Procedures

[wood]

Can someone tell me what types of procedural things an ER physician can perform as opposed to the things they must call surgery, anesthesiology for. Also what differentiates ER from critical care?

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[beyond all hope]

ER docs do mostly procedures that are emergent dealing with airway and vascular access. We also do minor procedures that are not worth calling in a surgeon for.

intubations
crikes
emergent tracheostomy
central lines +/- CVP monitoring
venous pacemakers/Swan Ganz lines
saphenous cutdown
chest tubes
incision and drainage of abscesses
suturing lacerations
closed reduction of fractures
splinting and casting
conscious sedation

We are not ICU docs but we do everything that ICU docs do in the first few hours.

 

[flighterdoc]

ER docs do mostly procedures that are emergent dealing with airway and vascular access. We also do minor procedures that are not worth calling in a surgeon for.

intubations
crikes
emergent tracheostomy
central lines +/- CVP monitoring
venous pacemakers/Swan Ganz lines
saphenous cutdown
chest tubes
incision and drainage of abscesses
suturing lacerations
closed reduction of fractures
splinting and casting
conscious sedation

We are not ICU docs but we do everything that ICU docs do in the first few hours.

Shouldn't ICU/CCU docs get patients that are already somewhat stabilized? Or at least not emergent?

 

[spyderdoc]

I've done a few chichothyroidectomies (open and needle), but never an "emergent trach" that beyond all hope listed above....
Never done a cutdown, never want to. Why do this when you can do a central line? On a kid, just do an IO...
I do plenty of lumbar punctures, tapping bellies, chests, joints....
Pericardiocentesis on a PEA code (damned u/s machine has all but taken away this fun procedure...)
Participated in a few thoracotomies...
Plenty of chest tubes...
Plenty of cardioversions.
Floated a few pacer wires.
No swans in the ED since we don't have the monitor setups for them.

 

[southerndoc]

What is the average number of LP's that an intern does in an EM-1 year?

I swear I've done *3* LP's this year! Talking with my co-interns, they've done from 20-40!! What's up with that? Am I just that unlucky that I'm not getting LP's? People talk about how they're getting febrile headaches, thunderclap headaches, etc. and I'm just not seeing those! I did an entire month of pediatrics and did only one LP.

It's driving me insane! I love to do procedures. I've got plenty of tubes, lines, etc. but I'm lacking on the LP's.

 

[DrQuinn]

What is the average number of LP's that an intern does in an EM-1 year?

I swear I've done *3* LP's this year! Talking with my co-interns, they've done from 20-40!! What's up with that? Am I just that unlucky that I'm not getting LP's? People talk about how they're getting febrile headaches, thunderclap headaches, etc. and I'm just not seeing those! I did an entire month of pediatrics and did only one LP.

It's driving me insane! I love to do procedures. I've got plenty of tubes, lines, etc. but I'm lacking on the LP's.

Law of averages, my brother. Dont' fret, its jsut a fluke. You'll get plenty. its true, I think LPs are probably the most common procedure in the ED. There are some shifts where I'll do 2-3. You still got plenty of time. At this point halfway through my residency, I'll pawn off all the LPs I can....

Q