“The petulant whine of an ER doc”

How often do you get paged stat to the ER? In ten years of practice I called for anesthesia help with an airway (which incidently never came). Nevertheless, I wouldn’t save my ego over saving a patient given other alternatives available.

I usually enjoy your posts because they are usually thoughtful. I am surprised to see you so ruffled and looking down your nose.

Of course the Difficult Airway Algorithm has a caveat to consider cancelling the case. Because the majority of the patients presenting to the OR are there electively; it is perfectly reasonable to revive a patient while they are still revivable rather than forge ahead needlessly. Regroup, reconsider, and resume care when a new plan is crafted. The culture that makes this work is important. Machismo is not rewarded. We do give accolade to our peers who subjugate their impulses to prove that they can get the airway if they just do this one more thing, and choose to save the patient over their ego. The opposite of this culture is typified by surgical mentality that can declare the operation a success even if the patient later dies.

Too often our EM colleagues forge ahead in airway management themselves when indicators suggesting greater than normal difficulty are obveous. Once shit has hit the fan they page us stat, documenting how many minutes it takes for us to arive, but not documenting how many minutes they fiddled about before paging us.

I do believe it may be hard to extrapolate anesthesia’s success to such disciplines as internal medicine, family medicine, and emrgency medicine where the knowledge base needs to be much wider. Additionally, anesthesiologist’s typically have much more control of outcomes in their specialty than the above mentioned specialties.

I luxury the EM physician does not have.