Practicing a field of medicine other then what you did residency in

[Bostonredsox]

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Ahem. And there have been times when I was called to PACU by anesthesiologists to help them out too. In my area specifically and at many community hospitals in general there is no anesthesia back up for the ED. Once you get away from academic institutions this ego based specialty urinating contest just falls by the wayside. No one has time for it. I don't want to do their job and they don't want to do mine.

The best way to look at this is that anesthesiologists are the masters of the airway in the OR and EM are the masters in the ED. We support each other when necessary.

And where I am neither of you come to the ICU. We are our own masters of the airway.

As docb said, what you do depends on where you practice. I can perc trach as a PGY3 IM. Will I do it routinely as an attending? Not unless its urgent and surgery isn't available. But I can if I need to. That FP that watched the kid die needed more airway training. Chances are a good paramedic could have intubated the kid. Or atleast got an LMA in and ventilated till transfer was available. Hard to know without details. Difficult airway course costs 1200$. Highly recommend it to all working in Ed or ICU hell even for hospitalists. Personally I wouldn't recommend practicing in an environment such as the Ed, ICU or any other similar setting in a rural area without backup unless you are proficient enough to intubate and obtain central venous access.

 

[Rendar5]

Just depends on what you're trained to do and what you actively do. I have both bailed others out of airways, and been bailed out of 2 airways myself (one as a resident, and one massive hematemesis with almost zero visualization by a skilled Respiratory Tech). That said, if you are not trained and comfortable with airways including getting your way around a failed airway, an ED without in-house Anaesthesia may not be the best place to work.

To AStark: sure they should be trained in PALS, but PALS does not teach you rapid sequence intubation, iirc, nor do you have actual live intubation training.

I second Boston's remark above about the difficult airway course. If you're gonna work in a place outside your specialty/comfort zone where you may need to intubate, please take one of those courses.