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

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

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  1. Venko

    Venko True to self Lifetime Donor Classifieds Approved 10+ Year Member

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    Folks...

    I will check back in a day or two, but please know this:

    The EM resident was too broad in their speech in my opinion.

    As a generality, I believe airways are the focus of study of anesthesiology.

    I continue to believe (despite how arrogant it may be) that there are some select ED docs who can under select circumstances perform better than select anesthesiologists.

    I am not the airway king of emergency medicine and am fortunate to work with great team of surgeons and anesthesiologists who back me up in those times of need.

    You all are great at what you do. Don't let the misguided ED resident make you feel less than valued. Please don't undervalue others either in return.

    I love that I'm not an anesthesiologist and that you all love that you are. The patients get the best of all of us this way.


    Sent from my iPhone using SDN mobile
     
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  3. TimesNewRoman

    TimesNewRoman 2+ Year Member

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    Where the hell are the mods???
     
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  4. MoMoGesiologist

    MoMoGesiologist ASA Member

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    Oh man that was the smoothest easiest AFOI I've ever seen. All he did was a transtracheal block and spray the VCs during the AFOI? No glycco, nebulized lidocaine plus multiple lidocaine swish and spits and lido sprays, no sedatives and infusions!? Is this really how people are doing these out there? So many ways of doing anesthesia I've never seen or experienced or can even think or dream of. What a world what a world...
     
  5. pgg

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

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    :hello:

    Use the report button if you feel strongly that a post or a thread needs action.
     
  6. B-Bone

    B-Bone Attending 10+ Year Member

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    Relatively recent Mayo anesthesia grad here (actually we were interns together!). At least during my tenure, CA-2 carrying code pager went to every level one trauma activation in the ED. Rarely (but definitely not never) intervened, but always present.
     
  7. Venko

    Venko True to self Lifetime Donor Classifieds Approved 10+ Year Member

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    Yup. All level reds. (We got rid of level 1 and 2 designations a few years ago).

    Of the percent of intubations in our ED, anesthesia attends...rarely.


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  8. pjl

    pjl ASA Member 10+ Year Member

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    I know exactly who that one anesthesiologist is.

    Guys, give the ED guy a break, he just is arguing that in some situations he may be better suited. Just like when a patient needed a trach in my ED, the two ED boarded people backed up and let anesthesia handle it...Generally ED is all over that, but not every time, everywhere.


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  9. Arch Guillotti

    Arch Guillotti Senior Member Lifetime Donor Classifieds Approved SDN Administrator 10+ Year Member

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    :whoa:

    Usually threads like this die out after everyone has beaten the subject to a pulp. Use the "REPORT POST" function if something bothers you terribly.
     
  10. anbuitachi

    anbuitachi ASA Member 7+ Year Member

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    I think he's just saying its not 100%. There may be a ED doctor somewhere who is better than an anesthesiologist somewhere. I dont disagree with that. Everyone has different backgrounds. Even in my department in one institution we have plenty of anesthesiology attendings whos done 2 residencys, or multiple fellowships, or switched over from another field (ortho, surgery, urology, medicine, etc). I can imagine our residents who were recently senior urology residents might put in foleys better than some urology attendings (who probably haven't put one in in a while). The same goes for ED, it depends on their environment/background/training.
     
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  11. bashwell

    bashwell Classifieds Approved 2+ Year Member

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  12. AdmiralChz

    AdmiralChz ASA Member 7+ Year Member

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  13. Psai

    Psai Account on Hold 2+ Year Member

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    It's really sad how quickly the term "board certification" became meaningless with nurses giving them out like little league trophies while medical boards are adding more and more expensive nonsense every year.
     
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  14. IlDestriero

    IlDestriero Ether Man 7+ Year Member

    You know her DNP research project was good because it is going to be published in the Journal of Emergency Nursing!
    I definitely want to read it.



    --
    Il Destriero
     
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  15. IlDestriero

    IlDestriero Ether Man 7+ Year Member

    Oooh, I found it!
    Cardiac or Anxiety: A Literature Review of the Young Adult Patient Who Presents to the Emergency Department With Chest Pain 108 Kathryn Lynn Miley, DNP
    It took 3 years to make it to print even though it was "accepted" in 2013 and was a literature review that we would give an intern or 4th year med student to do, if they had the time.
    I'm sure her patients sleep better knowing she's an expert in the very dangerous young adult chest pain!
    --
    Il Destriero
     
    Last edited: Aug 13, 2017
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  16. bashwell

    bashwell Classifieds Approved 2+ Year Member

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    As far as learning some actual airway management, the more senior residents and attendings might already know all this stuff so apologies if it shouldn't be here, but I really like Keith Greenland's videos (he's an anesthesiologist/anaesthetist in Australia).
     
  17. Arch Guillotti

    Arch Guillotti Senior Member Lifetime Donor Classifieds Approved SDN Administrator 10+ Year Member

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    They don't do a dissertation or anything really academic. Every one I have ever seen has been a literature review or some other nonsense.
     
  18. Arch Guillotti

    Arch Guillotti Senior Member Lifetime Donor Classifieds Approved SDN Administrator 10+ Year Member

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    This pretty much says it all. Just a wannabe.
     
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  19. Psai

    Psai Account on Hold 2+ Year Member

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    Excuse you, she's a board certified emergency medicine doctor and as such is better than trauma difficult airway management than everyone posting here except venko and groove. Do you deny that at least one np is better than some anesthesiol hahaha I can't finish it.
     
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  20. Newtwo

    Newtwo 2+ Year Member

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    ba ha ha ha ha, that is beyond funny....
     
  21. Newtwo

    Newtwo 2+ Year Member

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    Right on mate. Would this emerg resident take on a 300 pound category 1 c-section at 3am? Solo?
     
  22. Groove

    Groove Member 10+ Year Member

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    LOL. I love these anecdotal posts that somehow imply this vast evidence of "crashing airway" or "trauma airway" superiority in anesthesia vs EM. Like everyone else is aware of just how much we suck....except us and just don't want to tell us so that they won't hurt our feelings. Like we're the fat kid on the playground with our parachute pants split open exposing our soiled briefs but nobody has the heart to come tell us. (Ok, I'm showing my age here..) I'm just saying give some of us an effing break. If your mad skills are so superior then where is your data supporting this intubation superiority in the ED? Studies like this one just don't show ANY STATISTICAL DIFFERENCE between an emergency medicine attending and an anesthesiology attending with intubation success rates. Given...there is a dearth of studies out there, but the two that I managed to find show....nothing, nada, zilch.

    So, if you want to run around yapping about how superior you are at intubating my patients "and everybody knows it", then generate some studies so that you can do more than dog paddle in this evidence based swimming pool we live in these days. Generate some lit on anesthesia attending intubation success vs CRNA success while you're at it. (Why aren't there more of these?) I can't imagine the hell storm that would generate but still...

    I mean, do you have anything other than anecdotal "I was there on a murky night at 12am when a roided up ED attending with a cowboy hat on chewing on a toothpick single handedly perforated this guys esophagus and transected his spinal column with one DL attempt!" Horrors!

    CONCLUSIONS

    In a single, urban ED, we found that emergency physicians and EM residents under their supervision can safely manage the airways of trauma victims withsuccess and failure rates similar to those of anesthesiologists. It may be safe for trauma centers to utilize emergency physicians as the primary managers of the airway, with anesthesiologists available for difficult cases. Resistance to trauma airway management by EM is not supported by current data.


    :D

    Oh, and thanks to whomever posted the Keith Greenland link...very educational. I like those...

    Ok, I'll stop.
     
    Last edited: Aug 16, 2017
  23. nimbus

    nimbus Member 10+ Year Member

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    I don't understand the point of this. The original Reddit post says EM docs are superior. What could an anesthesiologist offer since we only intubate under ideal conditions? Wouldn't the EM doc be better for difficult cases? But you can call us for the ideal ones.
     
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  24. Southpaw

    Southpaw ASA Member 10+ Year Member

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    Please do. I was sympathetic to your desire for MD only care and supported your feelings. I was sympathetic to your initial posting, and stated as such saying we should all be on the same team.

    Now, you've gone entirely overboard, and appear to be shaming us with your desire for inferiority studies (CRNAs do the same, maybe PAs and NPs in the ED will pick up that baton before long). Please, take your ball and go home. You win, or whatever. Argument over. The only people who continue to care I imagine, are medical students, young residents, and bitter attendings. I'm surprised and disappointed this is the direction you've decided upon. I've always respected your posting in the ED forum (which I read often but rarely post in as I'm certainly a fish outta water there).
     
  25. Southpaw

    Southpaw ASA Member 10+ Year Member

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    It's a pointless study, and the conclusion was made before the study even began. Consider why one would even decide to undertake such a study.


    Edit - just read the conclusions that @Groove posted as I can't access the study. I'm so glad that ED docs concluded they're just fine w airway management provided there are anesthesiologists around to help when needed. Real ground breaking, shocking info there.
     
    Last edited: Aug 16, 2017
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  26. Groove

    Groove Member 10+ Year Member

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    Relax, most of my posts are half serious. I have nothing but respect for you guys.

    I just chuckle at some of these anecdotal posts where the ED doc sounds like a character out of South Park.
     
  27. AdmiralChz

    AdmiralChz ASA Member 7+ Year Member

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    Seriously, @Groove this thread was 4 days old and on the way to the depths of the forums when you revived it. We get it, we hurt your feelings. When you go on the attack on us with the CRNA stuff multiple times in a thread you aren't going to win many friends around here.

    This was a thread about a ridiculous, almost funny reddit post. People respond to such things with anecdotal stories, because they are also ridiculous and funny and give something to talk about - people do this in person all the time but unli

    Have I witnessed an instance of an anesthesiology attending in residency have a total meltdown and be unable to handle a huge emergency come crashing through the OR doors? Of course, residency is 3 years long.
    Have I seen some trauma surgeons lose their cool in similarly bad situations out of their control? You bet.
    Have I witnessed some really inappropriate airway management by ER residents and attendings during training? Of course. Have I seen some melt down and be unable to handle a critical stroke patient just before going to the IR suite? Yep.

    Unlike you, we aren't extrapolating these (often humorous, but sometimes scary) anecdotal stories to an entire specialty. On the whole, anesthesiologists are excellent at OR emergencies, trauma surgeons are great at dealing with life-threatening penetrating injuries and ER physicians are solid at resuscitation and triage.

    So, my point is, calm down and relax. Coming back after several days ready for another fight and backing yourself up with the non-inferiority studies (with a conclusion that having consultant specialists around is a good thing!) - it reeks of the behavior more expected of a militant physician extender in your ER or ICU. Also, quit complaining about other specialties - a quick visit to your own subspecialty forum finds threads in the top half of the first page lamenting about treatment from surgeons and how they suck, how internal medicine sucks, how anesthesiologists suck and how even your own scribes suck! Enough with the MD on MD violence, just go away.
     
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  28. booohooo

    booohooo 2+ Year Member

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    Personal anecdote time!

    Last weekend I was on call at a large academic hospital in a major US city as a lowly CA2.

    Airway pager goes off, location: Emergency Room. I barely leave the call room when airway pager goes off again, this time it's calling for the surgical airway team. I'm like F******

    I get down there, it doesn't look good. bloody LMAs, ETTs, DLs, glidescope. ED attending is up top bagging the patient. I identify myself and other ED attending near top of bed tells me it's impossible, LMA doesn't fit well, can't get a view with DL or glidescope, we must get a a surgical airway. Surgery wasn't down there yet so I insisted I take a look and intubated the guy on 1st attempt. Grade II view with some external manipulation.

    feltgoodman.jpg
     
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  29. IlDestriero

    IlDestriero Ether Man 7+ Year Member

    Boom! Good job. Hopefully he wasn't down long.


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  30. Urzuz

    Urzuz 5+ Year Member

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    I'm calling BS on this one. Evidence has proven that ED docs are not inferior to anesthesiologists when it comes to airway management.
     
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  31. Psai

    Psai Account on Hold 2+ Year Member

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    Where is your double blinded randomized inferiority trial? How can you be sure that you're statistically significant to the ed attending?
     
  32. plick

    plick 7+ Year Member

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    I'm in EM and boy was I glad when anesthesia helped get the tube when I couldn't during my PGY2 ICU rotation; patient was SVC syndrome marshmallow man who pulled out his tube. The attending intensivist also couldn't get the tube. Granted, the anesthesiologist attending told me afterwards that was the hardest tube ever in his life.

    Point is just be glad when there's other specialists that can be your backup. There's no need to minimize others and stroke your own ego.

    Interestingly, hardest tube of my PGY3 was an anaphylaxis with airway edema that I had no choice but to cric after multiple failed tube attempts. Coincidentally I didn't have any anesthesiology backup at that time.


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  33. Physio Doc 2 Be

    Physio Doc 2 Be Supratentorial problems 10+ Year Member

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    The most important thing I've taken away from this ****show is that we are all physicians and should be much more collegial and less "those damn x specialists." Another doc calls me for help and I think it is stupid? Guess what, I'll show up and do it even if I curse under my breath as I roll out of the call room bed. Because someone else who bears the same letters after their name said "I'm not the best person to handle this, could you please come help me and my patient." Because that's what is right.

    All the while we are fighting with one another and watching our profession and scopes of practice get eroded away by our laziness, greed, or infighting.

    But what do I know? I'm just a stupid resident who hasn't been out in the "real" world before.
     
    Last edited: Aug 17, 2017
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  34. booohooo

    booohooo 2+ Year Member

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    I don't have a a randomized control trial to document this lol. I was sharing a single recent personal anecdote.
     
  35. HooliganSnail

    HooliganSnail 5+ Year Member

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    I am an ER resident, and I cover codes and airways solo throughout the hospital. Our residents take rotating ICU call, and we are the crash team for the hospital when we are on.

    We are also a small community hospital, and I haven't seen an anesthesiologist outside the OR in 3 years.
     
  36. AdmiralChz

    AdmiralChz ASA Member 7+ Year Member

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    Dude, this thread was just about dead and you brought it back. Why, so you could provide a weak personal anecdote?
     
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  37. Psai

    Psai Account on Hold 2+ Year Member

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    We should go to the pulm forums and tell them that we are better than them at bronchs. "But we do it in emergent situations you only do it in controlled situations whaa"
     
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  38. HooliganSnail

    HooliganSnail 5+ Year Member

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    You have posted several times nagging others about "reviving this dead thread". A bit odd. It was created less than a month ago. Also, if it's so dead, why are you still reading it?

    The person I responded to was like "Let me know when ER docs can run codes on the floor, because I totally bail them out....blah blah blah." And I'm like.....ok, I'm letting you know. This is a fairly common practice.
     

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