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

[periopdoc]

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.

---

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[bashwell]

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.

 

[mmag]

We work hard to make it look easy.

 

[IlDestriero]

The "tracheal vomiting syndrome" gets me every time.

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


--
Il Destriero

 

[powermd]

Attending rolled in, half-asleep, casually crossed the room, DL'd, held out his hand for the tube, placed the tube, and casually strolled out. I remember thinking "what a boss, I want to be that guy."

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!

 

[acidbase1]

Here's one that happened to me from less than a month ago:

60 year old guy gets in an MVA while visiting another state 2 hrs away.

He goes to the local ER, he feels fine, gets a tetanus shot, negative head CT. He is discharged home and drives back to his home state with his wife.

On the ride home he notes trouble speaking, some pain in his throat. He decides to go to right to his home ER after the drive home.

He walks into the ER, gets a regular room, tells his story, says he thinks he is having an allergic reaction to the tetanus booster.

Starts to have difficulty breathing, increasing throat swelling, decision to intubate him by the ER attg after about 1-2hrs in ER room.

Then, my beeper goes off: Surgical Airway Code ER

I enter the room to find the ER attending attempting to intubate with a Miller 3, a bloody mouth, bloody glidescope blade, and a pale white patient who is being coded.

He places the tube and gets condensation but no CO2. Listen to the chest and its likely in the esophagus. Pull it out.

I put the glidescope blade that he was using back into the guys mouth. Nothing but red blood everywhere, no view of anything, ENT preparing to cut.

I change glidescope blades to a new one, see a clear picture now of a massively swollen oropharynx with barely visible tip of the epiglottis.

I managed to intubate him with one pass, and upon intubation pulse returned and he became less cyanotic and HD stable.

Good save, I thought. Next day, EEG shows brain death.

Holy shhhhjjjt

 

[deleted171991]

Next day, EEG shows brain death.

The EM doc's EEG?

</sarcasm>

 

[Hoya11]

The EM doc's EEG?

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.

 

[deleted162650]

and vpeven the crna

strictly taking the odds like I. A good poker game

The on,y thing

anesthesiaperson

end of the algorithm for intu Atkin

Ohad ballinsrbirith

Kids, don't drink and post.

 

[Noyac]

Lots of good points to consider here. But the bottom line is that when the chips hit the table and the cards are laid, chances are that the anesthesiologist and vpeven the crna is a better option than just about any ER doc, period. I'm not trying to be disruptive at all. I appreciate everything you ER guys/gals do but strictly taking the odds like I. A good poker game I'm going with the anesthesia team. The on,y thing more dangerous is overconfidence from the ER person(and anesthesiaperson as well). But we always know that we are attending end of the algorithm for intu Atkin and then it's off to the ENT. AND you saw the response from the one ENT on this post. I always bring them when I can to a bad airway. And it eases my mind if nothing else. I've even used them twice n my career. I'm very very thankful for them. But to have someone like this ER "resident" spew nonesense like this is disturbing to say the least.

Wow I should reread my posts before I hit send. It was late I guess. Hope the gist was conveyed.

 

[Noyac]

Kids, don't drink and post.

Ha ha. Yep. Didn't see this post until after I sent the previous one.

 

[Groove]

Deleted. I hate being the one to make inflammatory posts. This thread just rubbed me the wrong way.

 

[southerndoc]

There was a thread many months back in the em forum where one of them described how they managed a recent difficult airway. Everyone was giving him kudos for successfully getting the airway. I couldn't help but cringe at the flaws and missteps that were made and just the lack of knowledge in general. Didn't have the heart to tell em tho. Sometimes ignorance is bliss

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.

 

[Ezekiel2517]

Awww, did you guys get tired of getting beat down by all the CRNA >= MDA bitch-slappery or screamed at by the surgeon in the OR and need to create a thread where you could all circle round and hate on the EM doc together to get your egos re-inflated? Did the little PGY1-4 EM resident hurt your feelings?

What a ridiculous thread. Do we need to consult you guys more in the ED to make you feel important? Cuz God knows you'll be soooo responsive at 3am for the variceal bleeder projectile vomiting blood or the 650lb beached whale with a COPD exacerbation barfing and aspirating partially digested big macs who's cyanotic who needs intubation. Want to take over airway in the ED? 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 feel absolutely no need to brag on my airway skills in this thread or drop my pants and take part in this pissing contest nor do I need to defend ED docs everywhere. You've got docs who are airway masters and docs who are airway disasters and everywhere in between. If you think you guys are the only docs in the hospital with facile at airway management then you need to get out more.

One would hope we're reasonably good at disaster airway management in the ED because if it's you or your family member arriving in extremis with an indication for a definitive airway, it's going to be me or one of my colleagues standing over your bed intubating you and your loved one. Your anesthesia colleague is going to be nowhere to be found and can't remember the last time he/she was consulted in the ED and likely will have a hard time finding their way down here. C'mon, let's be honest though.... you'd send the CRNA.

Aww, I love you guys and girls! DON'T BE A HATER!

FRIENDLY EM DOC

 

[Apollyon]

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.

 

[Man o War]

Awww, did you guys get tired of getting beat down by all the CRNA >= MDA bitch-slappery or screamed at by the surgeon in the OR and need to create a thread where you could all circle round and hate on the EM doc together to get your egos re-inflated? Did the little PGY1-4 EM resident hurt your feelings?

What a ridiculous thread. Do we need to consult you guys more in the ED to make you feel important? Cuz God knows you'll be soooo responsive at 3am for the variceal bleeder projectile vomiting blood or the 650lb beached whale with a COPD exacerbation barfing and aspirating partially digested big macs who's cyanotic who needs intubation. Want to take over airway in the ED? 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 feel absolutely no need to brag on my airway skills in this thread or drop my pants and take part in this pissing contest nor do I need to defend ED docs everywhere. You've got docs who are airway masters and docs who are airway disasters and everywhere in between. If you think you guys are the only docs in the hospital with facile at airway management then you need to get out more.

One would hope we're reasonably good at disaster airway management in the ED because if it's you or your family member arriving in extremis with an indication for a definitive airway, it's going to be me or one of my colleagues standing over your bed intubating you and your loved one. Your anesthesia colleague is going to be nowhere to be found and can't remember the last time he/she was consulted in the ED and likely will have a hard time finding their way down here. C'mon, let's be honest though.... you'd send the CRNA.

Aww, I love you guys and girls! DON'T BE A HATER!

FRIENDLY EM DOC

Go away murse.
Your use of MDA is a dead give away.

 

[throckmortonDO]

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 *****.

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.

 

[Man o War]

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 *****.

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.

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.

 

[Man o War]

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 *****.

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.

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.

 

[Consigliere]

Whatever. I can say I pitch just as well as Jake Arrieta but that doesn't make it so.

 

[AdmiralChz]

@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!

 

[dchz]

EM attending here

I do have a tool that anesthesia might not have which is cric or surgical trach.
Thats about it.

I might have to disagree here, why is this tool more available to you than us?

 

[deleted128562]

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

 

[southerndoc]

I might have to disagree here, why is this tool more available to you than us?

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.

 

[Robotic Wis-Hipple]

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.

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.

 

[AdmiralChz]

I do have a tool that anesthesia might not have which is cric or surgical trach.

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.

 

[dchz]

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.

but if you do reach for it, it's not gonna be there because it's not available to you

 

[Groove]

@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!

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.

 

[urge]

Recently ran across an interesting conversation on reddit, started off by this quote from a third year EM resident:

"Almost any trauma that requires intubation by definition should be considered a difficult airway and require anticipation of a difficult airway. Similarly with medical resuscitations in the ED. These are precisely the patients that should be intubated by an emergency physician or intensivist, as they are the most competent airway team member in the room in those situations, not the anesthesiologist who intubates under ideal conditions."

I've never run into this line of thinking in real life, but still...

 

[Quixotic2501]

"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.

 

[dchz]

"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.

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.

 

[CardioDad]

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.

 

[deleted547339]

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.

 

[IkeBoy18]

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.

 

[G-Man82]

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.

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

 

[PageDrT]

This is so obviously subjective thinking. I'm not even a Resident but critical thinking says check your source

 

[deleted547339]

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.

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.

 

[Southpaw]

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.

 

[vector2]

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.

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.

 

[Groove]

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.

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.

 

[Groove]

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.

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.

 

[ranvier]

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.

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]

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?

It's so weird that an alleged "EM attending" spends so much time trolling the anesthesia forum. Not buying it for a second.

 

[pgg]

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.

 

[ranvier]

Retrograde wire for the win.

 

[nimbus]

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.

So why DO they use 22g cutting needles?

 

[anbuitachi]

So why DO they use 22g cutting needles?

my guess is that is what is in their kits

 

[nimbus]

my guess is that is what is in their kits

Don't they care about the literature regarding PDPHAs?

 

[grapp]

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.

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!

 

[pgg]

Don't they care about the literature regarding PDPHAs?

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.