What is the coolest procedure?

[OB1🤙]

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nothing more relieving than getting the tough tube on the third or fourth look (luckily we have some attendings that give us that many attempts).

Don't take this the wrong way, but as an anesthesia resident eavesdropping on this conversation, I'd submit that you're doing your patients a disservice by instrumenting difficult airways multiple times.

 

[DrWBD]

Lame, lame, lame. Our job is cool and fun. Even as weak attempts at humor, if this is your favorite, most exciting procedure, maybe you should re-examine your career choice (except for the ever-present slam from the IM flea, a student in this case). Just because you say you want to be, or are an EM doc, doesn't mean you should be one.

Someone takes themselves a bit too seriously 🙄

By the way, the term "flea" might have been in vogue in The House of God or something but not in this century.

 

[Apollyon]

Someone takes themselves a bit too seriously 🙄

By the way, the term "flea" might have been in vogue in The House of God or something but not in this century.

You're odd-man (woman?)-out here. And it's still in vogue at Duke, so you can take a walk.

 

[southerndoc]

Don't take this the wrong way, but as an anesthesia resident eavesdropping on this conversation, I'd submit that you're doing your patients a disservice by instrumenting difficult airways multiple times.

Enlighten me. If you can't get the tube on the first try, what do you do? Try again?

There's nothing wrong with trying multiple times as long as you are doing something different (i.e., different blade, different head positioning, etc.).

Not everywhere you work as an attending has anesthesia in house 24/7 where you can just ring them up and ask them to intubate.

 

[OB1🤙]

No no, what I'm saying is- an EM attending probably shouldn't give a struggling resident 4 cracks at an apparently difficult airway. The most experienced laryngoscopist in the room- the EM attending- should take over after probably 2 attempts at most by the resident IMO.

All I'm saying is that each attempt will muck up an already difficult airway that much more, and it's in the patient's best interest to minimize attempts at DL if they truly are a difficult intubation.

 

[La Fiera]

A nice fatty peritonsillar abscess, I like a paracentisis that drains out a couple liters as well.
The best is a thoracotomy though.

 

[DrWBD]

You're odd-man (woman?)-out here. And it's still in vogue at Duke, so you can take a walk.

Do they use "glorified triage nurse" down there also?

 

[rabidpanda13]

Maybe not really a procedure per se, but I always enjoy giving adenosine for SVT. Always kind of sphincter tightening for everyone (though it gets a little easier now that I am an attending).

I still always kind of like the rush of:
Getting a nice thread for a central line. I do my "happy thread, happy thread, happy thread" chant as I push the guidewire through.... and when it slides in easily that is always very satisfying...
And just endotracheal intubation. Sliding it through the cords, pulling out teh stylet, and bagging with nice yellow to the ETCO2 detector, that still is a nice relieving feeling.

I guess I Just like feeling relieved more than excited nowadays.

I delivered a turd about the width of a tennis ball a few days ago from a nursing home patient, by the way. Almost as exciting as docb's G tube replacement....

Q

I have had that done TO me and at the time I wondered why everyone was standing around looking at me like I was a nut and when it was over I thought they were all laughing at me. It was only later I found out what had actually gone on and they were laughing in relief. Good times...good times...

 

[Apollyon]

Do they use "glorified triage nurse" down there also?

Go away. Is that in vogue enough for you? You are not contributing to this thread.

Thank you.

 

[DrWBD]

Go away. Is that in vogue enough for you? You are not contributing to this thread.

Thank you.

Oh, is the flea bothering you?
Seriously, lighten up a bit there.

 

[lucky_deadman]

Oh, is the flea bothering you?
Seriously, lighten up a bit there.

I want to reiterate what Apollyon said.

It's time for you to move along or at least "be seen and not heard".

 

[aphistis]

I also like cardioverting nursemaid's elbows. The looks on the faces of the parents and nursing staff and hospital admin and jury are priceless.

seriously, I love those too as well as alveolar blocks for toothaches at 2 AM.

Anyone else like art lines? I think I'm the only guy in our group who does them, but I'm glad I have maintained this skill since residency. Sometimes they are really useful.

I find art lines are the single most frustrating procedure in medicine. Not because of my success rate, just because getting them is such a hit-or-miss thing and there isn't much to do except keep steering & stabbing.

 

[aphistis]

Don't take this the wrong way, but as an anesthesia resident eavesdropping on this conversation, I'd submit that you're doing your patients a disservice by instrumenting difficult airways multiple times.

No no, what I'm saying is- an EM attending probably shouldn't give a struggling resident 4 cracks at an apparently difficult airway. The most experienced laryngoscopist in the room- the EM attending- should take over after probably 2 attempts at most by the resident IMO.

All I'm saying is that each attempt will muck up an already difficult airway that much more, and it's in the patient's best interest to minimize attempts at DL if they truly are a difficult intubation.

I was thinking the same thing.

 

[Hawkeye Kid]

No no, what I'm saying is- an EM attending probably shouldn't give a struggling resident 4 cracks at an apparently difficult airway. The most experienced laryngoscopist in the room- the EM attending- should take over after probably 2 attempts at most by the resident IMO.

All I'm saying is that each attempt will muck up an already difficult airway that much more, and it's in the patient's best interest to minimize attempts at DL if they truly are a difficult intubation.

While I see your point, I disagree (to an extent). I think that in a patient who is stable and easily ventilated and whose airway is difficult to anatomy and not airway trauma, blood, emesis, etc., it is important to allow the resident the opportunity to work through their difficult airway algorithm. I'm not saying that they should look-fail-bag-look-fail-bag, but that at each point make some change(s) that make success more likely. I don't think that this should be done for an intern or an off-service resident for whom airway management is not a critical skill. But, for a senior EM resident--who will soon be the "most experienced laryngoscopist in the room"--I think this approach is acceptable. The first independent experience with a difficult airway should not be the first experience with a difficult airway.

Now, if the patient is unstable, the airway is being bloodied, or the resident isn't making progress, then the attending should absolutely take over.

The reality of academic medicine is that there will always be a balance between patient care and education. In fact, I think this is probably one of the most difficult aspects of being an academic attending--knowing when to take over care of the patient from the resident. Do it too late and you're doing it a disservice to the patient, but too early and you're doing a disservice to the resident (and, some would argue, their future patients).

 

[Shodddy18]

Always Gross, but I like draining big abscesses. 😱 I know you are all thinking that I am a disgusting human being... but for whatever reason, I always enjoy doing it!

 

[skiz knot]

I will admit, I do like pulling those back on. You're standing there, skiing, someone is pulling the skin out of the hole, and clunk.

You shouldn't have to "ski" on a ankle fracture-dislocation. There is generally so much ligamentous damage that it should reduce with relatively little force.

 

[stud247]

I find art lines are the single most frustrating procedure in medicine. Not because of my success rate, just because getting them is such a hit-or-miss thing and there isn't much to do except keep steering & stabbing.

what's an art line?

 

[pseudoknot]

what's an art line?

An arterial catheter, also known as an A-line.

 

[deleted109597]

what's an art line?

By Ellsworth Kelly, master of the ordinary.

 

[lucky_deadman]

By Ellsworth Kelly, master of the ordinary.

Nice. I would expect no less from you.

 

[DeeJay2728]

The reality of academic medicine is that there will always be a balance between patient care and education. In fact, I think this is probably one of the most difficult aspects of being an academic attending--knowing when to take over care of the patient from the resident. Do it too late and you're doing it a disservice to the patient, but too early and you're doing a disservice to the resident (and, some would argue, their future patients).

Well said...

 

[DoctorMedic]

This has to be one of my favorites, mostly because I can often see an immediate and tangible change in the pt's status (improved mental status mainly). Really anything that gives me instant gratification is pretty cool (I was trying to find that scene from bringing out the dead when Nicholas Cage pushes the narcan on that kid but I can't find it).

D50 and Adenosine I like for the same reason...

scene is from "bringing out the dead" great movie. and in spirit with that narcan is one of my favorites. like the guy who doped up fresh out of the slammer and fell asleep with a cigarette in his mouth that burnt a hole in his chest and didnt wake up.

D50 for similar reasons

I am a big fan of dopamine and pacing...nice to take a barely beating heart and beat the crap out of it some more in an effort to get them to the cardiologist and cath lab 😛

 

[skiz knot]

By Ellsworth Kelly, master of the ordinary.

Technically that's an art line segment as it has discrete endpoints.