intubation

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I work as a scribe and one time a specialist called the ER and requested a "favor" from the ER physician to intubate a patient. why do specialists defer intubation to the ER physician? It just seems lazy to me. You are supposedly a trained doctor and you do not know how to intubate or are too scared to do it yourself? Unbelievable.

 

[Doctor Strange]

Said specialist might not have intubated a patient for over a decade. Some specialties just don't require you to intubate patients all that often. It's a skill, and, like they say, if you don't use it, you lose it. Better to call someone who knows what their doing than to do it yourself and risk complications.

 

[TheWeeIceMan]

I get the impression that EM does a good deal of intubations, so some specialists are more comfortable defering to someone with more experience.

 

[mimelim]

I work as a scribe and one time a specialist called the ER and requested a "favor" from the ER physician to intubate a patient. why do specialists defer intubation to the ER physician? It just seems lazy to me. You are supposedly a trained doctor and you do not know how to intubate or are too scared to do it yourself? Unbelievable.

How high risk was the patient? How difficult of an airway was the patient expected to be? What was the patient's anatomy? What was the tongue size? What was the ROM of the neck? What was the thyromental distance? What was the inter-incisor gap?

I'm going to go out on a limb here...

1) You don't know anything about intubation.
2) You know little to nothing about medical training of ER physicians and a 'specialist'.

Probably not a good position to be in to judge people and what they do when you know next to nothing about what happened.

 

[mimelim]

Said specialist might not have intubated a patient for over a decade. Some specialties just don't require you to intubate patients all that often. It's a skill, and, like they say, if you don't use it, you lose it. Better to call someone who knows what their doing than to do it yourself and risk complications.

There is only one specialty that requires you to intubate patients all the time (anesthesia). There are a very limited number of specialties that on occasion will intubate patients when needed EM and Critical Care (from anesthesia, GS, Pulm etc).

 

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How high risk was the patient? How difficult of an airway was the patient expected to be? What was the patient's anatomy? What was the tongue size? What was the ROM of the neck? What was the thyromental distance? What was the inter-incisor gap?

I'm going to go out on a limb here...

1) You don't know anything about intubation.
2) You know little to nothing about medical training of ER physicians and a 'specialist'.

Probably not a good position to be in to judge people and what they do when you know next to nothing about what happened.

Again, those are questions a TRAINED PHYSICIAN should know regardless of the specialty.

I am familiar with those questions you posed (ASA classification, which blade to use, which tube to use etc etc), however I am not here to dick wave.

 

[1012526fs]

Clearly the specialist in question did the right thing. He/she called for help when they were either uncomfortable or unpracticed or otherwise just wanted assistance. That's the mark of a true professional; know your limitations and stay within them. You can mock that person all day, but whether or not they "should" know something and choosing to do what is best for the patient regardless, I will still side with the specialist in making that good judgment call.

 

[mimelim]

Again, those are questions a TRAINED PHYSICIAN should know regardless of the specialty.

I am familiar with those questions you posed (ASA classification, which blade to use, which tube to use etc etc), however I am not here to dick wave.

Once again, the fact that you understand next to nothing about intubation explains why this concept doesn't make sense to you. "Trained physician" is a completely meaningless description. This isn't about dick waving. This is about you having zero idea about what was happening around you. In general, if you are ignorant about something you shouldn't 1) take a strong position on it and 2) judge and bad mouth others.

 

[Druggernaut]

Again, those are questions a TRAINED PHYSICIAN should know regardless of the specialty.

It's not uncommon. There's even hospitalists, who are responsible for covering the ICU in community hospitals, who will defer intubation to respiratory therapists whenever possible when other physicians aren't available. Depending on what that doctor's specialty was and the policies of the hospital, it might've been an entirely appropriate request.

There are plenty of skills that some physicians don't do that they probably should be capable of (lumbar puncture, pelvic exam, etc.). I wouldn't lump intubation in there for a lot of specialties.

And as mimelim said, be careful about talking about what other, more highly trained people should or shouldn't know or do. You'll often be proven wrong because you don't know all the variables.

 

[blub1212]

Once again, the fact that you understand next to nothing about intubation explains why this concept doesn't make sense to you. "Trained physician" is a completely meaningless description. This isn't about dick waving. This is about you having zero idea about what was happening around you. In general, if you are ignorant about something you shouldn't 1) take a strong position on it and 2) judge and bad mouth others.

Agree completely. OP clearly doesn't understand. Intubation is a skill. Skills deteriorate if you don't use them. If you're in a specialty that doesn't normally intubate, you are doing the right thing to ask someone else, who does it more often, to help out. I applaud that physician for not letting their pride get in the way of patient care.

 

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What do you do if an EM is not available to do you intubation since you lack the confidence to do it yourself? If s/he is at a code on a different unit, they cannot come and save you. Do you just wing it or wait until the patient dies?

 

[Doctor Strange]

What do you do if an EM is not available to do you intubation since you lack the confidence to do it yourself? If s/he is at a code on a different unit, they cannot come and save you. Do you just wing it or wait until the patient dies?

 

[gasblaster]

What do you do if an EM is not available to do you intubation since you lack the confidence to do it yourself? If s/he is at a code on a different unit, they cannot come and save you. Do you just wing it or wait until the patient dies?

Typically anesthesiology comes to all codes.

You should really heed the words of the upper levels on this forum.

 

[HSUReddie]

Typically anesthesiology comes to all codes.

You should really heed the words of the upper levels on this forum.

This.

Sounds to me like the "specialist" was just being responsible and ensuring the best for his/her patient.

 

[Druggernaut]

What do you do if an EM is not available to do you intubation since you lack the confidence to do it yourself? If s/he is at a code on a different unit, they cannot come and save you. Do you just wing it or wait until the patient dies?

If the EM or anesthesia cavalry isn't coming, you could try to intubate yourself. Or possibly your respiratory therapists are trained in it and willing to give it a crack. Or you go with an LMA, King or Combitube, or some other rescue airway that doesn't require the same degree of skill. Or have someone track down a Glidescope. Or an oral or nasal airway with a bag valve mask. Or something else that's not coming to my medical student mind. But there's a long way to go between calling your colleague for a "favor" (which to me indicates something less urgent than a code situation, so the patient can wait a little while for their tube) and standing there wringing your hands until the patient dies.

What were the details of the situation, and what was the specialty making the call?

 

[deleted307836]

Once again, the fact that you understand next to nothing about intubation explains why this concept doesn't make sense to you. "Trained physician" is a completely meaningless description. This isn't about dick waving. This is about you having zero idea about what was happening around you. In general, if you are ignorant about something you shouldn't 1) take a strong position on it and 2) judge and bad mouth others.

👍

This is something better learned sooner than later...

 

[TheWeeIceMan]

What do you do if an EM is not available to do you intubation since you lack the confidence to do it yourself? If s/he is at a code on a different unit, they cannot come and save you. Do you just wing it or wait until the patient dies?

You go to the roof of the hospital, find and use the toilet on said roof, and wait for Michael J. Fox to arrive via helicopter.








(Please tell me someone gets that)

 

[JBOB]

👍

You go to the roof of the hospital, find and use the toilet on said roof, and wait for Michael J. Fox to arrive via helicopter.








(Please tell me someone gets that)

 

[GopherMD]

You go to the roof of the hospital, find and use the toilet on said roof, and wait for Michael J. Fox to arrive via helicopter.








(Please tell me someone gets that)

Yes!

 

[Internistt]

You go to the roof of the hospital, find and use the toilet on said roof, and wait for Michael J. Fox to arrive via helicopter.








(Please tell me someone gets that)

👍👍 Thats if he/she is a hot blonde.

 

[rain4venus]

you go to the roof of the hospital, find and use the toilet on said roof, and wait for michael j. Fox to arrive via helicopter.

+1 (+4?)

 

[KnuxNole]

Tons of doctors have barely done an intubation and more importantly, don't do it in their day to day career. What specialist was it? Its possible they have never touched a "blade" or intubated since their surgery rotation(ICU rotation as a resident can be considered too). If you find that shocking, you'll have a heart attack in med school

 

[KnuxNole]

What do you do if an EM is not available to do you intubation since you lack the confidence to do it yourself? If s/he is at a code on a different unit, they cannot come and save you. Do you just wing it or wait until the patient dies?

If there is only one EM physician and no gas people, then you need to summon the unicorns!

 

[WhittyPsyche]

You go to the roof of the hospital, find and use the toilet on said roof, and wait for Michael J. Fox to arrive via helicopter.

(Please tell me someone gets that)

Of course! That is the ONLY answer! 😛

 

[Pons Asinorum]

Again, those are questions a TRAINED PHYSICIAN should know regardless of the specialty.

I am familiar with those questions you posed (ASA classification, which blade to use, which tube to use etc etc), however I am not here to dick wave.

I lol'd.

 

[487806]

Typically anesthesiology comes to all codes.

You should really heed the words of the upper levels on this forum.

I agree but that won't happen. The OP suffers from the Arrogant Premed Syndrome, so he feels his views are more important than those of residents and attendings.

I agree with mimelim and others who state that skills not used after a long time are lost.

 

[Ismet]

I agree but that won't happen. The OP suffers from the Arrogant Premed Syndrome, so he feels his views are more important than those of residents and attendings.

I agree with mimelim and others who state that skills not used after a long time are lost.

OP isn't even a pre-med anymore, which makes it more amusing.

 

[Bacchus]

There is only one specialty that requires you to intubate patients all the time (anesthesia). There are a very limited number of specialties that on occasion will intubate patients when needed EM and Critical Care (from anesthesia, GS, Pulm etc).

Even though this guy seems to think I should be able to flawlessly intubate as a future FM, will I even be tubing people as an FM resident? I do my EM rotation intern year with EM residents (they need the numbers). I do my ICU month with IM residents (I assume they need the numbers, too).

As far as I see it, if I would ever need to intubate someone (God forbid, for me and them) I would have to rely on my 2nd rotation of third year when I did anesthesia.

I find it ludicrous for someone to think that's a skill I will retain and be able to do whenever/wherever.

With all that said, I did find intubations fun .

 

[alpinism]

I work as a scribe and one time a specialist called the ER and requested a "favor" from the ER physician to intubate a patient. why do specialists defer intubation to the ER physician? It just seems lazy to me. You are supposedly a trained doctor and you do not know how to intubate or are too scared to do it yourself? Unbelievable.

Again, those are questions a TRAINED PHYSICIAN should know regardless of the specialty.

I am familiar with those questions you posed (ASA classification, which blade to use, which tube to use etc etc), however I am not here to dick wave.

What do you do if an EM is not available to do you intubation since you lack the confidence to do it yourself? If s/he is at a code on a different unit, they cannot come and save you. Do you just wing it or wait until the patient dies?

Lol. Solid trolling.

 

[Cambino]

Lol. Solid trolling.

This is what I had begun to suspect too... I just didn't want to call it. 🙄

 

[FCMike11]

Sorry to bump this thread!

But I work in an ICU and so freaking commonly we will call our Pulmonologists at night with a patient requiring intubation and they seem to ALWAYS defer to an emergency physician. We consider it really lazy. The ER physician almost always does, but is a bit disgruntled.

 

[Mr Avante]

This thread is gold,
... I like how mimelim reacted

 

[Bacchus]

Even though this guy seems to think I should be able to flawlessly intubate as a future FM, will I even be tubing people as an FM resident? I do my EM rotation intern year with EM residents (they need the numbers). I do my ICU month with IM residents (I assume they need the numbers, too).

As far as I see it, if I would ever need to intubate someone (God forbid, for me and them) I would have to rely on my 2nd rotation of third year when I did anesthesia.

I find it ludicrous for someone to think that's a skill I will retain and be able to do whenever/wherever.

With all that said, I did find intubations fun .

Just wanted to say I'm starting my 4th rotation tomorrow as a PGY-1 and I haven't had to use my intubation knowledge yet . The closest I've come is when we were doing an axillary dissection last week.

 

[VisionaryTics]

I work as a scribe and one time a specialist called the ER and requested a "favor" from the ER physician to intubate a patient. why do specialists defer intubation to the ER physician? It just seems lazy to me. You are supposedly a trained doctor and you do not know how to intubate or are too scared to do it yourself? Unbelievable.

lol