What second year resident would you NOT want coding your loved one?

  • EM

    Votes: 10 3.9%
  • IM

    Votes: 8 3.1%
  • FP

    Votes: 23 8.9%
  • Peds

    Votes: 13 5.0%
  • General Surgery

    Votes: 6 2.3%
  • Psychiatry

    Votes: 127 49.0%
  • PM&R

    Votes: 31 12.0%
  • Anesthesia

    Votes: 4 1.5%
  • Radiology

    Votes: 47 18.1%
  • OB/GYN

    Votes: 24 9.3%
  • Pathology

    Votes: 90 34.7%
  • Opthalmology

    Votes: 42 16.2%

  • Total voters
    259

DrQuinn

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Just bored and curious (trying to not study for my in-service exam tomorrow).
 

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At least the Optho one was smart in school and read up on resus...

KIDDING KIDDING! Please don't bombard me with attacks! I was trying to be funny!
 

Weil-Felix

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Umm, when I'm a 2nd year pathology resident, I won't be touching a code with a ten foot pole! And I think the patients would be grateful for that. Why on earth would you put path, rads, and optho up there? They don't ever carry code pagers (at least not at any of the hospitals I've worked at!)
 
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The irony is the people that said they don't want anesthesia or EM to run the code - who else, then? IM? Who tubes the patient? And, IM isn't known for brevity or speed. FP? SURGERY? Hahahahaha!

Seriously, IM and FP can get it done, if they're all that's there. Critical Care docs are good, too. But, who does it more often? Gas and EM.

edit: whoops, I ignored the PGY-2 (Critical Care docs).
 

Docxter

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I'm a rads resident. This year alone, I've ran a code on three people including tubing them in the rads department. The "code" team usually gets to us about 10-15 minutes after calling code anyway (disadvantage of huge hospital). For patients who code in the IR suites, we often don't even call a code. What are they going to do anyway that we can't do? Tube the patient? Get central access? Give meds? Attach paddles and shock? Relieve tension PTX? Put a chest tube? Do an emergent echo? Do a pericardiocentesis? Put a transthoracic or IV pacer? Do an emergent crico? Do an emergent pulmonary embolectomy? We do all of that ourselves. Come on guys, running a code properly is not that difficult.

But in general I agree with you all. You don't want your typical radiologist running a code.
 

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I think a key point of the question is which PGY-2 would you want coding your mother. For me it's no question: Gas or EM. So a senior Rads resident might do well, but a PGY-2?

Casey
 
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Originally posted by Docxter
I'm a rads resident. This year alone, I've ran a code on three people including tubing them in the rads department. The "code" team usually gets to us about 10-15 minutes after calling code anyway (disadvantage of huge hospital). For patients who code in the IR suites, we often don't even call a code. What are they going to do anyway that we can't do? Tube the patient? Get central access? Give meds? Attach paddles and shock? Relieve tension PTX? Put a chest tube? Do an emergent echo? Do a pericardiocentesis? Put an transthoracic or IV pacer? Do an emergent crico? Do an emergent pulmonary embolectomy? We do all of that ourselves.

But in general I agree with you all. You don't want your typical radiologist running a code. Big no no!!

1. Good on ya for being on the ball!
2. Pulmonary embolectomy? Hell yeah! That's the ONE thing that we virtually never can save people from (and never ever in the ED).
3. In all the hospitals I've been at, Rads is proximate to the ED. Interesting. (And prescient that you have code equipment in the department!)
 

Docxter

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Originally posted by Apollyon
1. Good on ya for being on the ball!
2. Pulmonary embolectomy? Hell yeah! That's the ONE thing that we virtually never can save people from (and never ever in the ED).
3. In all the hospitals I've been at, Rads is proximate to the ED. Interesting. (And prescient that you have code equipment in the department!)

2. Of course you can't do an PA embolectomy in the ER (except maybe on the TV series). For surgical embolectomy, the patient often needs to go on a pump. I'm talking percutaneous embolectomy. Over the course of my residency I've seen two crashing patients saved (one temporarily-died two days later) by emergent percutaneous PA embolectomy (pull out that honker saddle embolus). The patients were lucky to be in IR when they crashed because it would have been too late if they were going to be transferred to us from the ER or unit.

3. No code equipment in your rads department?? Bad bad hospital. Don't patients in your rads department ever get anaphylaxis to contrast??!! No codes inside the CT or MR scanners (two of the favorite places to code)?
 

Docxter

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Originally posted by cg1155
I think a key point of the question is which PGY-2 would you want coding your mother. For me it's no question: Gas or EM. So a senior Rads resident might do well, but a PGY-2?

Casey

Actually, as far as running codes, rads get dumber and less competent as their PGY number goes up. The PGY-2s are actually just as good as other IM or surgery PGY-2s since they are fresh coming out of internship. The least competent ones are the diagnostic radiology attendings.

And I agree that the best ones are: 1. Anesthesia. 2. EM, in that order.
 

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The PGY-2s are actually just as good as other IM or surgery PGY-2s since they are fresh coming out of internship.

That's my point. In my experience Interns do not run codes well. I have seen some do excellent jobs though.

And I agree that the best ones are: 1. Anesthesia. 2. EM, in that order.

I might take exception to that. I have seen a number of anesthesia codes and a number of ED codes. In anesthesia there's access usually and if there isn't people freak out. In the ED there isn't access usually so people just run the code (and get access). In my very very limited experience the codes were better run in the ED.

Of course these are all based on a few observations and my obvious bias towards EM, but hey we're just having fun making wild speculations so it's ok.

FWIW I didn't check Rads, Gas, Surg, or EM.

Casey
 

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I thought of one other thing, in the OR the general mindset that I have observed is that things will go well, and when they don't it's a "surprise."

In the ED things are not expected to go well, everyone is expected to crash, and so it's not a "surprise."

Just another one of the ways that the ED mindset is different in an important way than other specialties.

the "C"
 
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Originally posted by Docxter
2. Of course you can't do an PA embolectomy in the ER (except maybe on the TV series). For surgical embolectomy, the patient often needs to go on a pump. I'm talking percutaneous embolectomy. Over the course of my residency I've seen two crashing patients saved (one temporarily-died two days later) by emergent percutaneous PA embolectomy (pull out that honker saddle embolus). The patients were lucky to be in IR when they crashed because it would have been too late if they were going to be transferred to us from the ER or unit.

3. No code equipment in your rads department?? Bad bad hospital. Don't patients in your rads department ever get anaphylaxis to contrast??!! No codes inside the CT or MR scanners (two of the favorite places to code)?

2. That's exactly the point - being able to pull it out.

3. Actually, I can't vouch for what resusc. equipment is in the Rads depts. in the hospitals I've been in.
 

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My take is that every case going into the OR not requiring just MAC is a "code". By virtue of the anesthetics, you're at least placing a person into respiratory arrest/compromise, making them hemodynamically unstable, etc...

My expereince in the ED is that most codes are expected to have a poor outcome. In the OR, however, the expectation is for a good outcomes.
 

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For myself or a loved one -- GAS, no doubt whatsoever. Airway mgt. is what they do for a living, for gosh sakes!

Funny story about optho -- at one interview the IM residents were cutting on one of the optho residents who had the week before ripped out a swan by tripping over it while doing an ICU consult :wow:
 

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Originally posted by Apollyon
Seriously, IM and FP can get it done, if they're all that's there.

After seeing how incompetent the FP doc's are at my school's clinic, I wouldn't want any of them anywhere near one of my loved ones in a code.
 

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Honestly, I looked at the list and ignored a few groups based on their daily access to "sick" hospitalized patients: ie pathology, psychiatry, ophtho etc...

I think based on my personal experience. I wouldn't want an ob/gyn coding my mom. unless they have a large gyn-onc service they never code anyone. My fiance is an ob and I know she couldn't run a code (and she is a smart girl too). Let them stick to the preggos.
In my opinion, I think EM runs a good code. I have never seen anesthesia run a code primarily. At our hospital they tube and run on the floors. I would imagine they are good at all aspects of a code not just the airway.
Medicine, from what I have seen, runs a sloppy code and the same with surgery. My exposure to Surgery codes is limited as I don't ever cover the sicu. They both don't run codes well because their exposure to them is limited by the number that occur.
Rads in my hospital does not run codes on their own, but again I cannot speak for all hospitals.
 

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Originally posted by Apollyon
The irony is the people that said they don't want anesthesia or EM to run the code - who else, then? IM? Who tubes the patient? And, IM isn't known for brevity or speed. FP? SURGERY? Hahahahaha!

Well, I'd disagree with the general surgery comment. We ran our own codes quite frequently without the help of the medicine teams. Around here, the ER doesn't run any of them except when they happen in the ER. I'd say all three (GS, medicine, EM) are quite capable of running codes.

Family medicine...no.

And, of course, I'll be around for airway. I try to go to as many as possible anyway just for that. I've fiberoptically intubated many coded patients and resorted to a few crics and one slash trach (man...bloody).
 

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The very fact that this hypothetical family member is "coding" spells doom for them. Most people who need that type of resuscitation don't do well post-fact. Might I point out that there's a difference between the person "running" the code and the people doing the code. At my particular institution medicine, anesthesia and surgery respond to all non-ER, non-OR codes. Anesthesia handles the airway or assists whomever got there first in "securing" it. Surgery assists or places central access if so desired and medicine (PGY-2 or 3, whoever's unlucky enough to carry the code pager) "runs" the code.

Running the code does not mean securing an airway. Or doing bag-mask ventilation. Or doing chest compressions. Or getting IV access. Or giving meds. It means standing at the end of the bed and telling everyone else what they should be doing. The moment you actually start doing any of it yourself you'll get distracted from what you are supposed to be doing which is monitoring the patient and rhythm and deciding what should be done next. And once you've decided what to do next you tell someone else to do it (i.e. hold compressions, check for a pulse, get me a line, etc.).

Coding patients are best served by a number of services showing up and participating, not posturing about "I can handle this all by myself."
 

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Coding patients are best served by a number of services showing up and participating, not posturing about "I can handle this all by myself."

But the beauty of it is that a bunch of Gas residents or EM residents could handle it all by themselves.

the "C"
 

dry dre

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Originally posted by Bobblehead

Coding patients are best served by a number of services showing up and participating, not posturing about "I can handle this all by myself."

The best post yet.

Paramedics run codes all the time, yet some docs think that they are the sheeat when it comes to "running a code."

Given that anyone can run a code, a better question might be who would you want managing your mother, should she re-establish a rhythm?
 
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What is a dermatologist, orthopedic surgeon's responsibility if someone codes on an airplane? I don't see too many of those guys carrying around acls cards. Do you just hide the fact that you are a doctor, can you get in trouble for not using your fiduciary skills?
 

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In my residency there are zero anesthesiology residents and it is ABSOLUTELY clear that the EM residents are the absolute best at running the codes. While the surgeons are more pushy, the EM docs understand ACLS and variants much better.
The EM residents generally "get off" on code situations. It means procedures to be had!
 

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here it is the opposite...there is no emergency dept. if there is a code, anesthesia is called, no matter which hospital (all the specialties have their own buildings, so if anesth is not in house, as they are for surg, ob/gyn, etc...then they get to run over to the other hospital)
 

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I'm surprised that peopel actually voted for EM to NOT code their family members. At my institution, the nurses on the floor are happy when they see us (the new EM interns) come up to the floors for the code. My senior resident (IM) on my CCU rotation had never intubated anyone... EVER.

Q, DO
 

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I think it was a backlash against the pro-EM stance this thread has taken. No worries, we know we're the shiz-nit.

Casey
 

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I don't know about elsewhere, but I'm an internal medicine resident. We run all codes at my hospital. Many (not all) of the ER docs at my hospital always seem to **** something up. Not the brightest bunch.
 

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It is likely where you trained...in places where EM is the "big dog"...the established department, the EM dept will have a corner on the "code" market.
Granted, very few programs have EM docs go to the floors for codes primarily because we are too busy, but on every off-service rotation I have been on, the EM lower level usually tells the IM upper level what to do! All the EM residents are ACLS instructors and are simply "expected" to act as such. But I am in an established EM area.
Certainly not a "slam" to IM, just we are Emergency Doctors, thus our training should emphasize codes/traumas stabilization.
 

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At none of the places/hospitals I've trained has EM run codes outside of the ER. I would expect at most places, a trauma team to run ATLS and a IM/CCM team to run in hospital codes and EM to run medical codes in the ER. IM docs train in ACLS as does every other doc in the hospital. IM training is broad consisting of folks that do office based specialties like endocrinology to folks who routinely handle, by far, the sickest folks in the hospital, the CCM guys. IM training in most academic places focuses on optimal inpatient care, which includes, if need be addressing inpatient emergencies and codes. Anaesthesia does not run codes anywhere in the hospitals I have worked and on occasion have been available to intubate. Beyond the A in the ABCs, I would trust a inpatient internist, ER doc or possibly a surgeon to take over a code vs. an anaesthesiologist...
Anyways, in theory, the first doc to respond to the code should be running it, regardless of his background (unless admittedly not ACLS certified) unless he/she defers that duty to another, more qualified person, at least in my experience, is the upper level IM resident.
 
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See, like I said...regional differences. At one of the main hospitals I train, EM residents do respond to codes on the floor as a response to the poor running of codes in the past. That is a response to a weak IM department.
I certainly do not think this is universal.
 

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Isn't there some Washington State hospital that has this interesting ER arrangement?

The IM team runs medical emergencies...chest pain, diarrhea, etc...

While the surgical team runs all of the traumas that come in.

And there are no ER residents to beg for the chance to put in the chest tube or intubate!
 

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Kinda depends on the situation.

If the pt who codes is a trauma pt or post op pt, I'd rather surgery residents run it. They understand those issues better.

If the pt codes for cardiac reasons, IM would handle that better.

Also depends on the quality of resident training. Where I went to school, the IM residents were rather weak. Surgery program was pretty strong. The IM code team would show up for any code, but if it was a pt on the surgical service, they basically just made sure there were enough hands and let the surgery folks handle it. I also saw the surgery residents stop by and offer to help with medicine codes (if they were nearby) and then basically wind up guiding the medicine residents through it.

At my current program, the code team is very pushy and will only "let" the surgery chief stay in the room for coding a surgcial pt. (they throw all other surgical residents out) However, the surgical ICU residents run any codes there without calling for the code team (the ICUS are pretty self contained)
 

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Originally posted by cg1155
But the beauty of it is that a bunch of Gas residents or EM residents could handle it all by themselves.

the "C"

Not where I trained... Gen Surg ran almost every code outside of the ER, except for the CTICU and MICU. Anesthesia ran no codes, ever.
 

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There are some hospitals where anesthesia carrys a code pager. Then there are some that only call anesthesia when they cant get an airway. Either way, Anesthesia does lines, intubations, difficult airways, res, all day every day and they would be just as capable, if not more, of saving a crashing patient as any other speciality on this list.
 

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Interesting thread. I guess the weaknesses/strengths of the various services differ at different institutions. No surprise really.

Where I'm at, the ER residents pretty much run the show, both in the ED and out. At our primary site, the IM residents are pretty strong and usually know what they are about. The difference is usually in the "pucker factor" for lack of a better word. In the ED, we see codes literally every day. It really is routine for us. The medicine guys, while smarter than me and most of my fellow residents (these guys are very academic) are sometimes "caught in the headlights" of the situation and need a minute to get their bearings. Just the other day, the senior IM guy was yelling for an ABG on a pt who had been down for at least 15 minutes. I told him I was psychic and knew that the pt. would be both hypoxic and acidotic. He didn't get my humor. ;)

At our secondary site, the only other program in the hospital is a FM program. These poor guys, while nice and fun to drink with, I wouldn't trust them to code a cat let alone a human pt. And I hate cats.

In the end, if you take a reasonably competent resident in one of the primary pt care fields who won't crumble under pressure and won't be intimidated by a bunch of floor nurses running around yelling at each other, and put him or her in a code situation, for the most part things will be done properly, if not a little sloppy at times.

Unfortunately it is just an exercise in team dynamics. The pt is most assuredly going down stairs to a steel bed regardless.

But I guess it is still fun to talk about.
 

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this is a good post.

To answer an above question: i think the dermatologist would hide in their first class seat on that plane.

But truthfully, all docs should be comfortable running a code, and since EM residents see it more frequently they're the most comfortable.
 

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dude, people on here are saying they would rather have a patholgist run a code than psych!! Listen, psych runs inpatient floors at many hospitals, and therefore must see at least a code per year. When the hell would a pathologist even get NEAR a coding patient? I dont get this.

??
 

neilc

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Originally posted by Ligament
dude, people on here are saying they would rather have a patholgist run a code than psych!! Listen, psych runs inpatient floors at many hospitals, and therefore must see at least a code per year. When the hell would a pathologist even get NEAR a coding patient? I dont get this.

??

well, since the patient will wind up in pathology no matter who runs the code, maybe these people are just thinking one step ahead.

:idea:
 

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I want whoever is doing them on a regular basis. So, this is obviously going to depend on the person and the residency. Where I am there were one or two IM residents who were very good. There were some that made me shudder.

So, if there is a surgeon who happens to run them on a regular basis and knows his/her stuff, go for it. Like all things, just depends on who is there and who is most qualified.
 

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After I saw what happened during a code on the Psych floor at my institution I wouldn't let one of them NEAR my family member!! If it weren't for the fact that two of the med students had been EMT's and one had done a critical care rotation it would have been a COMPLETE disaster. I couldn't believe that senior-level Psych residents and attendings were at a total loss. :eek:

ETA: Oh yeah. I agree with roja. At my institution the Anesthesiologists run most of the codes (when they can get there), so I'd prefer them. However, I know that it's different in every institution, so that would shape my answer.
 

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what about neurology?
I mean neurologists from the stroke and critical care team?
 

Thewonderer

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Originally posted by Ligament
dude, people on here are saying they would rather have a patholgist run a code than psych!! Listen, psych runs inpatient floors at many hospitals, and therefore must see at least a code per year. When the hell would a pathologist even get NEAR a coding patient? I dont get this.

??

That's why I believe that most people on this board do not know what they are talking about.

In the PGY I year, many specialities (i.e. radiology) have to do a prelim year in internal medicine or surgery.

On the other hand, psych residency involves four months of medicine (including inpt and EM) and two months of neurology in the internship year.

By comparision, pathologists start their internship year by going in straight to AUTOPSY and surgical pathology.

There should not even be a discussion about who you don't want to run a code when PGY II year comes: pathology. Many on this board are simply clueless. :confused:
 

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Honestly, I think a lot of people just dismissed the concept of a Pathologist running a code... why/when would they in reality? Psych on the other hand, might actually be the first one in the room... scary but true *shudders*
 

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how would I know which one I would or wouldn't want coding my mother...?

:confused: :confused: :confused:
 

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Originally posted by SMW83
how would I know which one I would or wouldn't want coding my mother...?

:confused: :confused: :confused:

You wouldn't Owl... b/c you haven't worked in a hospital unlike the rest of the people answering the question...
 
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