Is there anything good about EM?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad.
thegenius said:
Who here, speaking only to BC EM doctors, think they could do an appy by themselves with no other assistance besides the surgery tech help you out? And have a good outcome? It would be in a proper OR and appropriate anesthesia. You can use any tool available in the ER.

I think I could...might take me 2-3 hours though. Definitely open, not laparoscopic. I would make a bigger incision than normal. Estimated blood loss for me? Maybe 50 cc.

Just a thought question and please, for those dinguses out there who would take me seriously like I'm actually gonna do it. PHLUSSEEE
Click to expand...

Nope.
No idea how to do it.
Even open.
I forget how to "scrub in".
Find the appy, I could do.
What next ?
Get that magic stapler that they have ?
Okay. Maybe.
Cut off the appy after stapling it, I guess.
Close. Somehow.

Nope.
 
I would have no ****ing clue
thegenius said:
Who here, speaking only to BC EM doctors, think they could do an appy by themselves with no other assistance besides the surgery tech help you out? And have a good outcome? It would be in a proper OR and appropriate anesthesia. You can use any tool available in the ER.

I think I could...might take me 2-3 hours though. Definitely open, not laparoscopic. I would make a bigger incision than normal. Estimated blood loss for me? Maybe 50 cc.

Just a thought question and please, for those dinguses out there who would take me seriously like I'm actually gonna do it. PHLUSSEEE
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
We (doctors) are there for when it's hard/bad, not when it's easy. Appy? Straightforward, someone with a protocol book could do it. Carcinoid? Retrocecal? Tumor? Meckel's diverticulum? That's when you need a surgeon. It's like us in the ED - any schmuck can do croup. But, what about Kawasaki? The mentioned-in-the-other-thread retropharyngeal abscess? That's why we are there. Not for the 95% chip shots, but the 5% "badness that is just so slightly different from goodness". As the aphorism goes, "The eye does not see what the mind does not know."
 
RustedFox said:
Nope.
No idea how to do it.
Even open.
I forget how to "scrub in".
Find the appy, I could do.
What next ?
Get that magic stapler that they have ?
Okay. Maybe.
Cut off the appy after stapling it, I guess.
Close. Somehow.

Nope.
Click to expand...

I think I could....but then again I'm naively stupid.

Scrub in (I remember how to do that)
I ask the tech to hand me the sterile scrub / soap solution and scrub down the pt's whole abdomen
Tech hands me the drape and drape the entire dude
anesthesia you ready? I grab some forceps and pinch the abd skin, if the pt flinches or quivers then maybe the paralytic hasn't kicked in yet.
TIMEOUT!!!
make a 10-15 cm incision in the RLQ. dissect to the parietal peritoneum.
use the zapper cautery metal thing and zap anything that bleeds.
Hmm...entering the peritoneum. How do you do that without knicking the underlying bowel?
I think they use a pickup and "pick up"parietal peritoneum and make a tiny nick in it with scissors
but then blunt dissect everything else, don't want to damage the bowel
OK you are in. there is bowel. I'll pick it up and look at it. play around with it. Where is the appendix?
We all could find that. It probably doesn't look the same as the other bowel.
Find the entire thing.
Gotta cauterize the blood supply to the appendix.
Yea the GIA stapler. How do you use that thing? I think you just put it over the cecum (DON'T GET THE terminal ileum!!) and "BZZZZZZZZZ" and it just staples the entire thing shut. I think that's how it works.
I would ask the tech to get me some sterile objects in the OR and try it on that first, like some sterile drapes or something.
At the end of the day you could also just put a hemostat over the cecum and just take scissors and cut the appendix off. Then you have to sew the cecum closed. I would use 2.0 suture that absorbs in 60 days. Tech get me some of that.
Ok look for bleeding
Look
Look
ZAP!!
Look
Look
ZAP!!! ZAP
Look

then I would put in 2L of sterile saline into the entire cavity and suck it out with the suction tubing. Is there any more bleeding?
Do I even need to run the bowel? I would probably do a regional bowel run.
OK
appendix out no bleeding
close the parietal peritoneum FIRST with non-absorbable suture that is 2.0. Tech get me some of that please and load it on a needle driver.
MAKE SURE YOU DON'T SUTURE the bowel while closing the peritoneum. Use a metal plate to guard against doing that. Remember that while on your surgery rotation?


WAIT.......

Maybe I would put in a JP drain too just "to make sure" This case is not a perforated appendicitis so I don't think you need it, but I don't trust myself. So I would puncture a new hole in the peritoneum and place a drain, and suture it to the outside so it doesn't slip.


Now close the parietal peritoneum as above
Then I would do vertical mattresses or staples and close the rest of the skin.
bacitracin, gauze

anesthesia I'm done.

PACU

Pray

I think I could do it. ~3 hours though.
 
Apollyon said:
"Run the bowel"? What the **** does that even mean?
Click to expand...

You never heard that on your medical school surgery rotation?

It means you take the bowel out of the pt's body and run around the OR in circles. It helps air it out.
The faster you run, the more effective it is
 
thegenius said:
You never heard that on your medical school surgery rotation?

It means you take the bowel out of the pt's body and run around the OR in circles. It helps air it out.
The faster you run, the more effective it is
Click to expand...
I am half/3 quarters in the bag. At first, I had a serious/stupid response. Then, I read it again, and, good on ya!
 
I don't think most EM doctors could do an appendectomy. The same way (lesser scale) I don't think "most *****s" can handle croup/bronchiolitis. Just look at the unnecessary steroids (for bronchiolitis), antibiotics, and plain films provided.

Sent from my Pixel 3 using SDN mobile
 
I couldn’t do it. Much like an FP doc cant do a good job in the ed. I know might be unpopular. Similarly someone can do fine on 80% of em cases. It’s the other 20%.
 
TheSingularity said:
I don't think most EM doctors could do an appendectomy. The same way (lesser scale) I don't think "most *****s" can handle croup/bronchiolitis. Just look at the unnecessary steroids (for bronchiolitis), antibiotics, and plain films provided.

Sent from my Pixel 3 using SDN mobile
Click to expand...
"Schmucks", not "*****s". And, yes, not doctors handle croup. And, if you can confidently diagnose bronchiolitis just by clinical exam, well, you are either superior, or a cowboy.
 
Oh. I always thought it had something to do with causing the patient to have diarrhea.

/kidding
thegenius said:
You never heard that on your medical school surgery rotation?

It means you take the bowel out of the pt's body and run around the OR in circles. It helps air it out.
The faster you run, the more effective it is
Click to expand...
 
giphy.gif
 
Eh. I did a surgical internship. I can do it. I promise.

Because I have.
 
slz1900 said:
Don't really want to derail, but I literally saw pictures of it. Crazy stuff happens in public hospitals in developing countries.
Click to expand...

Not that kind of crazy stuff. I've lived in that part of the world. My wife and sister went to government schools there, along with a bunch of high school friends. Maybe during house job (intern year equivalent).

Anyway back to the topic, i like my 18-19 days off a month and my 400k+ paycheck. Would i pick EM again, i don't know anymore. It's a very stressful job and longevity of career isn't quite there.
 
slz1900 said:
Citation needed

My ex went to med school in India where as a student she did appendectomies and C sections unsupervised. That doesn't mean that general surgeons in the US are glorified medical students. Likewise, the fact that family medicine doctors in resource strapped countries are managing an acute abdomen does not mean that EPs are glorified PCPs. It's a reflection of an under supply of adequately trained doctors in very poor places - not something to aspire to. Just because something is boring and routine doesn't mean it's primary care.
Click to expand...

There's been tons of studied published on the US EM based healthcare system.

This should be mandatory reading for any med student thinking of going into emergency medicine.

www.theatlantic.com

The Worst Patients in the World

Americans are hypochondriacs, yet we skip our checkups. We demand drugs we don’t need, and fail to take the ones we do. No wonder the U.S. leads the world in health spending.
www.theatlantic.com www.theatlantic.com
 
alpinism said:
There's been tons of studied published on the US EM based healthcare system.

This should be mandatory reading for any med student thinking of going into emergency medicine.

www.theatlantic.com

The Worst Patients in the World

Americans are hypochondriacs, yet we skip our checkups. We demand drugs we don’t need, and fail to take the ones we do. No wonder the U.S. leads the world in health spending.
www.theatlantic.com www.theatlantic.com
Click to expand...

This should be mandatory reading for every patient that ever comes into the ER.

Before you get an MSE, you get a copy of this article, then you have to pass a quiz prior to getting any treatment.

Even if you have a knife in your neck.

I've been saying for years....we just need to put health care in the hands of people and not have them use insurance all the time, and there is NO SUCH THING AS free care. Well free in that you are allowed basic free care the way a poor criminal gets a public defender in court.
 
So which specialties have the best patient population? Which specially is really good at weeding out the demanding, disrespectful, annoying patients?
 
alpinism said:
There's been tons of studied published on the US EM based healthcare system.

This should be mandatory reading for any med student thinking of going into emergency medicine.

www.theatlantic.com

The Worst Patients in the World

Americans are hypochondriacs, yet we skip our checkups. We demand drugs we don’t need, and fail to take the ones we do. No wonder the U.S. leads the world in health spending.
www.theatlantic.com www.theatlantic.com
Click to expand...


I’m not a big defender of the way healthcare works in this country or the way EM here is structured but c’mon that article in no way supports your claim that emergency cases like acute abdomens are “all managed outpatient with greatly reduced cost and identical outcomes” in the resource poor places you have practiced abroad. We all know that healthcare in the US is incredibly wasteful, but saying that other countries achieve the same outcomes with FM doctors managing what we consider emergent conditions on an outpatient basis requires an actual source.
 
Last edited:
slz1900 said:
I’m not a big defender of the way healthcare works in this country or the way EM here is structured but c’mon that article in no way supports your claim that emergency cases like acute abdomens are “all managed outpatient with greatly reduced cost and identical outcomes” in the resource poor places you have practiced abroad. We all know that healthcare in the US is incredibly wasteful, but saying that other countries achieve the same outcomes with FM doctors managing what we consider emergent conditions on an outpatient basis requires an actual source.
Click to expand...

My post was in reference to abdominal pain in well appearing patients with normal vitals. I'm not suggesting that an acute surgical abdomen should be managed outpatient by primary care physicians. And I'm not talking about developing countries but rather other developed countries where they do manage these patients in clinic rather than send them to the emergency room.
 
cyanide12345678 said:
Not that kind of crazy stuff. I've lived in that part of the world. My wife and sister went to government schools there, along with a bunch of high school friends. Maybe during house job (intern year equivalent).

Anyway back to the topic, i like my 18-19 days off a month and my 400k+ paycheck. Would i pick EM again, i don't know anymore. It's a very stressful job and longevity of career isn't quite there.
Click to expand...

Current MS3 here interested in rads, EM, or anesthesia.

The fact that your can make that much while working relatively less hours is amazing but at the same time it's mind boggling to me that you have doubts about picking EM again. I scribed for a good 2 years before med school so I've seen how stressful it can be and the constant flipping schedules wears you down, I see it when I compared when the residents at my school came in vs how they look a couple of years in.

I really liked EM but I'm so hesitant to commit to it based on the stress, flipping schedules, dealing with difficult patients, being looked down upon by other docs. But at the same time when I'm in the ER I feel like I'm at home. Granted, this is based on my experience as a scribe,I have my rotation next year so maybe my opinion will change but it feels like it would be a good fit.

Do a lot of EM docs have back up plans for when they feel burn out creeping up on them?
 
Clockdoc89 said:
Current MS3 here interested in rads, EM, or anesthesia.

The fact that your can make that much while working relatively less hours is amazing but at the same time it's mind boggling to me that you have doubts about picking EM again. I scribed for a good 2 years before med school so I've seen how stressful it can be and the constant flipping schedules wears you down, I see it when I compared when the residents at my school came in vs how they look a couple of years in.

I really liked EM but I'm so hesitant to commit to it based on the stress, flipping schedules, dealing with difficult patients, being looked down upon by other docs. But at the same time when I'm in the ER I feel like I'm at home. Granted, this is based on my experience as a scribe,I have my rotation next year so maybe my opinion will change but it feels like it would be a good fit.

Do a lot of EM docs have back up plans for when they feel burn out creeping up on them?
Click to expand...

Go for EM b/c if you end up not liking your work, at least you have the money/time to do other things outside of work.
Rads, and anesthesiology also get looked down by other docs, even by many patients.
Anesthesiology also has many flipping schedules.
Radiology and anesthesiology are also oftentimes very busy and stressful (often in different ways). All 3 are employees so all are under pressure to produce revenue for the hospital.
 
Go Ortho.
anbuitachi said:
Go for EM b/c if you end up not liking your work, at least you have the money/time to do other things outside of work.
Rads, and anesthesiology also get looked down by other docs, even by many patients.
Anesthesiology also has many flipping schedules.
Radiology and anesthesiology are also oftentimes very busy and stressful (often in different ways). All 3 are employees so all are under pressure to produce revenue for the hospital.
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
VA Hopeful Dr said:
They have to deal with other doctors who can be just as disrespectful and annoying.
Click to expand...
Pathology deals with surgeons. I see very few issues at the places I worked with either Path or Rads.
 
EctopicFetus said:
Pathology deals with surgeons. I see very few issues at the places I worked with either Path or Rads.
Click to expand...
As does radiology, and the latter deals with everyone else as well.

In my almost 10 years as a doctor, the only time I've spoken to a pathologist was when one came by the office to convince me to use his lab.

I call a radiologist at least once/week now and more like once/day when I did Urgent Care.
 
VA Hopeful Dr said:
As does radiology, and the latter deals with everyone else as well.

In my almost 10 years as a doctor, the only time I've spoken to a pathologist was when one came by the office to convince me to use his lab.

I call a radiologist at least once/week now and more like once/day when I did Urgent Care.
Click to expand...
But those interactions are always easy and pleasant in my experience. The thing with pathology is the patient is often on the table still and the surgeon is trying to get off before his favorite martini bar closes.
Again I think both are great fields when it comes to the subject at hand.
 
TLDR - pay and vacation is good. Work with other docs you like.

Pay and job flexibility. It's pretty sweet to be able to take 3 week long ski trips this winter. Plus 2 big summer trips and a few smaller trips throughout the year too. I know many other people both inside and outside of medicine who only get a few weeks off each year and have trouble coordinating family vacations.

Honestly, any job is going to be just that --> a job. In any job, find a work environment you like. Where admin isn't breathing down your neck. Perhaps most importantly find other docs/colleagues you like. In a way, your career is a lifeline to adult interaction and social vs community participation. We spend considerable time at work. Single coverage can be lonesome. Nurses are important too, but our relationship with them is not the same as we have different responsibilities and therefore a different experience.
 
anbuitachi said:
Go for EM b/c if you end up not liking your work, at least you have the money/time to do other things outside of work.
Rads, and anesthesiology also get looked down by other docs, even by many patients.
Anesthesiology also has many flipping schedules.
Radiology and anesthesiology are also oftentimes very busy and stressful (often in different ways). All 3 are employees so all are under pressure to produce revenue for the hospital.
Click to expand...

I'm pretty sure EM gets looked down upon by every specialist. I'm sure we take more crap than not just radiology radiology but probably most other specialties.

Anesthesia is not stressful 90+ percent of the times. I've spent a few months on anesthesia, man they have a sweet gig. I wish i was introduced to anesthesia before i had already applied to EM. I know i have far more days off than them, but the pace and stress of my job is significantly more.
 
To paraphrase the recently departed Dr. Rosen:
Work is work. Get your lovin' at home.

I think he meant that in the general sense of "don't expect to have fun at work." Not just in the "don't cheat on your spouse with the nurses" sense. Good advice either way, really.
cyanide12345678 said:


This basically sums up my sentiment about any specialty. So pick one with the best lifestyle so you have time to do things that you love in life.
Click to expand...
 
cyanide12345678 said:
I'm pretty sure EM gets looked down upon by every specialist. I'm sure we take more crap than not just radiology radiology but probably most other specialties.

Anesthesia is not stressful 90+ percent of the times. I've spent a few months on anesthesia, man they have a sweet gig. I wish i was introduced to anesthesia before i had already applied to EM. I know i have far more days off than them, but the pace and stress of my job is significantly more.
Click to expand...

What did you do on your anesthesia month..? did you have as a student? even as a resident, unless anesthesia resident, i dont know why you would be stressed. you'd have zero responsbility, zero production pressure, and zero calls. i have students, EM/peds residents, Crit care/pulm fellows rotate thru our services, none have responsbilities, all leave before 4pm unless they want to stay, none take call, and all have plenty of breaks. why? because to us attendings, you are useless. at least on EM rotation, you work real shifts, see patients, put in orders, write notes, and do most of the grunt work. The experience you get on anesthesia rotation as an outside rotator is highly misleading as a judgment of stress.

EM can obviously be a stressful field if you work in a busy ED. Same with anesthesia. often types different types of stress though.
I was on EM too as a resident, 21 shifts a month at a very busy hospital, i didn't think it was stressful. It was just annoying since i didnt like the type of patients and the inefficiencies.
 
RustedFox said:
Nope.
No idea how to do it.
Even open.
I forget how to "scrub in".
Find the appy, I could do.
What next ?
Get that magic stapler that they have ?
Okay. Maybe.
Cut off the appy after stapling it, I guess.
Close. Somehow.

Nope.
Click to expand...
Lol, the first time I saw that stapler in the OR I was like: da fuq is dat.
 
We spent some time with the anesthesiologists in residency doing peds anesthesia. Those guys were busy. Start a case, phone goes off three times while in the room, run to the other rooms, jump back to the work area to do some charting, then run somewhere else to end a case, then start another one. And they didn't bother telling me the actual anesthesiologist stuff they were doing since they knew I was just there to do kid/baby airways.
anbuitachi said:
What did you do on your anesthesia month..? did you have as a student? even as a resident, unless anesthesia resident, i dont know why you would be stressed. you'd have zero responsbility, zero production pressure, and zero calls. i have students, EM/peds residents, Crit care/pulm fellows rotate thru our services, none have responsbilities, all leave before 4pm unless they want to stay, none take call, and all have plenty of breaks. why? because to us attendings, you are useless. at least on EM rotation, you work real shifts, see patients, put in orders, write notes, and do most of the grunt work. The experience you get on anesthesia rotation as an outside rotator is highly misleading as a judgment of stress.

EM can obviously be a stressful field if you work in a busy ED. Same with anesthesia. often types different types of stress though.
I was on EM too as a resident, 21 shifts a month at a very busy hospital, i didn't think it was stressful. It was just annoying since i didnt like the type of patients and the inefficiencies.
Click to expand...
 
yup they bust their asses around here, start at 6 am, leave when the last case is done, 11 at night for my kids knee surgery the other month. Mad props to Peds anesthesia.

TooMuchResearch said:
We spent some time with the anesthesiologists in residency doing peds anesthesia. Those guys were busy. Start a case, phone goes off three times while in the room, run to the other rooms, jump back to the work area to do some charting, then run somewhere else to end a case, then start another one. And they didn't bother telling me the actual anesthesiologist stuff they were doing since they knew I was just there to do kid/baby airways.
Click to expand...
 
TooMuchResearch said:
We spent some time with the anesthesiologists in residency doing peds anesthesia. Those guys were busy. Start a case, phone goes off three times while in the room, run to the other rooms, jump back to the work area to do some charting, then run somewhere else to end a case, then start another one. And they didn't bother telling me the actual anesthesiologist stuff they were doing since they knew I was just there to do kid/baby airways.
Click to expand...
Dr Mantis Toboggan said:
yup they bust their asses around here, start at 6 am, leave when the last case is done, 11 at night for my kids knee surgery the other month. Mad props to Peds anesthesia.
Click to expand...

its more the structure of the department/anesth group rather than it being peds anesthesia. academic anesthesia departments tend to be a bit more relaxed cause surgeons are slower and its a teaching hospital and you can only cover 2 residents at a time.. they may work a lot of hours but make little $$. private practice is running around like a chicken, but make more money, and you can be working multiple rooms at once depending on the model.

but yea unlike other rotations students or residents do, on anesthesia, outside rotators get in the way and slow things down, therefore most of the time its a very chill rotation for them
 
You must log in or register to reply here.

Similar threads

CoolDoc1729
Read anything good lately?? Book recommendations
Replies
28
Views
4K
Arcan57
Arcan57
B
EM Alliance
Replies
1
Views
989
RustedFox
RustedFox
E
Houston EM forum
Replies
3
Views
1K
HemeOncHopeful19
H
Boatswain2PA
Best EM podcasts?
2
Replies
64
Views
4K
Janders
J
G
EM Match 2025
2
Replies
90
Views
11K
RustedFox
RustedFox
Top