Procedures in the ED

[Renaissance Man]

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Hey guys,

I know that ED physicians do not do surgeries, however I recently shadowed a doc in the ER and he put in a femoral central line and it was one of the coolest things I have ever seen. I have also shadowed a plastic surgeon at his clinic for a week, but the central line was way cooler than a face lift or a rhinoplasty.

Now for my question, what other procedures do you all get to do? The ER I shadowed at was in the suburbs, so that was about as intense as it got during my three days there. Any favorite procedures?

Thanks 👍

 

[WilcoWorld]

Common procedures include:

Intubation
Chest tube
Central lines (femoral, internal jugular, subclavian)
Paracentesis
Incision & Drainage
Laceration repair
Orthopedic reductions
Nerve blocks

But my all time favorite thing to do in the ED... discharging a patient.

 

[RxnMan]

Hey guys,

I know that ED physicians do not do surgeries, however I recently shadowed a doc in the ER and he put in a femoral central line and it was one of the coolest things I have ever seen. I have also shadowed a plastic surgeon at his clinic for a week, but the central line was way cooler than a face lift or a rhinoplasty.

Now for my question, what other procedures do you all get to do? The ER I shadowed at was in the suburbs, so that was about as intense as it got during my three days there. Any favorite procedures?

Thanks 👍

There's a long list in the FAQ. And a bunch of other general EM info too.

 

[gutonc]

Hey guys,

I know that ED physicians do not do surgeries, however I recently shadowed a doc in the ER and he put in a femoral central line and it was one of the coolest things I have ever seen. I have also shadowed a plastic surgeon at his clinic for a week, but the central line was way cooler than a face lift or a rhinoplasty.

Now for my question, what other procedures do you all get to do? The ER I shadowed at was in the suburbs, so that was about as intense as it got during my three days there. Any favorite procedures?

Thanks 👍

Not to ruin your day or anything, but, if you've done more than 6 months of just about any adult medicine residency (IM, FM, OB, GS), throwing in a fem line should be a no brainer. I'm an oncologist and can do one of these with my eyes closed.

My ED colleagues OTOH can do a lot more procedures, the majority of which are cooler and more life saving than any X-oplasty.

Anybody else notice the OP has only shadowed in ER and Nip/Tuck so far? When is the "diagnostician" rotation?

 

[Renaissance Man]

I tried to be nice and I searched all the forums, type in variations of "procedures in ER" or other random searches and see what turns up, its a bunch of trauma surgery verse ER docs threads.

thank you WilcoWorld for not jumping down my throat and answering the question

and gutonc...I am a sophomore in college, I am not doing "rotations" I am shadowing doctors that I actually sort of know just to get some clinical hours and experience...but thanks for being SOO encouraging to an interested pre-med student.

I wish SDN users (cough mods cough) were more receptive to questions, believe it or not most people do search first, how many wasted posts are from mods who just say "use search function"?

 

[packitinstan]

how much suturing does one have to do in EM?

 

[docB]

I tried to be nice and I searched all the forums, type in variations of "procedures in ER" or other random searches and see what turns up, its a bunch of trauma surgery verse ER docs threads.

thank you WilcoWorld for not jumping down my throat and answering the question

and gutonc...I am a sophomore in college, I am not doing "rotations" I am shadowing doctors that I actually sort of know just to get some clinical hours and experience...but thanks for being SOO encouraging to an interested pre-med student.

I wish SDN users (cough mods cough) were more receptive to questions, believe it or not most people do search first, how many wasted posts are from mods who just say "use search function"?

Here are some good threads about procedures found doing an advanced search of the EM Forum using the term "procedures."

I'm sorry you found some of the responses abrasive. The regulars tend to be a little snarky when a frequently asked question pops up. Sometimes the best course is to either be prepared for the mild barbs or spend more time doing research.

I did check the FAQ and I think we could use a better post there about the procedure question. It'll likely end up with some of the same links you now have below.

Good luck with your education.

ED Procedures

What are the typical procedures EM docs perform?

frequency of procedures in the ED

Procedures

 

[Renaissance Man]

thank you docb, i really was not just being lazy, appreciate your response

 

[ccfccp]

thank you docb, i really was not just being lazy, appreciate your response

No worries... but we're going to remember you weren't able to find the answer with the search function when you apply for the match in 7 years...

 

[Doctor Bob]

how much suturing does one have to do in EM?

A few times a day

 

[Arcan57]

Once every 3-4 shifts. That's why God invented mid-levels.

 

[J ROD]

Once every 3-4 shifts. That's why God invented mid-levels.

 

[NateintheED]

Once every 3-4 shifts. That's why God invented mid-levels.

Unless you're single coverage.

 

[Jeff698]

Unless you're single coverage.

That's what I was thinking. Or double (thank God we got some help!) without midlevels. I'm in community practice and suture a lot. It's pretty rare that I go through a shift without repairing some sort of laceration.

Take care,
Jeff

 

[Arcan57]

Do you guys do extensor tendon repairs? I had a guy with a lac that got his extensor tendon (but not the sagittal bands) just distal to the PIP joint. Ortho told me to fix it, but I couldn't find the proximal end of the tendon. One plastics tray, one midlevel continuously retracting, and 1 hr of ortho's time later it finally was fixed.

 

[Venko]

I would add the following procedures as well...

Ultrasound (echo, vascular, retinal, abdominal, pneumothorax, etc.)
Pericardiocentesis
Thoracotomy (not usually a comforting situation however)
Lumbar puncture
Arthrocentesis
Cricothyrotomy
Needle thoracostomy
Ocular (& general) foreign body removal
Lateral Canthotomy
Thoracentesis
arterial line placement
perimortem cesarean section
Anoscopy (not my favorite, but valuable)
Bronchoscopy
Splinting / Casting
nasopharyngoscopy
fasciotomy
escharotomy
Diagnostic Peritoneal Lavage

....there are plenty, plenty more! 🙂 [MAN I LOVE THIS SPECIALTY!]

 

[Jeff698]

Do you guys do extensor tendon repairs? I had a guy with a lac that got his extensor tendon (but not the sagittal bands) just distal to the PIP joint. Ortho told me to fix it, but I couldn't find the proximal end of the tendon. One plastics tray, one midlevel continuously retracting, and 1 hr of ortho's time later it finally was fixed.

Just out of curiosity, what did your waiting room look like after you were done? That's what kills me about these long, protracted repairs. While I may be able to do the repair, it isn't the best thing for all of my patients, including those with chest pain I haven't seen yet. Plus, just 'cause I can do a repair (after reviewing it in a procedure book) doesn't mean I'm the best person to do it.

That's why I just clean, close, splint and refer to ortho hand. Fortunately, we have ready access to a hand guy who has no problem with this approach. It would suck to be somewhere you can't get your patients into specialty care.

Take care,
Jeff

 

[Arcan57]

Jeff, that ended up being my take home point. I've now added extensor tendon repairs to revision of phalangeal amps as something I will never do again. The problem with this guy is he was traveling out of state that evening, and wouldn't stick around to be seen by plastics in the am.

 

[WilcoWorld]

Jeff, that ended up being my take home point. I've now added extensor tendon repairs to revision of phalangeal amps as something I will never do again. The problem with this guy is he was traveling out of state that evening, and wouldn't stick around to be seen by plastics in the am.

Oh how this behavior irks me.

Doctor "I recommend treatment XYZ PDQ, which I almost never do. It can safely wait for a few days, so I made an appointment for you to see the specialist tomorrow."

Patient "That's not convenient for me. Can't you just do it now while I'm here?"

arrrg

 

[Jeff698]

Patient "That's not convenient for me. Can't you just do it now while I'm here?"

"Sure, I'll be happy to. There are some things you should know though.

First, while I understood the words written in the textbook about how to do this and have done it once or twice, the specialist I would send you to has done many, many of them and is much better than I am.

Second, I won't be treating the patient dying from the heart attack next door while I'm doing this hour long procedure, non-emergent procedure so that you aren't inconvenienced. "

Take care,
Jeff