ENT Emergencies?

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Nice Marmot

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Hello Otolaryngologists of SDN!

M3 here planning on going into Oto. I was talking to an ENT resident the other day who was telling me that he/she gets slammed on overnight call - foreign bodies, facial trauma, airway issues, the works.

Yesterday, I was stuck in the ED for 3 hours draining 25L of ascitic fluid from someone's belly and started talking to a very friendly ED attending. She told me that in her ED (a busy level-1 trauma center, albeit a community/non-academic hospital) she has only seen ENT come in once overnight. She said she will consult ENT over the phone every few weeks for something but she takes out her own foreign bodies, does her own airway management, and plastics takes facial trauma. She packs her own bleeding noses, etc. etc. Basically most patients with ENT issues are either treated by other providers, or stabilized enough until ENT comes in the morning.

Can anyone comment on this discrepancy? I'm guessing that what both people are telling me (the Oto resident, and the ED attending) are true - the difference is just institution dependent? I'm asking mostly out of curiosity, and also because I do like responding to occasional emergencies. I was kind of bummed to hear from this attending that she rarely sees ENT in the ED overnight.

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I think you're right that it is institution dependent. Where I train, we do all the crazy call stuff you describe. But these things (epistaxis!) tend to get old over time, by the time you're an attending you probably don't want to deal with them at 2am in the ED. That said, I hear both sides from attendings- some who are still being called to take care of relatively simple stuff, while others have been able to educate their colleagues on more judicious use of the ED consult.
 
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Our program has home call (like most do, aside from peds heavy programs). Many nights I'm busy until 1am or so seeing trauma, abscesses, epistaxis, angioedema, etc in addition to usual floor stuff like post-op and flap checks. Some nights are very slow (i.e. I get called once at 8pm for angioedema and am quiet the rest of the night), some are busy until sunrise, but most are in the middle.

This is very institutionally dependent. Our peds hospital has a separate call pool which is similarly busy (but if you added them together like some programs do, it would suck). We take facial trauma call every day, but ER docs are good about only calling for orbits/open mandibles/nasty lacs through nose or lips/etc. They sew 98% of lacs and are good about sending simple fxs to clinic. They pack most nosebleeds and call us if it's not stopping.

Also agree with @educ8r that being up all night seeing stupid **** gets old fast. Just because ENT residents are up all night doing the ER's job for them doesn't mean they're getting good training.
 
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Hello Otolaryngologists of SDN!

M3 here planning on going into Oto. I was talking to an ENT resident the other day who was telling me that he/she gets slammed on overnight call - foreign bodies, facial trauma, airway issues, the works.

Yesterday, I was stuck in the ED for 3 hours draining 25L of ascitic fluid from someone's belly and started talking to a very friendly ED attending. She told me that in her ED (a busy level-1 trauma center, albeit a community/non-academic hospital) she has only seen ENT come in once overnight. She said she will consult ENT over the phone every few weeks for something but she takes out her own foreign bodies, does her own airway management, and plastics takes facial trauma. She packs her own bleeding noses, etc. etc. Basically most patients with ENT issues are either treated by other providers, or stabilized enough until ENT comes in the morning.

Can anyone comment on this discrepancy? I'm guessing that what both people are telling me (the Oto resident, and the ED attending) are true - the difference is just institution dependent? I'm asking mostly out of curiosity, and also because I do like responding to occasional emergencies. I was kind of bummed to hear from this attending that she rarely sees ENT in the ED overnight.

Yes, we get slammed on call. I frequently do no sleep on call and without a post-call day it is miserable. If you are in a big city with ENT coverage, the call is brutal. The ENT attendings locally here also get brutalized on call. Just because someone "doesn't see ENT in the ED" does not mean they weren't there. If a tree falls in the woods.....
 
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It's all very area dependent. In my practice in a small, college town I rarely end up in the ER on call. I'm on call every third night and every fourth weekend. So far this year I think I've gone in twice. Generally speaking the ER should be able to manage most lacs, triage most trauma (i.e. almost none needs overnight evaluation), pack most noses. I generally go in for bad airways (angioedema, epiglottitis, Ludwig's) , bleeding after tonsillectomy, and dental problems (odontogenic abscess/cellulitis) - because dentists don't actually care to take care of people. There's only so much of that stuff that happens in a smaller area.
 
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