Our options are to run the gambit - IVs, antibiotics, breathing machines, admission to the hospital for likely weeks. His quality of life is nil, and this time he says he’s not going to recover. This is his fifth bout with lung infections this year. He is spiking another fever and coughing up green phlegm. He can no longer walk, no longer breathe without an oxygen tank and no longer eat without a surgical tube. An all too common scenario is the 70-year-old man with lung cancer that has spread to almost all his organs, whose family has called 911 because he is having trouble breathing. We will make phone calls to consultants, social workers, case managers we will do procedures that others can’t or aren’t willing to do.īut sometimes, these fast decisions are not so distinct. ER doctors aren’t afraid to say “I don’t know.” But we do have the courage to mobilize a team to help. Many times, we don’t know, and that’s OK. On that same token, we can think in reverse and eliminate critical diagnoses. Where others think it’s stomach acid reflux, we think it’s a heart attack. Where others think it’s a strep throat, we think it’s a pus pocket that can block the airway. Our training dictates that we search for the bad and the really bad. Our job is to rapidly diagnose, treat and decide what the next steps are. Thankfully, we did it.ĮR doctors take care of patients - now. I phoned for help from other specialists, but time was running out. ![]() If I can’t get a breathing tube from his mouth to his lungs, I may have to cut his neck to do it. If he can’t get oxygen to his lungs, he will die. He was getting worse quickly he couldn’t even swallow his own saliva. He had much more than a simple strep throat he had a pus pocket in the back of his throat that was impeding his airway. As a new graduate, I thought this would be simple case. He was sent from an urgent care clinic for antibiotics and fluids for strep throat and dehydration. ![]() I remember one of my first patients as an attending. All of this had to be done before the ophthalmologist could bring him to the OR. I had to cut the ligament that supports the eye to release that pressure on the visual nerves or else he would go blind forever. We discovered that blood was quickly building behind his eye, and the pressure was making him go blind. He was rushed to the ER and was losing vision in his right eye. Recently, a 30-year-old driver hit a light pole and smashed his face on the dashboard. Perhaps more recognizable for what we do are traumas. He has to be alive before the cardiologist can make that difference. All of this must occur first before the cardiologist can unclog his arteries. I placed a tube in his airway to keep him breathing, led our team in chest compressions, electrically shocked his heart, and chose medications to keep his blood circulating. His first stop was through the ER, where I could get his heart beating again. He had suffered a heart attack severe enough to stop his heart. Take, for instance, my 50-year-old patient who suddenly dropped dead at home. ![]() Rather, emergency medicine (EM) physicians are masters of resuscitating the dying, the dead - stabilizing the sick. Clearly, it would be disingenuous to proclaim we are masters of every organ in the body. Even non-ER physicians have some misunderstanding of our qualifications, our duty, and our specialty.Īcute-care scenarios are why we exist - or why we train. Or that we exist to do whatever they demand because we are the ER. Some also believe that we can take the place of their family doctor. A common question that patients ask is, “What specialty are you hoping to go into?” The misconception is that emergency rooms are staffed by cardiologists, internists, etc., who are trying to make extra income. As an ER physician, my job is frequently misunderstood.
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