From: Prater, Samuel J <[log in to unmask]>

About 2 years ago, our department actually assumed primary responsibility
for this condition and are now accepting these transfers from community EDs
unable to perform the procedure. We most often drain via needle aspiration;
occasional open drainage. Most of our patients are young adults and don't
require sedation. Occasionally there will be a young child and we will
sedate and consult ENT to perform the procedure to ensure there is an
someone attending to the airway. We have adult and pedi ENT 24/7.

--> If we (EM) decide that we (EM) should perform a procedure, then we (EM) sedate for it as well (1 practitioner does the sedation; another the procedure).

If we refer the patient to have a procedure done by another speciality, as I have already clarified, that speciality arranges to have the sedation provided by whomever provides sedation for them for all their other procedures (regardless of the fact that this might, on occasion, be done in the ED). Sometimes we send our trainees to participate, for their own education, being taught/supervised by the person providing sedation.

Hope it's OK to ask a question... You say that you have taken over this condition's management and that patients are transferred to you from other places for this purpose. Yet, you appear to have ENT on site. For my own education, what is the reason that ENT cannot have primary responsibility for this condition? Is it to do with financial reasons? Is it that ENT are not actually "on site" all the time? Also, for those who need sedation, why does the EP who would otherwise do the procedure not do it anyway and get another EP or anaesthesia to do the sedation? Unless I miss something, ENT is being called to do a procedure that EM normally does at your institution...

My question is just for my own education. We have some near-parallels here. There are certain procedures which we consider to be in the realm of our own speciality, which appear to belong elsewhere. For example, we manipulate Colles fractures in the ED - we don't call orthopaedics. We do call orthopaedics to manipulate similar fractures in patients who are not elderly with osteoporosis. But if it ever happened that someone from elsewhere called ahead to get us to accept a patient with a Colles # in order for us to assess/manipulate it, such a call will be re-directed to orthopaedics - we have bone experts on site, so why should anyone else take such patients... Such a patient will likely be managed within the ED, but will be under the care of orthopaedics the whole time.

BTW, why can't "community EDs" do it if you can? It's not such a difficult procedure...


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