- Joined
- Apr 6, 2003
- Messages
- 48
- Reaction score
- 0
Hi everyone, I'm a first time poster......what do you guys LOVE and HATE about EM ?? 
Pros and Cons of EM
- Thread starter DOtally great
- Start date
- Joined
- Jun 26, 2001
- Messages
- 476
- Reaction score
- 1
actually what i'd like to know is that how do EM docs deal with the things like a random patient coming in with TB comes in and coughs/vomits all over u.... or a car accident victim comes gushing blood everywhere and later u find out that he/she was HIV+... how do u guys deal with dangers like that? You might have these patients in other specialties but, in the ER its in a totally different context and somtimes when u find out if ur patient had TB or somthing, its AFTER he coughed blood all over u.
- Joined
- Apr 16, 2003
- Messages
- 805
- Reaction score
- 14
i'd also like to hear pro's and con's of the specialty. i've been warned by friends that there is a very high burnout rate in EM, but how many of these people didn't want to be ER docs in the first place and missed their top choice...how many of the EM's burnout because they can't handle the pressure of the ER? it seems like ER docs who work ~15 shifts/month and are never on call (they aren't ever on call, right?) should be in for a pretty sweet job....
- Joined
- Nov 24, 2002
- Messages
- 23,747
- Reaction score
- 12,051
There are a few types of call:
Disaster call (as implied, only for disasters, thankfully rare) - this is usually standing, since it's almost never used. This is similar to a 'general alarm' (for all you FF types).
Administrative - if you are a boss-type person, and are a manager who gets called for bureaucratic issues
Sick call - when someone else can't make it
Second call - when the department gets overrun, and is bogged down. Some places have this standing, others use a set person every time, others just call the chair or vice chair, and so on. With the advent of diversion, especially in teaching hospitals (with lots of residents), this isn't used as much - they just work until they catch up. In non-teaching hospitals, though, the money (literally) is in moving the patients through, so there would be more of this (until the pattern is recognized, and another provider is regularly scheduled for the crunch times).
The key, though, is infrequency, and at home. Your colleagues are competent and efficient (just like you!), and you only get called when you are REALLY needed.
Disaster call (as implied, only for disasters, thankfully rare) - this is usually standing, since it's almost never used. This is similar to a 'general alarm' (for all you FF types).
Administrative - if you are a boss-type person, and are a manager who gets called for bureaucratic issues
Sick call - when someone else can't make it
Second call - when the department gets overrun, and is bogged down. Some places have this standing, others use a set person every time, others just call the chair or vice chair, and so on. With the advent of diversion, especially in teaching hospitals (with lots of residents), this isn't used as much - they just work until they catch up. In non-teaching hospitals, though, the money (literally) is in moving the patients through, so there would be more of this (until the pattern is recognized, and another provider is regularly scheduled for the crunch times).
The key, though, is infrequency, and at home. Your colleagues are competent and efficient (just like you!), and you only get called when you are REALLY needed.
- Joined
- Jun 6, 2002
- Messages
- 13,868
- Reaction score
- 4,419
EM docs are rarely those who didn't get their top choice in another specialty. I've yet to hear someone who is applying for derm, rads, or another competitive specialty say "I'm also applying to a couple EM programs just in case!"
EM isn't the most competitive specialty, but it does rank up there in terms of competitiveness. Consider the limited number of programs. That coupled with the lifestyle issue that people perceive makes it a competitive field.
People think EM is a pretty easy lifestyle. EM docs do have a lot of time off, but when one considers that they work an average of 4 shifts per week, then the total hours worked each week is around 48-50. This is consistent with many other specialties (e.g., family practice, dermatology, radiology). However, I've yet to see a dermatologist pull a 7 pm to 7 am shift.
Furthermore, EM shouldn't be perceived as a specialty where you get to spend a lot of time with your family. Work a couple of night shifts in a row, and you may not see your family for a few days. What do you do during the daytime? Sleep.
EM isn't the most competitive specialty, but it does rank up there in terms of competitiveness. Consider the limited number of programs. That coupled with the lifestyle issue that people perceive makes it a competitive field.
People think EM is a pretty easy lifestyle. EM docs do have a lot of time off, but when one considers that they work an average of 4 shifts per week, then the total hours worked each week is around 48-50. This is consistent with many other specialties (e.g., family practice, dermatology, radiology). However, I've yet to see a dermatologist pull a 7 pm to 7 am shift.
Furthermore, EM shouldn't be perceived as a specialty where you get to spend a lot of time with your family. Work a couple of night shifts in a row, and you may not see your family for a few days. What do you do during the daytime? Sleep.
- Joined
- Apr 6, 2000
- Messages
- 1,678
- Reaction score
- 5
The docs I work with in a suburban ER work about 10-12 shifts a month. ANYWAY YOU SLICE THAT IT IS AWESOME! and plenty of family time. the docs I work with (about 8) have tons of time off and travel a lot. One of the docs just left to go work at a EM residency ER and work 10, 8 hour shifts a month. SWEET. plenty of family time regardless of how many nights you work. just my personal experience. Worked in several ER's over last 6 years, paramedic 5 years etc.... talked to a lot of EM docs. All residency trained except a few. Key point: practice location
later
later
- Joined
- Oct 10, 2002
- Messages
- 1,128
- Reaction score
- 8
Did an ER rotations for a month and found it to not to be to my liking for a variety of reasons. But one of the things that chafed me the most was the prospect of spending virtually your entire working existence in the ER. Granted, our ER sucks. It's small and cramped, and always feels like there's way too many peeps in there. I was always looking for excuses to get out of there. I couldn't imagine spending my entire career being a shift worker in this kind of environment.
- Joined
- Jun 6, 2002
- Messages
- 13,868
- Reaction score
- 4,419
Anyone seen the new UAB hospital? I hear their new hospital is supposed to be over 850,000 square feet with a new ED the size of a football field. Sweet!
It's not supposed to be completed until end of 2003 with a move in of January 2004. Just curious if anyone has walked through the in-progress construction.
It's not supposed to be completed until end of 2003 with a move in of January 2004. Just curious if anyone has walked through the in-progress construction.
- Joined
- Mar 19, 2003
- Messages
- 28
- Reaction score
- 9
Emergency Medicine has its drawbacks like any other speciality however, for those that choose it, the good out weighs the bad. It is a bit of a cowboy specialty in that you are expected to work hard and make do with what you get: ie- cramped spaces, too many in too little time, angry consultants, dirty patients, and a sense of bieng a grunt on the front lines. Glory goes to cardio-thoracic surgery. So ED docs tend to be relatively humble and tend to be fairly cool. The are expected to take action on every patient and can't sit around thinking too long, so their necks are always on the line, opening themselves up to criticisim often. They are rather curt and impatient b/c somewhat like surgery, it is a "doing" speciality in that you've got to get alot done ASAP.
The great benefit is that you don't have to follow patients (bye, bye 2nd year med school notions). Yes -this is considered a great benefit to those that enter EM. You get instant gratification and move on. And you still get to feel like a real doctor, b/c you are using all of your skills (80% medical and 20% surgical), and have to know your stuff well. On top of that, the shift work and extra free time give you the opportunity to work hard and play hard, so you can still have a life -EM weeds for well rounded and "normal" candidates in general.
So it's like driving an old army jeep. It isn't for everyone, but if you can tolerate the rough ride it can be alot of fun.
The great benefit is that you don't have to follow patients (bye, bye 2nd year med school notions). Yes -this is considered a great benefit to those that enter EM. You get instant gratification and move on. And you still get to feel like a real doctor, b/c you are using all of your skills (80% medical and 20% surgical), and have to know your stuff well. On top of that, the shift work and extra free time give you the opportunity to work hard and play hard, so you can still have a life -EM weeds for well rounded and "normal" candidates in general.
So it's like driving an old army jeep. It isn't for everyone, but if you can tolerate the rough ride it can be alot of fun.
- Joined
- Nov 18, 2002
- Messages
- 5,220
- Reaction score
- 2,435
Amen to Wrangler, except the comment about CT surgery. Any specialty that turns 100% of their patients into pumpheads (that's the hit every CABG patient takes mentally) can't be all that glorious. Besides, 7 years to do CABG after CABG? I'd rather do EM in a janitorial closet for the next 30 years.
- Joined
- Dec 3, 2002
- Messages
- 107
- Reaction score
- 0
Looking back at my 3rd year as I am wrapping up my last rotation this year, I consider myself lucky that I knew throughout med school that I was going into EM, I also got to see the view of EM from other departments.
Of the complaints that I heard about EM, the most consistant throughout various departments had to do with the workups. That in a case which is an obvious admit, instead of starting the workup, the EP will consult the respective service then "wash their hands" of the patient so-to-speak. I can actually say that I've seen this, not just hearsay, and honestly, it was I was embarrassed for them. For example, a patient presenting with a partial small bowel obst gets consulted to surgery. We got down there, he has no NG, no foley, didn't even do a rectal, just dx by hx and air-fluid levels on AXR. Now, the EP was right, it was a SBO, but since when does management of the pt end at consultation? The patient is still yours until it is off the ward, period.
Have any of you had similar experiences?
Overall, I feel it is like in any practice, operator-dependent so to speak. I know great internists, and crappy internists, and similarly in all practices. But, from everyone's experience, do you feel this practice is an exception or the norm at your various programs?
Of the complaints that I heard about EM, the most consistant throughout various departments had to do with the workups. That in a case which is an obvious admit, instead of starting the workup, the EP will consult the respective service then "wash their hands" of the patient so-to-speak. I can actually say that I've seen this, not just hearsay, and honestly, it was I was embarrassed for them. For example, a patient presenting with a partial small bowel obst gets consulted to surgery. We got down there, he has no NG, no foley, didn't even do a rectal, just dx by hx and air-fluid levels on AXR. Now, the EP was right, it was a SBO, but since when does management of the pt end at consultation? The patient is still yours until it is off the ward, period.
Have any of you had similar experiences?
Overall, I feel it is like in any practice, operator-dependent so to speak. I know great internists, and crappy internists, and similarly in all practices. But, from everyone's experience, do you feel this practice is an exception or the norm at your various programs?
- Joined
- Jun 6, 2002
- Messages
- 13,868
- Reaction score
- 4,419
You're at a teaching hospital. What kind of teaching can be done if the EM physician did everything before consulting the residents?
The residents need to learn.
- Joined
- Dec 6, 2000
- Messages
- 4,226
- Reaction score
- 17
Coleman is right (atleast in this case)... the initial treatment/workup should be done by the EP. There is no excuse for letting a possible SBO sit there without any intervention whatsoever. Actually, at the small hospital I did my cores at (osteopathic hospital), the lack of Txing a SBO in the ED lead to a death (87 year old lady, aspirated on the way up, coded literally 5 feet in the ICU).
Q
- Joined
- Dec 3, 2002
- Messages
- 107
- Reaction score
- 0
In regards to Geek Medic's comment:
Geek Medic:
"You're at a teaching hospital. What kind of teaching can be done if the EM physician did everything before consulting the residents?
The residents need to learn."
By EM physician at my teaching hospital, it includes the resident who worked up the pt and the attending who signed off. So, both treated the patient inadequately. If you mean the surgical residents need to learn (i.e. how to w/u a SBO) they get plenty of that on the floors w/their post-op pts.
I look at practicing medicine like playing the piano, the less you do it, the worse you are at it.
Geek Medic:
"You're at a teaching hospital. What kind of teaching can be done if the EM physician did everything before consulting the residents?
The residents need to learn."
By EM physician at my teaching hospital, it includes the resident who worked up the pt and the attending who signed off. So, both treated the patient inadequately. If you mean the surgical residents need to learn (i.e. how to w/u a SBO) they get plenty of that on the floors w/their post-op pts.
I look at practicing medicine like playing the piano, the less you do it, the worse you are at it.
- Joined
- Feb 11, 2002
- Messages
- 948
- Reaction score
- 219
Well, unfortunately, most of my interaction with emergency physicians (and residents) has been disappointing.
As has been mentioned, I too encounter EPs who make the diagnosis, consult surgery, and then wash their hands. Often, these poor folks have been in the ER for 8 hours with PSBOs or SBOs and their solutions have been to give the patients Phenergan or Zofran. Nevermind their BUNs of 30, their doughy skin, or bowel loops the size of Texas.
Another one I like is the guy who comes in with your typical signs and symptoms of appendicitis and the EPs somehow feel they just have to get a CT scan. This burns a couple more hours. Finally, after 8 hours of being in the ER with acute appendicitis, they call you in a tizzy stating that their guy has to go to the OR immediately.
I typically despise the call about a patient with abdominal pain who is being admitted to a medicine service and they're calling you to "give you a head's up" about the patient. "You don't need to see the patient now, but I suspect medicine will want you to." (Great, quit paging me and let medicine page me when they want the damn consult.)
The one I hate the most is the "Since you're already here, there's another guy in room 6, and we just want you to take a look at him" (i.e., please do our workup for us).
I once got a call to disimpact a woman who had a hartman's 2 years ago (colostomy never taken down because the woman weighed 400 pounds).
I once got called about whether to use Prolene or nylon to close skin.
Don't get me started on all those IJ/SC lines gone awry. "Okay, get a thoracotomy tray ready. . .."
I once was approached by my attending who asked if I was disrespectful to an ER attending since she complained that I asked her too many questions about the consult patient over the phone.
----
Ugh.
Anyway, come June I spend my obligatory month in the ER. I guess I'll see how the other side lives. It should be interesting...
As has been mentioned, I too encounter EPs who make the diagnosis, consult surgery, and then wash their hands. Often, these poor folks have been in the ER for 8 hours with PSBOs or SBOs and their solutions have been to give the patients Phenergan or Zofran. Nevermind their BUNs of 30, their doughy skin, or bowel loops the size of Texas.
Another one I like is the guy who comes in with your typical signs and symptoms of appendicitis and the EPs somehow feel they just have to get a CT scan. This burns a couple more hours. Finally, after 8 hours of being in the ER with acute appendicitis, they call you in a tizzy stating that their guy has to go to the OR immediately.
I typically despise the call about a patient with abdominal pain who is being admitted to a medicine service and they're calling you to "give you a head's up" about the patient. "You don't need to see the patient now, but I suspect medicine will want you to." (Great, quit paging me and let medicine page me when they want the damn consult.)
The one I hate the most is the "Since you're already here, there's another guy in room 6, and we just want you to take a look at him" (i.e., please do our workup for us).
I once got a call to disimpact a woman who had a hartman's 2 years ago (colostomy never taken down because the woman weighed 400 pounds).
I once got called about whether to use Prolene or nylon to close skin.
Don't get me started on all those IJ/SC lines gone awry. "Okay, get a thoracotomy tray ready. . .."
I once was approached by my attending who asked if I was disrespectful to an ER attending since she complained that I asked her too many questions about the consult patient over the phone.
----
Ugh.
Anyway, come June I spend my obligatory month in the ER. I guess I'll see how the other side lives. It should be interesting...
D
deleted6669
the impulse to get a ct r/o appy often is based on the fact that many surgeons refuse to eval a pt until one is done. in my dept, we often page surgery with obvious appy/high wt count/classic presentation and are told to call back when we have a ct result. this may be a regional issue, however it may also be due to the fact that all our surgeons are> 50 yrs old/burnt out and want to spend as little time in the ED or OR as possible. also the request for ct often comes when they are off call in a few hrs as a stalling technique to get them home on time. I have worked with a number of excellent surgeons in the past, just not at my current position.
- Joined
- Jun 6, 2002
- Messages
- 13,868
- Reaction score
- 4,419
I remember reading a study a year or so ago that demonstrated that surgeons had higher proficiency at reading CT scans to r/o appendicitis. Basically the article recommended that only surgeons or radiologist should read those CT scans.
D
deleted6669
I agree that surgeons and radiologists excel at reading ct's. all of our ct's are read by radiology who then call us with a report.
- Joined
- Mar 19, 2003
- Messages
- 28
- Reaction score
- 9
Neutropeniaboy:
I'm sorry in advance... but I have to ask. Is that PGY-1 at the bottom of your message accurate? If so, and I truely am sorry, who is it that asks the surg intern's advice for anything??? Hopefully not anyone remotely connected to EM. Perhaps the family medicine intern??
No offense to my surgical buddies, but I've got alot of stories where they dropped the ball too. Not to be an a**hole, but I couldn't resist.
Sorry if you are actually the attending. Ha, ha, ha..... funny stuff.
I'm sorry in advance... but I have to ask. Is that PGY-1 at the bottom of your message accurate? If so, and I truely am sorry, who is it that asks the surg intern's advice for anything??? Hopefully not anyone remotely connected to EM. Perhaps the family medicine intern??
No offense to my surgical buddies, but I've got alot of stories where they dropped the ball too. Not to be an a**hole, but I couldn't resist.
Sorry if you are actually the attending. Ha, ha, ha..... funny stuff.
- Joined
- Feb 11, 2002
- Messages
- 948
- Reaction score
- 219
Originally posted by Wrangler
Neutropeniaboy:
I'm sorry in advance... but I have to ask. Is that PGY-1 at the bottom of your message accurate? If so, and I truely am sorry, who is it that asks the surg intern's advice for anything??? Hopefully not anyone remotely connected to EM. Perhaps the family medicine intern??
No offense to my surgical buddies, but I've got alot of stories where they dropped the ball too. Not to be an a**hole, but I couldn't resist.
Sorry if you are actually the attending. Ha, ha, ha..... funny stuff.
At the places I train, it's either the EM attending or the EM resident who calls the surgical consultant. At one particular hospital, the intern is the surgical consult.
I'm sure all things vary, but at this particular hospital, the private practice EM physicians aren't very slick at all. I've often dug out pretty important components of the history that clarify the diagnosis and do better physical examinations than they have done.
But, if the point of emergency medicine is to do the minimum necessary to clear a patient from the bay, then they do a good job.
Funny stuff.
- Joined
- Feb 11, 2002
- Messages
- 948
- Reaction score
- 219
I think that's pretty sad.
I've encountered a lot of surgical residents who just want to know the labs and the imaging results. It's unfortunate that the art of the H&P has been lost in many of us. I agree that you should use your tools, but we should use them selectively.
- Joined
- Dec 3, 2002
- Messages
- 107
- Reaction score
- 0
neutropeniaboy,
I'll give you that the art of a good H&P is lost to most physicians, but I hope that your only exposure to EM physicians is not a private group of docs out at some rural location. If you don't think EP are any good, then
A.Why you here?
B. You are obviously just looking for the negative in everyone you've come into contact with.
Overall, you should know that no matter how good your H&P when it comes to an appy dx, the only definitive answer is CT and/or ex-lap.
I'll give you that the art of a good H&P is lost to most physicians, but I hope that your only exposure to EM physicians is not a private group of docs out at some rural location. If you don't think EP are any good, then
A.Why you here?
B. You are obviously just looking for the negative in everyone you've come into contact with.
Overall, you should know that no matter how good your H&P when it comes to an appy dx, the only definitive answer is CT and/or ex-lap.
True Story:
I work at a private urban ER with no residents in any of the services. Several of my surgical colleagues are quite good and will take a clear cut appy straight to the OR without imaging. Others are not so good and will ask for a CT, especially if it is late at night and it means a few extra hours of sleep.
One night at about 2:00 AM I saw an absolutely classic appy. Male, 25, 6 hours of slowly worsening pain, initially periumibilical now RLQ, nausea, anorexia, even has the white count the surgeons know and love.
Unfortunately, his insurance is an HMO that wants all their patients transferred to a specific hospital. I call the ER physician at the HMO and explain the case. I said the surgeon on call for my hospital would certainly take this guy straight to the OR but since it takes about 15-20 minutes for my surgeon to come in and to get the OR ready I would certify the patient as stable for transfer if he promised me that the patient would be seen by surgery immediatly on arrival and presumably wisked off to the OR. The accepting hospital is a teaching center with multiple OR's running all night. When my patient arrived the surgical intern was consulted at around 3:00AM and of course order a CT without ever seeing the patient. The net effect was to delay my patients appendectomy by almost 4 hours. If he had perf'd during that time I would have been pissed and her certainly would have had grounds for suing someone. (maybe me for transferring him)
I work at a private urban ER with no residents in any of the services. Several of my surgical colleagues are quite good and will take a clear cut appy straight to the OR without imaging. Others are not so good and will ask for a CT, especially if it is late at night and it means a few extra hours of sleep.
One night at about 2:00 AM I saw an absolutely classic appy. Male, 25, 6 hours of slowly worsening pain, initially periumibilical now RLQ, nausea, anorexia, even has the white count the surgeons know and love.
Unfortunately, his insurance is an HMO that wants all their patients transferred to a specific hospital. I call the ER physician at the HMO and explain the case. I said the surgeon on call for my hospital would certainly take this guy straight to the OR but since it takes about 15-20 minutes for my surgeon to come in and to get the OR ready I would certify the patient as stable for transfer if he promised me that the patient would be seen by surgery immediatly on arrival and presumably wisked off to the OR. The accepting hospital is a teaching center with multiple OR's running all night. When my patient arrived the surgical intern was consulted at around 3:00AM and of course order a CT without ever seeing the patient. The net effect was to delay my patients appendectomy by almost 4 hours. If he had perf'd during that time I would have been pissed and her certainly would have had grounds for suing someone. (maybe me for transferring him)
- Joined
- Feb 11, 2002
- Messages
- 948
- Reaction score
- 219
Like I said earlier -- I have an EM rotation coming up, and I wanted to get a feel of what goes on in the ER these days.
Furthermore, I'm at private hospital in a medium-sized city, and for the rest of the time, I'm at a regional trauma center. So, it's not just community medicine.
Well, that's partially true.
Horsepoop. Horsepoop. Horsepoop. I've seen plenty of "definitive" CTs for appendicitis that have revealed normal appendicies on ex-lap.
- Joined
- Nov 24, 2002
- Messages
- 23,747
- Reaction score
- 12,051
The last call before this (Sapphire and tonic, post-call - oh my, what am I thinking?), we get called for an admission around midnight. The patient is a prisoner from a local lockup, seen by an MD (not PA) in their infirmary, sent over for meningitis vs. urosepsis. Ding! Two tests come to mind. How many are done? None. The kicker? Although it's an EM teaching program, the resident was an IM rotator - screwing her own colleagues.
As a side note, this was the first time I tried an LP - even though I used a lot of lidocaine, it's a good thing this guy's a paraplegic, or else I think he might not have dug it too much.
As a side note, this was the first time I tried an LP - even though I used a lot of lidocaine, it's a good thing this guy's a paraplegic, or else I think he might not have dug it too much.
I'll agree with that and vice/versa. Unfortunately the sensitivity and specificity of CT for appy is not 100% and the papers quoting high 90's were done at academic centers with body ct specialist looking at every scan. I'm sure our community hospital sensitivities and specificities are no where near that high
- Joined
- Mar 19, 2003
- Messages
- 28
- Reaction score
- 9
Neutropeniaboy:
You really are a funny guy (sorry-Goodfellas). Anyways, hope that ALL your ED interactions aren't so bad. In my program we work closely with our surg buddies and we think alike most of the time. They really appreciate and need our help in the SICU, in the trauma room, and on the consult services as rotators, and we cover the entire surgical residency's patients and calls at once for their holiday parties and other residency activities. (So they can get that rare break)
I just think that a lot of surgical residencies teach their young at an early age to act as if they are the only capable doctors in the hospital, which can be really amusing if the residency is not that strong and the candidates are weaker than even those from non-competitive specialities.
I've got alot of respect for the efficient approach and hard work of surgeons, but no one where I am puts up with any BS from surgery. (and sometimes our occasional head-butting leads to frank skull-fracturing)
Most importantly though, have a good beer for me on your next day off. Take care.
You really are a funny guy (sorry-Goodfellas). Anyways, hope that ALL your ED interactions aren't so bad. In my program we work closely with our surg buddies and we think alike most of the time. They really appreciate and need our help in the SICU, in the trauma room, and on the consult services as rotators, and we cover the entire surgical residency's patients and calls at once for their holiday parties and other residency activities. (So they can get that rare break)
I just think that a lot of surgical residencies teach their young at an early age to act as if they are the only capable doctors in the hospital, which can be really amusing if the residency is not that strong and the candidates are weaker than even those from non-competitive specialities.
I've got alot of respect for the efficient approach and hard work of surgeons, but no one where I am puts up with any BS from surgery. (and sometimes our occasional head-butting leads to frank skull-fracturing)
Most importantly though, have a good beer for me on your next day off. Take care.
- Joined
- Mar 25, 2002
- Messages
- 4,477
- Reaction score
- 31
Geek Medic,
I have, but only late night after all the people had gone
There isn't much finished beyond the concrete floor and the piping - your best bet is to look here:
http://www.fab.uab.edu/d&tfac/Masterplan.htm
There's at least one slide on the ER layout.
Yours,
- Joined
- Oct 10, 2002
- Messages
- 1,128
- Reaction score
- 8
The only definitive answer is an ex-lap. But the standard of care for an appy work-up is the H&P.
As for CT, there have been a number of studies with varying numbers regarding the utility of CT scans for appy. None of them have affected the standard of care. If all suspected appys are treated with an ex-lap, then you will have around a 5-10% (I think) rate of negative ex-lap. That has yet to be improved by routine CTing. Ask yourself how a CT will change the management of a patient with suspected appendicitis? It won't. A negative CT scan will not keep a suspected appy out of the OR.
- Joined
- Mar 19, 2003
- Messages
- 28
- Reaction score
- 9
I agree. You don't usually CT a good appy story. They go to the OR, there is no need for CT. Depending on how the CT is done there is a high 80's - high 90's% sensitivity. PR contrast is best.
Unrelated- "Fishing around" with the CT for abdomenal pain tends to turn up alot of junk b/c the positive predictive value is low so the false negatives increase alot (iv'e seen this with some community guys).
The negative appendectomy should be higher than 5-10%, otherwise you risk missing too many (bad consequences even if happens rarely). According to Tintinalli 15-40% of all operations for appendicitis turn up negative -though these studies seem alittle old. Better to have a bunch of negative ex-laps than a missed hot appy though.
Tintinalli also has good info on what Hx, exam, and studies and have good (+)LR and (-)LR for acute abd conditions.
Unrelated- "Fishing around" with the CT for abdomenal pain tends to turn up alot of junk b/c the positive predictive value is low so the false negatives increase alot (iv'e seen this with some community guys).
The negative appendectomy should be higher than 5-10%, otherwise you risk missing too many (bad consequences even if happens rarely). According to Tintinalli 15-40% of all operations for appendicitis turn up negative -though these studies seem alittle old. Better to have a bunch of negative ex-laps than a missed hot appy though.
Tintinalli also has good info on what Hx, exam, and studies and have good (+)LR and (-)LR for acute abd conditions.
