just wondering which surgical specialty you guys tend to consult the most in the ER?? also which surgical specialty is most often needing to actually have to come in for the consult? i'm particularly interested in ortho, uro, ent, and even neurosurgery...thanks!
who do you consult the most??
- Thread starter remote
- Start date
Academic Center Tertiary Care Facility
A lot:
Ortho (strong dep't, they end up getting called for all moderate to major reductions), Gen Surg, Neurosurg (transfers increases volume)
A moderate amount:
Hand, Ob-Gyn, Urology
A small amount:
Vascular, CT, +/- Plastics (usually parent request), Surg Onc, Colorectal, Bariatric, ENT
A lot:
Ortho (strong dep't, they end up getting called for all moderate to major reductions), Gen Surg, Neurosurg (transfers increases volume)
A moderate amount:
Hand, Ob-Gyn, Urology
A small amount:
Vascular, CT, +/- Plastics (usually parent request), Surg Onc, Colorectal, Bariatric, ENT
- Joined
- Aug 21, 2007
- Messages
- 8,405
- Reaction score
- 14,804
Agree w/ above at my tertiary care academic center, though I'd put "vascular" up a notch and "hand" down a notch. We get waaay more outstanding vasculopaths than hand traumas.
Also; what is it that makes parents think that there's some kind of magic to plastics? Simple lacs are simple lacs. I see far too many parents (always upper-middle-class moms) insist that plastics repair their son's submental 2-cm chin lac. At the end of the day; its the same.... living tissue, small sutures, and good approximation.
In the same vein; I recently had a patient's mother bring him to the ED with a complaint of "dribbling after urination". Kid was fourteen, and was wanking off far too much. Kid admitted it to me when mom was out of the room. Mom absolutely needed urology to tell her that it wasn't prostate cancer, going so far as to state: "Well, that's why I brought him here... I figured we could get to a urologist immediately."
Can you read the sign out front, beeyotch ?!
"EMERGENCY DEPARTMENT"... not "Urgent Care: Urology".
Also; what is it that makes parents think that there's some kind of magic to plastics? Simple lacs are simple lacs. I see far too many parents (always upper-middle-class moms) insist that plastics repair their son's submental 2-cm chin lac. At the end of the day; its the same.... living tissue, small sutures, and good approximation.
In the same vein; I recently had a patient's mother bring him to the ED with a complaint of "dribbling after urination". Kid was fourteen, and was wanking off far too much. Kid admitted it to me when mom was out of the room. Mom absolutely needed urology to tell her that it wasn't prostate cancer, going so far as to state: "Well, that's why I brought him here... I figured we could get to a urologist immediately."
Can you read the sign out front, beeyotch ?!
"EMERGENCY DEPARTMENT"... not "Urgent Care: Urology".
- Joined
- May 3, 2004
- Messages
- 12,772
- Reaction score
- 3,604
3 community hospitals. 1 level one trauma center..
A lot is the same as above.. I would knock down Uro and Ob from mod to small and leave hand there. The rest are all mall. Typically their own surgical complications.
- Joined
- Dec 4, 2003
- Messages
- 1,251
- Reaction score
- 1,153
Community hospital with large elderly population:
Neuro: Don't have it --> transfer
ENT: Fix it myself, but if really need --> transfer
Trauma: Don't have it. --> transfer (unless isolated chest, then occasionally cardiothoracic will take it. But that's exceptionally rare.)
General: By far the most called, and usually give orders and show up whenever. Very surgeon dependent, and they are expected to handle anything that isn't clearly another surgical specialty we have. (Colorectal, onc, bariatric, etc.) Hell, one of our most ballsy general surgeons took a lady in DIC from a botched abortion to the OR for an emergent hysterectomy a couple years ago. (It was a cluster%@$* of the greatest magnitude, but he saved her life)
Vascular: A couple of our generals also cover vascular, and we call occasionally... dialysis issues mostly, occasionally for AAA, arterial bleeds we can't control, or ischemic limbs.
Uro: a fair amount, and have an awesome group who will come in. Lots of old guys = booming uro practice.
Ortho: All the hips get admitted to medicine, and ortho gets consulted in the morning because they pitched a fit about getting called at night. Simple things get reduced and send to the office. Nasty trimal fx get admitted, but usually to medicine as these people are rarely healthy young'uns. Occasionally will admit primarily.
Hand: Hand? Hand? No hand surgeons here. Ok, well, 2 of our orthos do hand, but the chance of them being on call is nil. Therefore if it really needs a surgeon today, it gets transferred.
Cardiothoracic: Rare, but we have an open heart program, so they are available. I recall calling them in twice in the last 4 years. Once for a thoracic dissection, once for a homeboy-ambulance GSW to chest. Nicest cardiothoracic guys on the planet, I swear.
Plastics: If it's THAT bad, it gets transferred, as there is nothing of the sort here.
Peds: The pyloric stenoses get shipped as well. Same for little kiddos with appys. A couple of my surgeons will operate on down to age 5, but a couple won't.
I actually see the general surgeons and the urologists the most.
- Joined
- Aug 21, 2007
- Messages
- 8,405
- Reaction score
- 14,804
Hey D !
See you in Florida soon.
What's a homeboy-ambulance GSW? 🙂
See you in Florida soon.
What's a homeboy-ambulance GSW? 🙂
- Joined
- Jul 26, 2011
- Messages
- 150
- Reaction score
- 1
A GSW who was transported in a POV (privately owned vehicle).
- Joined
- Feb 25, 2007
- Messages
- 160
- Reaction score
- 70
I get more stabbings and GSWs that come in by homeboy ambulance than are transported by Detroit EMS. I love the homeboy ambulance!
- Joined
- Dec 4, 2003
- Messages
- 1,251
- Reaction score
- 1,153
I'm not at a trauma center, so that's the only way we see significant trauma. And usually, all hell breaks loose...
- Joined
- Nov 2, 2004
- Messages
- 4,483
- Reaction score
- 5,296
Any doc I see going to such lengths for a patient gets a free pass on ash-holery during future interactions (durable but not irrevocable).
- Joined
- Oct 28, 2006
- Messages
- 3,156
- Reaction score
- 2,034
Wait, what? I must have missed this lecture...
hell yeah!!! nothing warms my heart more than a consultant who goes out of his/her way to do the right thing... b/c we, in many cases, do it ALL DAY LONG
- Joined
- Nov 21, 2003
- Messages
- 3,434
- Reaction score
- 3,063
I once saw this lady that had a marginal story for temporal arteritis, but good enough to get the steroids and biopsy routine. Optho came in and saw her in the ED (on the weekend) and scheduled her for an outpatient biopsy. Didn't hear anything about it until I'm talking to their chief a couple of weeks later. It turns out she missed her appointment, so they sent one of their junior residents to her house to drive her to clinic. Biopsy ended up coming back positive.
- Joined
- Nov 24, 2002
- Messages
- 24,392
- Reaction score
- 17,390
Did she go blind, though?
- Joined
- Dec 4, 2003
- Messages
- 1,251
- Reaction score
- 1,153
Wilco and Gringa, I'll have you know that he's awesome. Old school guy, and does the right thing, even though it's often the hard way, and I worry he's getting burned out.
I let him take out my appendix. Yes, he happened to be on call, but that's beside the point.
And no, you can't have him!
(Because I think he's the only man who calls me "babe" on a regular basis and gets away with it.)
I let him take out my appendix. Yes, he happened to be on call, but that's beside the point.
And no, you can't have him!
(Because I think he's the only man who calls me "babe" on a regular basis and gets away with it.)
