From: Thomas Krzmarzick ([log in to unmask])
> one of our plastic surgeons is repairing complex wounds in small children in the ED rather than take them to the operating room
--> Must say that, although the idea of surgeons trying this on is not unheard of in the UK, I would have thought that, in the USA, where more attention is paid to costs of things as well as to the litigation-related-who's-responsible-for-things, would NOT see this sort of thing...
> My gut tells me that a case that takes longer than 90 minutes or so needs to be done elsewhere (OR)
--> My gut refuses to enlighten me about anything other than food & drink, so yours is way better ;-)
The rest of me tells me that it should not be a quantity of minutes which is the guiding principle here, but what is best for the patient first and the ED service second. I do not mean to insult anyone by saying it this way, but I think we are all sometimes guilty of "doing favours" or declining to argue when we should...
If the wound requires decent lighting, more than basic suture kits (ours are INTENTIONALLY very basic - needle holder, one forceps, suture scissors), privacy, sedation, etc. then they get done where those things are set up, i.e. operating theatres.
Sometimes, when we force the orthopods to take distal wrist fractures in YOUNG adult bones (i.e. not Colles) to the theatre, when they want to have a go at it in the ED (a matter of only minutes) an argument does develop... Well, not really an argument, but mostly them mumbling something about having to find an anaesthesiologist, to which we reply that they don't - they can use whatever block they were planning to use in the ED, but in the theatres they have fluoroscopy imaging and their own casting materials, etc...
At the end of the day, plastics/orthos cannot argue this effectively for 2 reasons:
1. We might use the well-tested tactic of "where would your mother have this done?"...
OR, if all else fails:
2. "It says Emergency Department above the door. The day it says Plastic Surgery, THEN you make the rules"
We are, in principle, against anything and any process which appears to "use" the ED or its staff as someone else's place they don't have to tidy up or staff of their own they don't have to "trouble"...
Another thing, as it's been mentioned... Sedation...
If a surgeon needs someone to do any service which an anaesthesiologist might make a living providing, then we leave that service for anaesthesia to provide. We NEVER sedate for anyone but ourselves - it's not in the job description. Of course, we do have the skills, but if EM did everything it was best at, then there'd be little else for all others ;-)
And anaesthesia have an operating theatre where they provide that service...
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