How 'hands-on' is EM?

[Handsome88]

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What hands-on procedures do you do on a daily basis?

Do EM docs ever have to do minor operations or do surgical procedures (stitching a cut is not operating) or do they just consult the trauma surgeon if there is say a stab-wound?

How many resuscitation procedures do you do?

 

[deleted109597]

What hands-on procedures do you do on a daily basis?

Not many. I do my best work on the phone.

Do EM docs ever have to do minor operations or do surgical procedures (stitching a cut is not operating) or do they just consult the trauma surgeon if there is say a stab-wound?

Sure, the other day I took out an appy in fasttrack.

How many resuscitation procedures do you do?

Not many. They usually just die.

Sort of tongue in cheek.

 

[leorl]

to McNinja

Seriously though to the OP, we do tons. Is there anything specific you want to know? Some places (ie. tertiary referral centers or even secondary centers) may do more. Once you do a procedure x amount of times it loses its appeal. Different hospitals have different policies. At some hospitals, trauma team does more stuff. At others, ER does trauma resus and the subsequent procedures. Regardless if trauma team does not show up for a period of time, ER is going to do the resus with whatever procedure needs to be done.

Not many. I do my best work on the phone.
Sure, the other day I took out an appy in fasttrack.
Not many. They usually just die.

Sort of tongue in cheek.

 

[Chrism611]

I'm definitely not a physician, just a volunteer in my ER.

We are a Level 2 Trauma Center.

Our ER is all we have. We have ortho and General Surgery. No trauma surgeons.
It's hands on in the ER. Ive seen 2 open chests due to GSWs. Seen 2 patients resuscitated, but a lot more who are not so lucky.

If our current General Surgeon cannot handle the case and they are stabilized they usually get a helicopter ride. Emergency Medicine here is very hands on though.

I think the hands on experience depends on where you are and the facility you are working in.

 

[Arcan57]

What hands-on procedures do you do on a daily basis?

Do EM docs ever have to do minor operations or do surgical procedures (stitching a cut is not operating) or do they just consult the trauma surgeon if there is say a stab-wound?

How many resuscitation procedures do you do?

Other than admit chest pain (McNinja MD speaks truth), I don't think there's anything I do every shift. The common procedures in emergency medicine are going to be suturing (quite common depending on presence of midlevels) to airway management (much less common). Both of these procedures (with rare exceptions) are difficult to foist off on other specialties (suturing because no one wants to and airway management because of the time factor). Some docs put in central lines commonly, some docs never put in a line (depends on ICU coverage and how often you need to transfer to a high level of care). Lumbar punctures and joint reductions would be the second tier of procedures, with chest tubes and vaginal deliveries being extremely rare.

Note that depending on where you practice, you may do some uncommon procedures much more than your colleagues. ED doc in ski country will likely see a ton of dislocations, tertiary care docs may put in CVLs every shift, inner citiy EPs with loads of penetrating trauma may do chest tubes more frequently. We don't do surgery, and I've never seen the point of cracking someone's chest if I don't have access to a trauma surgeon. Let someone else start the autopsy.

There are a lot of procedure rich specialties, and EM is on the low end of that spectrum in terms of number of procedures performed. We have to be proficient at a wide variety of procedures that we rarely perform and when we do they are often under adverse conditions. That's the challenge moreso than the technical skill required to do the typical EM procedure.

 

[heroin5]

 

[IamSuperDoctor]

whats going on in that picture Laparotomy&Thoracotomy

 

[gutonc]

whats going on in that picture Laparotomy&Thoracotomy

ED autopsy.

 

[HankReardon]

I'm gonna guess that things ended poorly for that patient...

 

[TrumpetDoc]

Definitely has a lot to do with presence of midlevels.
Lots and lots o intubations.
Lots of lines...particularly with the sepsis fascination.
Really depends...busy ED - lots more procedures. Just a numbers game.
Prob do more LPs than anything else.

 

[FDNewbie]

My $0.02, YMMV (your mileage may vary). It's completely different from place to place. There are places (with and without a residency, mind you) that consult for anything and everything. And then there are places that DO everything. I made it a point to find that out before applying to residency, because I did NOT wanna end up at a place that consults everyone. What kind of procedural skill do you think you'd end up with at a place like that? That's where the "ER doc = phone a friend doc/glorified triage nurse" rep comes from. Granted, everything has it's place. When you're getting killed with sick patients, spending 20-30 min doing a procedure may not be the best use of your time, when you can see a few very sick patients and get their workup/treatment started in the same amount of time. So it is a game of utilizing your time & skills appropriately.

Where I'm doing my residency now, we pretty much do every procedure under the sun ourselves. We don't run Trauma per say, but there's always an EM Resident on the Trauma team, and the resident working in the ED runs airway. If Trauma hasn't arrived, we'll run it until they arrive. If it's really busy (multiple traumas at once), we'll run some and they'll run some.

Another thing to think about is, with many (not all...that's my disclaimer) of these large academic programs, you have 1001 fellowships. In turn, you'll have the fellows swooping down to steal many procedures from ya. Which again is why I love my program. Huge community program with full residencies, but only 3 fellowships - and none of them interfere with your procedural/educational experience.

Lastly (as already mentioned by previous posters) is your acuity level. Our acuity level is VERY high; we admit 30% of our patients. Ppl are sick as heck when they come in to our ED. Vs. say some EDs I've been to where a croupy kid was a Level 1 haha (a Level 1 for us is a cardiac arrest, impending resp failure req. intubation, or a STEMI).

Something to think about.

 

[deuist]

I'm about 10 months into my residency and not counting the anesthesia rotation:

50 central lines,
10 lumbar punctures,
20 intubations, and
1 chest tube

We don't have lots of penetrating trauma; so the thoracotomies and other cowboy moves are not there. As mentioned earlier, your mileage will vary based on location.