Second year medical student asking about the field

[ERMudPhud]

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I'm assuming this was done in the ED?

In L&D/OR. The alternative was doing it with a lot of local. I don't think I would wish that on anyone. I say always take care of the patient first. Worry about the lawyers later. I've given a lot of ketamine for a lot of things over the years and am comfortable with it. There is a lot of surgery of all sorts, including c-sections, done around the world with just IV or IM ketamine. Here is a good place to start
ketamine in resource poor environments.

I learned a few things
1.Bring my own ambu bag, airway stuff, O2 to OR. Stuff I'm familiar with. Hard to figure out how to set up their circuit and their O2 and everyone else was busy doing important stuff like getting the baby out and resuscitated. Best to have stuff you know.
2. Looked it up later. Ketamine crosses placenta in about a minute so you could put the baby in a k-hole I guess. Not sure what that would look like. Apgar's suggest baby was fine but baby was out awfully quick(rock star FP) so maybe didn't get so much. Either way we use ketamine a lot in peds.

Also for those who are wondering how you end up with such a short notice crash c-section in middle of night... ...home birth going bad. With any patient on L&D they have some idea of how the trajectory is going and if it looks like it might be heading to c-section anesthesia stays in house.

 

[ERMudPhud]

Lol if you are rural you will be doing everything, and will be called to the floor for central lines, intubations etc. High acuity tertiary hospitals are the LEAST likely place to do procedures, as there are subspecialists, PICC nurses, IR, radiology, and even residents.

In a small hospital EM does EVERYTHING- paracentesis, pleuros, chest tubes, intubations, central lines, reductions.

I have to agree and I think everyone in residency should find a place to do a bit of rural EM. And by rural I mean really rural. The kind of places where you fly out most admissions and have to triage who flies first and who goes by ground or even boat. Where you have to decide what to do when the CT scanner breaks and Walmart doesn't have the parts. Where you do most of the reductions, lines, tubes, para's, thora's and there is no one in house to back you up. You may find you like it. If nothing else you will know you can do it if you have to. Most of your jobs won't be at academic centers and some of the jobs you end up loving might be at rural places just like that. I did time during medical school and residency at rural Alaskan hospitals and it opened my eyes to the fact that there is a whole lot of good medicine out there that is unbelievably different from the ivory towers I had been exposed to up until that point.(ivy league and old school academic EM places)

 

[Apollyon]

I remember an OB from when I was in residency that talked to us during conference. She said they can get the kid out in 90 seconds. It ain't pretty, but the kid lives.

 

[miacomet]

I have to agree and I think everyone in residency should find a place to do a bit of rural EM. And by rural I mean really rural. The kind of places where you fly out most admissions and have to triage who flies first and who goes by ground or even boat. Where you have to decide what to do when the CT scanner breaks and Walmart doesn't have the parts. Where you do most of the reductions, lines, tubes, para's, thora's and there is no one in house to back you up. You may find you like it. If nothing else you will know you can do it if you have to. Most of your jobs won't be at academic centers and some of the jobs you end up loving might be at rural places just like that. I did time during medical school and residency at rural Alaskan hospitals and it opened my eyes to the fact that there is a whole lot of good medicine out there that is unbelievably different from the ivory towers I had been exposed to up until that point.(ivy league and old school academic EM places)

I actually think even every med student needs two weeks of non academic EM- they would have a better and more complete picture of the field and what most jobs in EM are like. It's not all like ABEM General and academia.

 

[Apollyon]

I actually think even every med student needs two weeks of non academic EM- they would have a better and more complete picture of the field and what most jobs in EM are like. It's not all like ABEM General and academia.

ABEM General - with ID/heme/medical genetics on call, but no ortho or gen surg.

 

[JacobMcCandles]

I actually think even every med student needs two weeks of non academic EM- they would have a better and more complete picture of the field and what most jobs in EM are like. It's not all like ABEM General and academia.

Even attendings would benefit from two weeks of non-academic EM every year.

 

[WhatJobDoIPick]

I actually think even every med student needs two weeks of non academic EM- they would have a better and more complete picture of the field and what most jobs in EM are like. It's not all like ABEM General and academia.

I wish I was given a month of drunks and decompensated psych yelling at me, and having to meet metrics w constantly cycling admin goal posts while seeing 2pph. Would have convinced me quite readily not to pursue this trash heap speciality.

 

[Apollyon]

Even attendings would benefit from two weeks of non-academic EM every year.

So they can flounder for 2+ weeks?

 

[miacomet]

Even attendings would benefit from two weeks of non-academic EM every year.

Lol they would implode

 

[Brigade4Radiant]

Most academic attendings would not survive working by themselves they can barely handle their 6 academic ED shifts

 

[CajunMedic]

I have to agree and I think everyone in residency should find a place to do a bit of rural EM. And by rural I mean really rural. The kind of places where you fly out most admissions and have to triage who flies first and who goes by ground or even boat. Where you have to decide what to do when the CT scanner breaks and Walmart doesn't have the parts. Where you do most of the reductions, lines, tubes, para's, thora's and there is no one in house to back you up. You may find you like it. If nothing else you will know you can do it if you have to. Most of your jobs won't be at academic centers and some of the jobs you end up loving might be at rural places just like that. I did time during medical school and residency at rural Alaskan hospitals and it opened my eyes to the fact that there is a whole lot of good medicine out there that is unbelievably different from the ivory towers I had been exposed to up until that point.(ivy league and old school academic EM places)

Sounds like one of the places I worked PRN right after residency. I was down on the WV/VA border in the coal fields. Had days with one copter on the helipad doing a hot load, with one circling waiting on the other one to take off. Traumas brought in in the back of company pickup trucks. Positive FAST exam, ATLS, line, blood, TXA, and bird to mothership in less than 45 mins. BLS crews bringing in spontaneous tension pneumothoraces. I've definitely triaged who gets the helicopter first.

OK, Now I kinda miss that place, wish it wasn't so far away