How in the heck would three nurses and I ever orchestrate ECMO in the middle of the night in my community ED? I pondered this over tuna tartare while listening to ivory tower docs discuss cutting-edge modalities like they were part of treatment algorithms everywhere. The conversation turned to REBOA, and I wondered how many academicians had ever manned a single-coverage ED.
Ivory tower medicine and my world, where there is only one doc and three nurses to handle whatever comes through the door, are vastly different. Practicing in the trenches of a small community ED means I’ll never see REBOA or experimental treatments offered at only a handful of hospitals. I’ll read about cutting-edge modalities, but I’ll never provide them first. I’ve never used TXA. Our pharmacy doesn’t even have it. And ketamine, now widely used for multiple indications, is still strictly thought of as procedural sedation in my ED. Instead, I wait impatiently to try new practices.
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Sandra Scott Simons is an emergency physician. This article originally appeared in Emergency Medicine News.
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