1. It’s Test Prep Week! Visit the Test Prep Forums to learn about test prep products and services, ask questions in test-related AMA threads, take advantage of exclusive SDN member discounts, and enter to win free stuff!
Whether you’re preparing for the USMLE, COMLEX, NBDE or APMLE, Test Prep Week Exhibitors can help you ace your boards!

EM residents claiming they are better at trauma/difficult airway management than anesthesiologists??

Discussion in 'Anesthesiology' started by operavore, Aug 7, 2017.

  1. SDN is made possible through member donations, sponsorships, and our volunteers. Learn about SDN's nonprofit mission.
Thread Status:
Not open for further replies.
  1. periopdoc

    periopdoc Cardiac Anesthesiologist Lifetime Donor 7+ Year Member

    2,199
    263
    Sep 8, 2008
    Kalispell, Montana
    My ER colleagues must be pretty good at airway management. They never call me for backup, or to bail them out.

    Pulm intensivists too. They only call for the really gnarly airways, and never ask for me to back them up (even though I sometimes can tell that is what they kind of want). If they call me for an airway that I find only has a moderate pucker factor, I will usually offer to back them up.

    Thanks guys.


    But don't get me started on the paramedic students. They are banned from my OR now.
     
    grapp and PharmD500 like this.
  2. SDN Members don't see this ad. About the ads.
  3. bashwell

    bashwell SDN Bronze Donor Bronze Donor 2+ Year Member

    1,922
    1,869
    Mar 20, 2013
    Anesthesiology has got to be one of the most underappreciated specialties. Almost everyone seems to think they're better than anesthesiologists at x, y, z . . . until they get rekt and have to call anesthesiology for help! But I appreciate the schadenfreude. :rofl:
     
    ToldYouSo, CardioDad, FFP and 2 others like this.
  4. mmag

    mmag Member 10+ Year Member

    165
    18
    Aug 19, 2006
    We work hard to make it look easy.
     
    ToldYouSo and ranvier like this.
  5. IlDestriero

    IlDestriero Ether Man 7+ Year Member

    "Wow, this guy must have a TE fistula."


    --
    Il Destriero
     
    Wiscoblue and twoliter like this.
  6. powermd

    powermd Lifetime Donor 10+ Year Member

    2,505
    293
    Mar 30, 2003
    Northeast
    Physician
    I practice pain medicine full time now, but this reminds me of my first night of team captain call at my training institution. First 15 minutes on duty and I get 3 pages for stat airway assistance. The first was in IR. I had to intubate him awkwardly ducking under the c-arm. Done with that, I headed over the CCU. Just as I'm assessing the situation, the pager goes off for the children's hospital. The CCU guys were cool and said, yeah... go take care of THAT instead, we got this old guy.

    I book it on over to the new baby-momma unit and wade through a crowd of people in the room. Apparently a new mom had smothered her 1-day old under her breast and the baby went apneic. The PICU people apparently couldn't intubate and were bagging the very cyanotic kid. Calmly I pulled out my miller 1 and got the airway in about 10 seconds. I think that may have been my easiest tube ever. The baby pinked up soon after. On to my next job. To this day I still wonder what became of that kid.

    So I think I got to be "that guy" a few times. I'm glad my present job is much less exciting!
     
    WhiteCoatWonder, ToldYouSo and Psai like this.
  7. acidbase1

    acidbase1 5+ Year Member

    199
    61
    Jul 28, 2011
    Holy shhhhjjjt
     
  8. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor 7+ Year Member

    5,135
    4,005
    Oct 17, 2007
    The EM doc's EEG?

    </sarcasm>
     
    Last edited: Aug 9, 2017
    Moose A Moose and twoliter like this.
  9. Hoya11

    Hoya11 Senior Member 10+ Year Member

    610
    172
    Sep 4, 2004
    He made it to the unit intubated/sedated no pressors after intubation. The EEG was maybe a day after he came in. It was a surprise to me and an indication of just how long the ER doc struggled before calling directly for the surgical airway.

    CT of the neck while he was in the unit showed a big hematoma starting from the carotid, no evidence of allergic reaction. He had had a CABG ~1 yr ago and was on plavix and asa.
     
  10. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay 10+ Year Member

    1,814
    2,030
    Aug 10, 2007
    Closer to Mexico
    Kids, don't drink and post.
     
  11. Noyac

    Noyac ASA Member SDN Advisor 10+ Year Member

    6,980
    1,525
    Jun 20, 2005
    Wow I should reread my posts before I hit send. It was late I guess. Hope the gist was conveyed.
     
    ToldYouSo likes this.
  12. Noyac

    Noyac ASA Member SDN Advisor 10+ Year Member

    6,980
    1,525
    Jun 20, 2005
    Ha ha. Yep. Didn't see this post until after I sent the previous one.
     
    ToldYouSo likes this.
  13. Groove

    Groove Member 10+ Year Member

    1,107
    266
    May 3, 2004
    Physician
    Deleted. I hate being the one to make inflammatory posts. This thread just rubbed me the wrong way.
     
    Last edited: Aug 9, 2017
  14. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor 10+ Year Member

    11,384
    275
    Jun 6, 2002
    Atlanta
    Physician
    Don't recall seeing this post, but not all emergency physicians are pompous. I didn't train in anesthesiology, so I'm not an expert. In fact, when a severe angioedema, 400 pound patient came in the other day, I paged anesthesia immediately. It took 4 anethesiologists to intubate the patient. I recognized my limitations and didn't try. Some of my colleagues would call that weak, but I call it being smart.

    I don't pretend to be a cardiologist because I see a ton of EKG's, I don't pretend to be a trauma surgeon because I do the initial assessment of trauma patients, I don't call myself a neurosurgeon because I see many patients with subdurals and subarachnoids, and I certainly don't call myself an anesthesiologist because I intubate frequently. Frequently for me is way more than most emergency physicians -- at least once every other shift in one of the nation's busiest ER's -- but that number is a laughable number compared to what an anesthesiologist does on a daily basis.

    I drive on the interstate frequently and don't consider myself a NASCAR driver.

    Consider your source here. A PGY-3 who either is full of himself or works in a department where faculty are full of themselves.
     
    Last edited: Aug 9, 2017
    WheezyBaby, MakoMD, abolt18 and 8 others like this.
  15. Ezekiel2517

    Ezekiel2517 Anesthesiologist 10+ Year Member

    416
    327
    Jan 21, 2005
    CA
    Physician
     
  16. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

    17,992
    1,904
    Nov 24, 2002
    SCREW IT!
    Physician
    I don't Reddit. Honest question - is there any vetting? Or can anyone claim to be X, Y, or Z? My point is that, could this be from someone just wanting to fan the flames? If so, it seems effective.

    Where I am, way the hell out in the boonies, when I get a code coming in (during business hours), the CRNAs both turn out, and tube the pt. I'm fine with that. Between 3pm and 7am, it's me.
     
  17. Man o War

    Man o War 2+ Year Member

    669
    593
    Apr 13, 2015
    Go away murse.
    Your use of MDA is a dead give away.
     
  18. throckmortonDO

    throckmortonDO 2+ Year Member

    64
    81
    Jan 22, 2014
    EM attending here

    Anesthesia intubates multiple times a day. I don't. when you do something repeatedly like that, you develop the skills to be the best.
    I've had some humbling airway experiences over the past 5 years, I do have a tool that anesthesia might not have which is cric or surgical trach.
    Thats about it.

    You guys are the airway kings. the guy who posted about tubing better sounds like a moron.

    And whoever said Groove is a 'murse' got it wrong. He's an experienced EM attending.

    instead of trashing each other, shouldn't we be focused on the fact that corporate groups are pillaging our specialties and making us responsible for overseeing midlevels we don't get to vet or train?

    Think about it.
     
  19. Man o War

    Man o War 2+ Year Member

    669
    593
    Apr 13, 2015
    I'm happily proven wrong. What's his name?
    He's been trolling this forum hard since the whole "I just had surgery and I've always asked for an MD but now I'll take the CRNA". Stinks to me.
     
    AdmiralChz likes this.
  20. Man o War

    Man o War 2+ Year Member

    669
    593
    Apr 13, 2015
    And I agree, this is a dumb argument. There's about 1000 things you guys are better at than me. That's why we specialize in medicine.
     
  21. Consigliere

    Consigliere 7+ Year Member

    2,003
    1,434
    May 28, 2008
    Neither here nor there
    Whatever. I can say I pitch just as well as Jake Arrieta but that doesn't make it so.
     
    chocomorsel and Ronin786 like this.
  22. AdmiralChz

    AdmiralChz Random-zilla 7+ Year Member

    1,744
    810
    Sep 8, 2008
    Southeast
    @Groove did you really go and post in the EM subforum about how hurt your feelings are? Trying to get backup?

    Everybody wants to be a hater...

    I'm sorry that you didn't get anyone to back you up in your crusade against us, your responders so far have agreed with us! We are just saying to respect the airway and critiquing how cocky a random reddit user was. Coming here and insulting us won't really prove anything... C'mon man!
     
    ranvier, bashwell and dchz like this.
  23. dchz

    dchz ASA Member 2+ Year Member

    92
    45
    Sep 25, 2012
    Texas
    I might have to disagree here, why is this tool more available to you than us?
     
    bashwell likes this.
  24. Mr. Hat

    Mr. Hat 10+ Year Member

    887
    684
    Dec 20, 2006
    Doc on doc crap like this is why we'll soon be arguing who the real master of the airway is: The ER DNP or the CRNA
     
  25. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor 10+ Year Member

    11,384
    275
    Jun 6, 2002
    Atlanta
    Physician
    I think a lot of people think the anesthesiologists aren't allowed to use a scalpel. Just because you choose not to use it doesn't mean you aren't trained in it or aren't credentialed for it.
     
  26. Robotic Wis-Hipple

    Robotic Wis-Hipple

    416
    407
    Feb 25, 2016
    My credentials say I can place chest tubes lol. I sure as hell am not letting a pt die without a scalpel, finger, bougie cric attempt.
     
    bashwell, FFP, dchz and 1 other person like this.
  27. AdmiralChz

    AdmiralChz Random-zilla 7+ Year Member

    1,744
    810
    Sep 8, 2008
    Southeast
    Surgical trach equipment definitely not, but a cricothyrotomy kit (typically Melker, but there are others) are on almost all difficult airway carts that I've seen. At my residency program hospital (typical large, tertiary care center), such a kit was used exactly once over the past 10 years outside of the emergency room when we went looking for statistics (at least, that's all that we could find evidence of).

    To be completely honest I've seen some really horrendous airway disasters, but with all the modern and solid equipment we have now (mostly LMAs to get SOME ventilation through in a pinch) I hope to never have to reach for the cric kit.
     
    dhb likes this.
  28. dchz

    dchz ASA Member 2+ Year Member

    92
    45
    Sep 25, 2012
    Texas
    but if you do reach for it, it's not gonna be there because it's not available to you :(
     
  29. Groove

    Groove Member 10+ Year Member

    1,107
    266
    May 3, 2004
    Physician
    I posted a long response in our own thread in the EM forum and I stand by what I said. I think what ultimately pissed me off about this thread were the derogatory and insulting comments (by a few of you, not all) criticizing ER docs and EM residents who improperly manage the airway (in your opinion) in areas of the hospital where anesthesia traditionally is just never available. The whole thread started because of an EM residents' post on reddit about finding an attending with the most experience when intubating messy, crashing trauma patients. You think that's you? You think you intubate more of that patient population than anybody else in the hospital? I don't. I just found this thread and some of the comments incredibly counterproductive and unprofessional and it reminds me why we're losing the battle to MLPs who by and large work together and respect each other to a much greater degree and hence why they are lobbying state legislatures much more effectively. Yes, my original post was not helpful either, which is why I deleted it.
     
  30. urge

    urge 10+ Year Member

    3,469
    852
    Jun 23, 2007
     
    AdmiralChz, Quixotic2501 and dchz like this.
  31. Quixotic2501

    Quixotic2501 2+ Year Member

    27
    19
    Dec 30, 2014
    "Want us to consult you to the bedside STAT for every "intubation assessment"? What about the floor codes, do you want to have to respond to all of those instead of the ER doc or the intensivist? (Because you're sooooo good at intubation)? Yeah, I thought not."

    I know that the post was deleted, but for the record, at my institution, anesthesia are at all the floor codes to intubate and help manage care as well as respond on the floor for anyone who needs to be emergently intubated. We are called not uncommonly into ICUs where non-anesthesia intensivists feel uneasy about the airway. We carry the difficult airway pager in the children's hospital. We place the tube in less than 5 seconds after induction in a stat C-section. And I know you said it sarcastically, but, yeah, we, as a rule, tend to be soooooo good at intubation.
     
    WheezyBaby, dchz and AdmiralChz like this.
  32. dchz

    dchz ASA Member 2+ Year Member

    92
    45
    Sep 25, 2012
    Texas
    This is the exact situation at my training program as well. But @Groove works at a hospital where anesthesiologists are not available. I could understand from his world view why he would think that way, but it really speaks more to how little he has seen rather than who has the mastery of airways.
     
  33. CardioDad

    CardioDad

    6
    14
    Aug 18, 2016
    mic drop.gif
     
    dchz likes this.
  34. TimesNewRoman

    TimesNewRoman 2+ Year Member

    1,729
    1,196
    May 14, 2013
    It's amazing how much people have this wrong. There are some people that are excellent at taking care of sick people and some that aren't. Anesthesia intubated much more often than EM (assuming you don't just follow around 4 CRNAs all day), so, by the very nature of the job, you should be better. That being said, it's not always true.

    Intubating in these conditions are about two things, and no one on this board seems to have the insight to explicitly identify the more important factor. There is obviously the mechanical and mental ability to think through an intubation and perform the task. This skill is obviously better cultivated in anesthesia.

    The second, and certainly more important, factor in this setting is stress management. Being able to keep your cool is a bad situation is arguably more important. Yes, technical ability is important, but when you use a CMAC to intubate a variceal bleed that vomits on the camera, it's more important to not let your pulse increase, suction aggressively and switch to DL. As several people have said, safe delivery of anesthetics should be boring, and some of my anesthesia colleagues have the superior technical proficiency to me but loose their cool in a crisis. It's the same thing as when you hear about a patient dying an airway death without an attempt at a surgical airway. Everyone knows that a surgical airway is the last step in the airway algorithm and will get that right on boards, but having the mental toughness to not get task oriented and loose the big picture is what allows this process to work correctly in real life. This follows for all specialties dealing with sick patients. A brilliant intensivist who looses his cool around actively decompensating patients is useless.

    At the end of the day, I don't care if an ER doc, anesthesiologist, or intensivist intubates me. I care they are facile at intubation AND keep their cool in a crisis. Yes, an anesthesiologist should be more technically adept at the procedure, but I don't want the guy who becomes all thumbs when a patient crumps.
     
    PharmD500 likes this.
  35. IkeBoy18

    IkeBoy18 ASA Member 10+ Year Member

    656
    59
    Jul 13, 2005
    Whats this talk abt crisis management? Maybe its my residency location, volume of trauma, out of OR intubations and extremely sick patients, but I thought crisis management, emergent cric and resuscitation was well within the purview and skillset of the typical anesthesiologist. Maybe Im wrong.
     
  36. G-Man82

    G-Man82 10+ Year Member

    396
    181
    May 16, 2005
    The Southeast
    Physician
    Same at all the places where I physically work. On the anesthesia side, I'll occasionally be assigned the attending airway pager and will go staff the airways (and occasionally just do them myself) all over the hospital. In my ICU when I'm on service the only time I called my colleagues in the OR was for a reintubation in a known difficult airway, which is a situation where I want as much assistance as possible. My colleagues are more than happy to assist.

    I do teleICU as well and cover a community hospital 200 miles away. That place is the sticks. No intensivists on staff. So at night, lines are placed by the on-call Surgeon who sometimes puts up a fight about coming back in. Airways are managed by the ED physician, who happens to be the only MD in house. I won't comment on his skill, but I have seen him just ram a tube down some morbidly obese woman's throat while RNs held her arms down. She was hypercapnic but not completely unresponsive. No video laryngoscopes exist there and I think he was afraid to over-sedate, so I don't blame him. The patient had a secured airway.

    Different arenas exist all over. In major healthcare organizations and academic facilities, we often exist 24/7. But in the community or the VA? Nope. At the VA the RT or hapless medical intern at night will tube the few times it's necessary. Talk about disaster.

    My point being that hospitals make do with the resources they have. Unfortunately that isn't always good. That community hospital at least has a physician who can intubate at night, unlike some of the others I've seen.


    Sent from my iPhone using SDN mobile
     
    Last edited: Aug 10, 2017
  37. PageDrT

    PageDrT

    15
    16
    Jul 22, 2017
    This is so obviously subjective thinking. I'm not even a Resident but critical thinking says check your source
     
    ToldYouSo likes this.
  38. TimesNewRoman

    TimesNewRoman 2+ Year Member

    1,729
    1,196
    May 14, 2013
    It should be, but every so often you read a headline about an airway death in an OR without an attempt at a backup/surgical airway. That was my point.
     
  39. Southpaw

    Southpaw ASA Member 10+ Year Member

    784
    93
    Aug 12, 2004
    What a dumb thread. Docs need to work the same sideline, not opposite sides. Long written responses by residents and young attendings are totally missing the point. I don't care who's schlong hangs lowest. I'll help take care of the patient if called. If you don't need me, then great. I hope that line of communication goes both ways, for all specialties. I know it doesn't, but it should.
     
  40. vector2

    vector2 ASA Member 10+ Year Member

    854
    383
    Dec 26, 2006
    You may very well be right that EM intubates more traumas in a particular institution than anesthesia, but the point you're missing is not that anesthesia may be able to successfully DL some difficult airway that you couldn't (although I'd guess that our pre test probability is somewhat higher). What we really get paid for is having a deft enough hand to not turn the airway into hamburger when a DL is difficult, and for having the sound judgement and skill to move to more advanced airway techniques before the **** has hit the fan.
     
  41. Groove

    Groove Member 10+ Year Member

    1,107
    266
    May 3, 2004
    Physician
    Listen to you... "At my training institution..." again. Dude, you are a baby resident who knows jack s*** about 90% of what you're talking about with nothing better to do than troll these threads trying to convince everyone you have a relevant opinion on topics you have some of the least experience with when compared to most posters here. You haven't even left your nest yet, nor are you even ready or capable of passing your boards. When you get out in the real world, become a real attending and start realizing how little most hospitals reflect the environment you were trained in as a resident, some of these scenarios will start to make more sense. A PGY 2 lecturing me about what I have or haven't seen. LOL.
     
    NeuroSpeed likes this.
  42. Groove

    Groove Member 10+ Year Member

    1,107
    266
    May 3, 2004
    Physician
    Because I lack sound judgement in those scenarios and will turn their throat into a laryngeal and hypopharyngeal slushie with my frenetic DL attempts? Advanced airway? Is that like a King Airway? Haha, I get your point man but still... try implementing your pre test algorithms when the 600lb whale with a short neck, small mouth in a c-collar, aspirating her own vomit and cyanotic with a sat of 60% rolls through the ambulance bay doors and plops down on your trauma stretcher. It's not like all these pt's arrive with normal VS and wrist bands that say "I will catastrophically decompensated in 7.4 minutes, plan accordingly!". It sure would make my life easier though.
     
  43. ranvier

    ranvier I can't anesthetize a rumor. 10+ Year Member

    214
    114
    Jul 17, 2006
    When I visited the EM forum on this topic, the group seemed alot more collegial than you. You are becoming annoying. Sounds like you are amazing and never need help. We actually instantly implement those algorithms even in the example you list here. It's what many of us do. Why don't you go away since you aren't here for a real discussion?
     
    Man o War likes this.
  44. Man o War

    Man o War 2+ Year Member

    669
    593
    Apr 13, 2015
    It's so weird that an alleged "EM attending" spends so much time trolling the anesthesia forum. Not buying it for a second.
     
    ranvier likes this.
  45. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

    10,526
    4,372
    Dec 14, 2005
    Home Again
    My brother is an EM doc.

    I give him **** all the time about doing LPs with barbaric 22g cutting needles and being the #2 cause of headaches in the hospital (behind nurses). Or about his noble task of saving the world from seeing their PCMs.

    And he gives me **** about being a stool-sitting monkey who stares at a monitor all day listening to beeps, a task that would be done by actual monkeys if not for a different group of monkeys (JHACO) making rules about poo-flinging.

    Obviously we respect each other's fields.

    This thread ... some doofus EM resident wrote something ridiculous about airway management, we made a little fun of it, and all of a sudden feelings got hurt. FFS guys, lighten up.
     
  46. ranvier

    ranvier I can't anesthetize a rumor. 10+ Year Member

    214
    114
    Jul 17, 2006
    Retrograde wire for the win.
     
    twoliter and nimbus like this.
  47. nimbus

    nimbus Member 10+ Year Member

    1,842
    995
    Jan 13, 2006

    So why DO they use 22g cutting needles?;)
     
  48. anbuitachi

    anbuitachi ASA Member 7+ Year Member

    2,626
    509
    Oct 26, 2008
    Utah
    my guess is that is what is in their kits
     
    pgg likes this.
  49. nimbus

    nimbus Member 10+ Year Member

    1,842
    995
    Jan 13, 2006
    Don't they care about the literature regarding PDPHAs?
     
  50. grapp

    grapp EMT 2+ Year Member

    Don't get me started on the audacity of paramedic students, I'm only an EMT and I know how stupid they can be. Lol!
     
  51. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

    10,526
    4,372
    Dec 14, 2005
    Home Again
    The 22 cutter is in the kit ... and since they're draining off CSF and measuring opening pressure, they need a larger needle. The procedure is technically easier with a bigger/stiffer needle too.

    But it seems to me they could at least use pencil-point 22 g needles. Maybe one of our EM visitors could tell us. :)
     
    nimbus and grapp like this.

Thread Status:
Not open for further replies.

Share This Page