them up, or we line them up in the OR.

 

[SpacemanSpifff]

Lets be clear. In my experience that never happens. Even in patients that I feel need it. The typical ED patient has a 20 g in the AC. In trauma bleeding patients I'm happy if they send to us pt with a single 18 g and a sprinkle of 20 g. High acuity patients either go to the ICU first where the surgical ICU resident / fellow lines them up, or we line them up in the OR.

Where do you work? No trauma patient leaves our bay without the at the very least 2 18’s from our nursing staff. If that’s not possible (rare) or they are sick (less rare) they get large bore central access. If you are consistently seeing hypotensive bleeding patients with inadequate access, give some feedback to the department and help them improve. Nobody wants to deliver ****ty care.

 

[thegenius]

This thread is a great example of why the suits are winning over the doctors.

@RustedFox posts a story about being chided by admin for providing perfectly reasonable care (sure, you might not have handled it exactly the same way, but there's no malpractice here). What do we do? We jump all over each other criticizing everything from Nursing School curricula to hospitalists to other EM doc's disposition decisions of hypothetical cases.

Divided we fall.

Well...we are on an anonymous message board. Most of the things said here would not be said in real life if we were hanging out havin a beer

 

[GeneralVeers]

Where do you work? No trauma patient leaves our bay without the at the very least 2 18’s from our nursing staff. If that’s not possible (rare) or they are sick (less rare) they get large bore central access. If you are consistently seeing hypotensive bleeding patients with inadequate access, give some feedback to the department and help them improve. Nobody wants to deliver ****ty care.

Your place must have a ton of residents. In my Level III trauma center, if they have 20 ga access they are good to go to the OR. Let anesthesia put in a central line if needed. Not sure why ED docs all have fetishes about doing central lines on everyone.

 

[WilcoWorld]

Well...we are on an anonymous message board. Most of the things said here would not be said in real life if we were hanging out havin a beer

Yeah, which is one of the biggest problems with anonymous message boards IMO - they provide fertile grounds for incivility.