ER Residency hours

[KinesiologyNerd]

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Both exist, but it's recommended to do 4

No it's not, but as others have said EM is preferred over ER.

 

[Tenk]

I work at a major level 1 trauma center in a highly populated area and I have to say -- EM here is a joke. Their patient/provider time is ridiculously low -- so low that I've been consulted before they actually seen the damn patient..." -- their PAs handle 90% of the paper-work, general surgery runs all their traumas and does most of the intubations/chest tubes/thoracotomies, and yet somehow, it's "high stress."

Not once in my entire career have I seen a non-ENT surgeon intubate.

Is it just cultural for surgeon to hate the ED? Probably.

No it is not cultural for surgeons to hate the ED. It is cultural for RESIDENTS to hate the ED. The ED gives you more work that you don't get a penny for. Once you become an attending you will learn to love the ED because they will tuck your patients in for the night so you don't have to drive to the hospital at 3 am to admit somebody. Instead, you can get a full nights sleep for your day in the OR tomorrow. I am friends with pretty much all my hospitalists and surgeons. I help them out, they help me out. By doing so everyone is happy instead of being miserable. Hopefully you will find a place where this is true. Otherwise, you should find another job.

 

[caffeinemia]

Not once in my entire career have I seen a non-ENT surgeon intubate.

WTF are you talking about? All general surgeons and general surgery residents have shoved a ET tube down someone's throat. You are thinking about an emergency cricothryoidotomy.

 

[Tenk]

WTF are you talking about? All general surgeons and general surgery residents have shoved a ET tube down someone's throat. You are thinking about an emergency cricothryoidotomy.

No I am not. Head of the bed is always ER or anesthesia in every single level 1 trauma center I have been at or visited which is quite a few in multiple different states.

Nice job dodging my other points though. Take care and good luck in the future for you.

 

[tiedyeddog]

No I am not. Head of the bed is always ER or anesthesia in every single level 1 trauma center I have been at or visited which is quite a few in multiple different states.

Nice job dodging my other points though. Take care and good luck in the future for you.

What is your point here? Yes in traumas ER or anesthesia runs the airway. At my institution it is always anesthesia for level ones.

I have to have intubations as part of my procedures by the time I graduate as a neurosurgery resident. Am I going to get the airway in a trauma? Hell no. Why would I do it if anesthesia is right there with 1000x the experience I have?


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[Tenk]

What is your point here? Yes in traumas ER or anesthesia runs the airway. At my institution it is always anesthesia for level ones.

I have to have intubations as part of my procedures by the time I graduate as a neurosurgery resident. Am I going to get the airway in a trauma? Hell no. Why would I do it if anesthesia is right there with 1000x the experience I have?


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Did you read his post or just post reactively? He stated at his busy level 1 trauma center, surgery "does most of the intubations." That is literally a direct quote that is just 100% not true. I know surgery residents intubate in the OR under the guidance of anesthesia as residents. ENT docs are the only attending surgeons I have seen who regularly intubate in the OR. I have even seen an ENT doctor intubate a PICU patient who anesthesia couldn't get. He walked in calm as hell like a boss and dropped that tube in seconds. It was very impressive. I am not saying surgeons cannot intubate, I am saying as surgery residents, you do not intubate regularly in the ED in a trauma situation. That is my point.

 

[tiedyeddog]

I am not saying surgeons cannot intubate, I am saying as surgery residents, you do not intubate regularly in the ED in a trauma situation. That is my point.

That's a fair point, I have only intubated in the OR or ICU and will never intubate in the ED. I thought you were literally saying surgery residents never intubate.


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[Zebra Hunter]

Trauma usually runs the traumas but the EM resident will be involved and occasionally the senior EM will run the traumas if the trauma service is tied up with other traumas in the next bay. My hospital is the only trauma in the county and with multiple interstates crossing near us we get tons of traumas back to back and the trauma service will often get swamped. EM does intubations and lines occasionally though they do a piss poor job and we have to redo lines when the patients get to the OR.

I'm curious what exactly about the ER's lines (I'm assuming you're talking central line), was done so poorly that it had to be redone? It's either in the IJ/femoral/subclavian or it's not. I have a very hard time believing you are frequently replacing ER-placed central lines while in the OR.

 

[caffeinemia]

I'm curious what exactly about the ER's lines (I'm assuming you're talking central line), was done so poorly that it had to be redone? It's either in the IJ/femoral/subclavian or it's not. I have a very hard time believing you are frequently replacing ER-placed central lines while in the OR.

Lines not sutured in, lines half sutured in, lines curled inside the vessel and never even get near the RA. Positional a-lines with piss poor waveforms. Tubes in the R mainstem, tubes barely past the cords, tubes in and then dislodged because they weren't secured. You name it, seen it all. Granted, in an trauma situation, you get what you can get and if it's moving fluid it's moving fluid. Re-doing a line or tube in a controlled environment like the OR isn't really a big deal.

No I am not. Head of the bed is always ER or anesthesia in every single level 1 trauma center I have been at or visited which is quite a few in multiple different states.

Nice job dodging my other points though. Take care and good luck in the future for you.

You probably haven't seen as many as you'd like to think then. Given there's >1500 trauma centers of all sorts in this country, your sample doesn't mean anything. See getdown's post above to prove my point.

Also, what other points? That you admit patients from the ED for other physicians? Oh ho, god forbid you do your one sole job, other than picking up the phone and calling consults. Where I work, surgeons and the surgical service actually see their patients and deal with their own readmits. Hence, the idea of direct admissions and surgeons having admitting privileges. No thanks ED, the sooner our patients get the hell out of there, the better.