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?
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
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.
i survived the next day just fine though it was on my mind!
In over 15 years of ED practice I have still not seen a medical registrar say ‘thanks’ for an admission referral!
you’ll need more than 15 years to hear that!
Hey Andy
Lateral canthotomy – anatomists dream emergency!
Seen one after the fact, missed it though
Casey
I am not old,, but i’ve seen all this case!!
But i wish i could did crio not just see it
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!
Come to inner city usa and youll see lots of thoracotomy post gsw.
Priapism in sicklers.
Toxic alcohols in our urban alcoholics.
Yeah a very different population in big city USA. Good for us not for the patients!
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.
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Hi Andy,
Again age is an issue I have seen all of these bar Cyanide toxicity on many occasions. With regards to inborn error of metabolism its very location specific. I worked in a childrens ED where all first seizure presentations less than one had a full metabolic screen sent. Due to certain cultural practices this had a pick up rate almost approaching 50%.
Brendan