Why so much Critical Care in EM now?

[gro2001]

You dont want your first pediatric tube to be as a new attending. Tubin kids is butthole tightening enough.

Right, but the better way to remedy that is with a peds anesthesia rotation. In two weeks on peds anesthesia I got to intubate around 15 kids. In a month of PICU, I got exactly zero intubations. I don't think my experience was atypical for either rotation.

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[gro2001]

I will say that the PICU discussion here is giving bonus points to some programs I'm looking into which don't have an in-house PICU fellowship.

It's not that easy. No PICU fellowship will also likely mean less sick kids, less faculty interested in teaching pediatric critical care, and less nursing staff used to dealing with trainees.

 

[deleted109597]

Because we aren't there for the patients who aren't sick. They can be seen by the midlevels, the nurses, or the ****ing janitors for all I care. We are there to snatch people out of death's grip. Otherwise, we wouldn't have a specialty.

 

[CliveStaples]

You dont want your first pediatric tube to be as a new attending. Tubin kids is butthole tightening enough.

Sorry, I didn't mean that they didn't have a PICU experience at all (though I've seen one program that didn't have one and it's something I'm considering a slight negative), rather a PICU experience where a resident gets some patient ownership and procedural experience.

It's not that easy. No PICU fellowship will also likely mean less sick kids, less faculty interested in teaching pediatric critical care, and less nursing staff used to dealing with trainees.

This is an astute observation. I think that's a program by program problem, and while I agree with the general assumption there are always exceptions. For instance, my medical school is affiliated with a large level 1 tertiary care center and gets plenty of sick kiddos, but we just happen to not have a pediatric critical care fellowship. Plenty of pediatric and EM residents rotate through the PICU but it's just them and the attending. Yes, this does mean that less interested residents can back off and let the attending run the show (as they are wont to do) - but I've also seen strong residents get a lot of autonomy once you show you won't leave a brown stain on the floor at the sight of a sick kid. And I think that for a lot of off service experiences your education is what you try and make out of it.

 

[deleted547339]

Intubating a kid doesn't scare me, it's the other stuff that does.