How do you feel if...

[melonque]

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How do you feel if in a trauma case you are pushed to the side watching all the trauma surgeons saving life, or making final decision w/out your input? And your only part is to put the tube in.

How do you feel that after all these years of training you begin to find out as a EM physician you are not needed to save a life?

How do you deal with these emotions under these situation? Isn't that at the bottom of most EP's heart, they want to save a life?

Thanks

 

[SHOX]

Clearly an attempt to start a controversy...

All I will say is in the universally accepted ABCs of Trauma, what comes first? Not cut, not thoracotomy, not chest tube or DPL.... but AIRWAY. Gee, I wonder why it's first?

Oh, and I'm sure I speak for most if not all EPs in saying w can do any trauma procedure as well as any other health professional in the clutch. But this is beside the point since A comes first and we all know who is the king of A in the ED... roar!!!

Enough said.

SH

 

[drpcb]

You know what's great about "just putting the tube in?"
Never heard of anyone getting Hep C or HIV from an ET.
If I work somewhere where I just have to "put the tube in" I consider myself very lucky, and my wife and son feel the same way. I wish there weren't so many bloodborne incurable pathogens out there but I guess thats reality.

 

[melonque]

I don't have too much time to start any kind of controversy here in the internet. Sorry to those who are offended by my seemingly ignorant questions.

The reason I asked is that I was in a level-1 trauma center, and there was a really bad MVA of a guy w/ GCS of 3. The situation was just like what I described: after the EM physician put in the tube, then he really stepped aside to let the trauma team totally take over. And I noticed the EM attending was not even asked for anything. I was surprised and not cool by the situation, and thus I asked all these questions.

Sorry, I have too little experiences to sort these things out, and I could not ask anyone for this, so I wanna ask ppl here.

Anyway, sorry again for the questions, but they really are givin' me a lot of thinking recently, and I need guidance.

Enough explanation? For those who try to bash on EM in this thread, please do not attempt. I am all pro-EM, so these questions are important to me. thanks in advance.

 

[sweetfynesse]

melonque,

i think its fair of you to post whatever questions your heart desires.

its very difficult to explain the dichotomy between trauma surgeons and emergency physicians. the truth is, the function of both teams is dependent upon the hospital. there are several ways traumas are run in my experience: 1. where i trained as a medical student, we had a trauma service that was paged in the event of a trauma code and they ran the entire code. the emergency physicians didn't even step into the trauma bay (aside: and the anesthesiology residents passed the tube). 2: in other hospitals i've also seen it where trauma and emergency rotate who runs the trauma code, ie trauma runs the code on even days of the month, and em runs it on odd days. 3. where i am now, we (the emergency physicians, run the trauma and we call the surgeons if there is a significant chance they may need surgical interventions or a stay in the sicu.

bottom line, it really depends on what type of hospital you want to work in. i know some ep's that are happy with the idea of not having to run traumas. and then there are many others who live for the next bilateral chest tubes, et, thoracotomy, and stabilization just prior to the pt heads to the or. in the end, its always ABCDE anyway. not too much thought...

and er isn't just about penetrating/blunt traumas, there are just as, if not more exciting, life-saving manuevers in non-traumatic patients...MIs, dissections, appendicitis, sepsis, pte, ape, chf, etc, i can go on forever...there's enough life-saving to go around....

 

[Sessamoid]

After residency, and now working in a level 2 trauma center, I can say that I've pretty well had my fill of trauma. I don't have any aversion to it, but it doesn't really make my day either. It's messy, the initial work is relatively routine, and doesn't require much thought unless and until the patient goes to the OR.

I'm quite happy just putting in a tube now and then for the trauma guys or putting in a chest tube once in a while until our surgeons get there.

 

[Apollyon]

The first thing to remember is that, without the patients, none of us would be there. As such, the patients need the best person for the job.

As SHOX says, we can do any trauma procedure as well as any other health professional. As much or as little as we might get, there's always more coming. That's why it's not a big deal.

We're all on the same team. Patients get the best care from a continuum. And, someone willing to get elbow deep in guts, I will freely wave them by. But, if they ask for me, or wave me in, I'm in there just as quickly.