I do see your point, in the small rural areas where I work, the intensivists are more valuable. What happens here is that we just transfer the pts to another center, it's sad but true. Actually we first get the interventional people, then the surgeons, and if they are not available we transfer.
Hey guys. I realize I am bumping an old thread, but wanted to share an idea for airway for any potential "sole house physician in a small rural hospital with a patient that needs an airway". I am EM and not IM but definitely moonlit at places like this during residency (We covered the ED, but were the only doctor in house for inpatient codes, etc...).
For the crashing patient that needs an airway, do the basic primary airway interventions and start bagging them (also, if you are in this situation you should spend a little bit of time familiarizing yourself with LMA and supraglottic devices and bagging - as long as you can oxygenate a patient with bagging, you can put off intubation for a bit) and -
Call EMS. All paramedics are trained in airway, and paramedics in rural areas are usually well adept at it. If nothing else, they can help with the airway and supraglottic devices and hopefully get the patient transferred somewhere where a definitive airway can be established (make sure in the heat of the moment you do a formal transfer via EMTALA rules).
Also consider asking a respiratory therapist if they are there (they train to intubate too generally) - though if it's like some of the hospitals I moonlit in, there isn't even a ventilator after 5 PM. Learned that the hard way after intubating a patient in the ED and then bagging them until we could transfer them and EMS arrived.
It's not a great or even a good situation, but it might save a patient from going into respiratory arrest. Like I said, probably not something you would think to do normally, but might save the patient if you are ever in that (somewhat rare and unique) situation that you might not think about.
Other than that, I'll step out of the thread.