Things I have yet to see

I’ve been training in EM/ICU full time for 5 years with a smattering of other things for another 3 years. Despite this length of time there’s a whole host of things that I’ve never seen and managed. A lot of them are core competencies for EM docs and like a lot of stuff we need to know how to manage it whether or not we have experience or not with it. Below is a list of some of the big things that come to mind:

  • major burns/escharotomy
  • cyanide toxicity
  • spontaneous aortic dissection (I suspect I’ve seen it and missed it)
  • compartment syndrome
  • emergency thoracotomy (though in retrospect I’ve been present when it should have been done)
  • emergency cricothyroidotomy (again I think it should have been done…)
  • toxic alcohols
  • pregnant cardiac arrest
  • priapism

What’s on your list?

 

About Andy Neill

EM Reg/Resident based near Dublin. Former anatomy lecturer, theology student and occasional musician @andyneill | + Andy Neill | Contact

Comments

  1. Hi Andy,

    I’ve seen all of the above…but I am older so time will bring them to you.

    Your post has inspired me to write the latest St.Emlyn’s post on one of the aspects of major burn management.

    http://stemlynsblog.org/2012/09/little-white-lies-in-the-resus-room/

    S

  2. Oh man. I hope you’re not working tomorrow. In fact, having shared this today, you might want to take the rest of the week off.

  3. David Rosengren says:

    In over 15 years of ED practice I have still not seen a medical registrar say ‘thanks’ for an admission referral!

  4. Hey Andy
    Lateral canthotomy -- anatomists dream emergency!
    Seen one after the fact, missed it though
    Casey

  5. I am not old,, but i’ve seen all this case!!
    But i wish i could did crio not just see it

  6. Mike Jasumback says:

    Sadly, over the last 16 years, I have seen and done all of those, except of course, being thanked for an admission! I have never picked up a new inborn error of metabolism though. I suspect that I have missed a few.

    • i’ve suspected the inborn error thing a number of times but have never had one confirmed. Heterotropic pregnancy is the other one that springs to mind and i’ve seen that twice which seems weird when i haven’t had a dissection yet!

  7. Come to inner city usa and youll see lots of thoracotomy post gsw.

    Priapism in sicklers.

    Toxic alcohols in our urban alcoholics.

  8. Hey Andy
    Seen some of those but some other “uncommon ED” stuff not seen

    major burns/escharotomy pt when to theatre for same but not in department.

    cyanide toxicity nope

    spontaneous aortic dissection (I suspect I’ve seen it and missed it)yeah, didnt survive the transfer.

    compartment syndrome yup, got to take few to theatre with ortho boss (small hosp life)

    emergency thoracotomy (though in retrospect I’ve been present when it should have been done) Pretty rare in NZ

    emergency cricothyroidotomy (again I think it should have been done…)Never seen it.

    toxic alcohols, yeah saw bad home distillery..

    pregnant cardiac arrest nope thank God

    priapism yup got to insert cannula *CrossesLegs*

    Aint seen Carbon Monoxide poisoning.

Trackbacks

  1. […] what’s got me thinking this week? To be honest it’s the post by Andy Neill over at the emergencymedicineireland blog. Andy has listed some of the really challenging presentations that we as emergency physicians […]

  2. […] Things I have yet to see -- Andy shares with us a list of things he’s yet to see in EM. What’s on your list? […]

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