PAs and NPs in the er

[igcgnerd]

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Do PAs and Nps typicaly manage critical patients or play active parts in codes and traumas such as intubations and chest tubes?

 

[deleted6669]

Do PAs and Nps typicaly manage critical patients or play active parts in codes and traumas such as intubations and chest tubes?

it depends on the setting. pa's on trauma and critical care/icu teams do this stuff frequently. pa's working at trauma ctrs in emergency depts do this a lot less because there is always a doc(or the trauma team pa) around who wants the cool procedures. if you want to manage critical pts as a pa in a big city you need to be a trauma/critical care pa. if you want to manage EVERY pt in a rural area it is easy to do that because often you are the only one staffing the er. I work 5-6 nights/month solo in a small facility(28k pts/yr) and see whatever comes in the door(trauma,codes, mi's, etc). it pays a LOT less(about 1/2 as much) than my regular job(trauma ctr er 100k pts/yr) but is personally a lot more fulfilling.when I get a bit closer to retirement and have more debt paid off I hope to work solo all the time.

 

[DNP student]

If you work a small-town hospital on the Interstate, you'll see lots of traumas.

 

[lloydchristmas]

I agree with EMEDPA. I'm a rural NP and share ED call in a small very rural hospital (1000 ED pts/year). If I'm on, then whatever comes in is what I have to deal with. Scary thought for how crappy NP training is in the ED (um... absolutely none). Luckily, I worked in the ED during school and put myself in the right places to learn as I anticipated this horrific training. And, now I read almost exclusively ED stuff to get better and better at it. And before all the docs or wannabes or anti-NPs bark, let me just say that I passed ATLS and the docs I work with failed.

 

[DocWagner]

Its fair to say that the "plan" is to have the Attending Physicians manage the "critical" patients in the ED. This happens >90% of the time.
BUT, critical patients sometimes evolve from NON CRITICAL PATIENTS! This is the world of Emergency Medicine.

Example from today.

Non critical "easy" patient triaged to a non-monitored bed. History "bronchitis and seizure". He has a seizure history, he seized at home...he comes in talking, doing fine. Actually being a jerk "of course I take my f...ing medicine!" No distress, no abnormal vitals.

20minutes later, Status Epilepticus.

This could have been a PA patient...then evolved into an attending patient.

I intubated him, sedated him while on a vent etc.

This is EM.

The good thing, we have such a good raport and understanding of roles in the ED...I and the midlevels work together as a team...fluidly.

I really like my PAs.

 

[Bandit]

I would certainly agree with wagner here to the extent that he is probably in a larger facility. This is how I was utilized in the bigger ones.

I also worked in others where I was responsible fully for my pt and their course.

 

[deleted6669]

I would certainly agree with wagner here to the extent that he is probably in a larger facility. This is how I was utilized in the bigger ones.

I also worked in others where I was responsible fully for my pt and their course.

agree with you and wagner with regards to large er's. in a rural/smaller dept setting though it's anyone's bet who runs the show.....
I work night shifts solo at a facility that sees 28k pts/yr. staffing is 24/7 pa coverage with an 8 hr doc shift during the day.

 

[Mary Smith]

I work at a huge trauma center in the chicago land area and NPs play a prominent role here including working with trauma patients. One of the trauma NPs I work with actually runs the trauma codes in the trauma bay of the ER here. She runs one of the clinics and sees patients after discharge. She's been here for about 10 years and is considered a colleauge with the physicians. She has equal the seniority of a fourth year resident and a huge amount of autonomy and responsibility.

I truly believe that the location of the place you work in really does determine what an NP or PA can do.