Trauma Surgeon in ER Question

[medislife15370]

Would a trauma surgeon, whom works primarily in the ED (L1) be able to intubate a pt? Or is this primarily left up to the Emergency Medicine Physician?

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[SterlingMaloryArcher]

Depends on the place whether there would actually be a need for them to. If you actually end up a trauma surgeon and by then you are really just hellbent on doing the intubation you could probably just say let me do it before they arrive.

Maybe if one of your admitted patients codes on a floor you would also have the opportunity.

 

[Winged Scapula]

1) Trauma surgeons don't work primarily in the ED. They spend time there but most of their time would be spent in the OR, ICU, floors etc.

2) Trauma surgeons can intubate

3) But most of the time the patient either arrives already intubated by the transport crew, or the intubation is done by Anesthesia (who would be present for a Level 1 trauma) or the EM physician. Trauma activations and response may differ depending on hospital. At ours (for residency and fellowship), EM was not present for Level 1 and 2 trauma activations; they were run by general surgery.

YMMVEspecially if there’s an emergency medicine residency at your hospital.

 

[Winged Scapula]

Moving to HSDN

 

[jonak]

Moving to HSDN

Wrong forum, doesn't belong in hsdn

 

[Winged Scapula]

Wrong forum, doesn't belong in hsdn

You’re right… Someone reported this post stating that the OP was a high school student. I should have verified. Nonetheless it does not belong in the surgery forum

 

[AnatomyGrey12]

Anesthesia would likely do it. Trauma surgeons don't spend much time in the ER.

 

[Cryc_to_the_point]

I cannot imagine the trauma surgeon would do it (and at the 1 trauma center I have experience in they as a rule, never would be asked to) with at least 1 airway expert there (EM or Anesthesia)

 

[LizzyM]

"Able" as in "can successfully do it if necessary": yes, most likely is minimally competent.


If this is something you've seen a trauma surgeon do in a TV drama, well, that's TV and not the way it typically goes down in the real world. There are other specialties with far more experience with intubation who would take charge of the airway while the trauma surgeon has other fish to fry.

 

[LilKangaroo]

It would be unusual for the trauma surgeon to intubate. They are generally running the trauma, which is more of a leadership and medical decision making role. EM or anesthesia will take the airway, depending on the shop.

Trauma surgeons are often certified in surgical critical care, so they may have intubating experience in their training, but when it comes to people’s lives, it best to let the experts do their job, and surgeons are not airway experts.

 

[DrFortiusNatando]

In most academic Level I trauma centers where there is an EM residency, EM residents and attendings do most of the medical and trauma intubations in the ED. Even difficult airways. For REALLY difficult airways, a team of providers is called to the bedside - this includes trauma surgeon (for cric if need be), as well as ENT and anesthesia - and anesthesia brings their "tower" of specialized equipment. No trauma surgeon has done an endotracheal intubation in more than 10 years in our ED.

 

[LucidSplash]

In most academic Level I trauma centers where there is an EM residency, EM residents and attendings do most of the medical and trauma intubations in the ED. Even difficult airways. For REALLY difficult airways, a team of providers is called to the bedside - this includes trauma surgeon (for cric if need be), as well as ENT and anesthesia - and anesthesia brings their "tower" of specialized equipment. No trauma surgeon has done an endotracheal intubation in more than 10 years in our ED.

I’m a bit late to the party but for what it’s worth: intubation is a critical care skill and “trauma surgeons” do a critical care fellowship. There are some non-accredited “trauma” fellowships that are tacked on as an extra year to accredited critical care fellowships but that’s just marketing. At a Level 1 place, which the OP referenced, then it is correct that there is likely to be EM or anesthesia managing the airway in the trauma bay. That being said, most “trauma surgeons” also manage the SICU/trauma ICU as critical care docs and it would be very typical for them to manage the airway of patients there. It would be unusual to have a true “trauma surgeon” who hadn’t intubated anyone “in 10 years.” Maybe true they haven’t done it in the ED, but likely that they’ve done it elsewhere in the course of their responsibilities.

 

[Danbo1957]

No trauma surgeon has done an endotracheal intubation in more than 10 years in our ED.

Why not? A required Trauma Surgeon skill here in our L1 ED.

 

[alpinism]

Probably 90% of L1 centers have EM physicians performing intubations with the other 10% being done by Anesthesiology.

While its technically possible to intubate during traumas its not the norm and certainly not something Id expect to do a regular basis.