This topic has 12 replies, 10 voices, and was last updated 9 years, 10 months ago by Anesthesia Mom. Patients should be premedicated with drugs that provide sedation and analgesia prior to anesthetic induction with drugs that allow endotracheal intubation. For me, I wanted to be in a team. I haven't had either rotation yet, but have worked/ been in the ER for over 3 years and have my anesthesia rotation starting in a few days. one thing that turned me off from gas is that you have to be in the OR super early (6-7) for the rest of your career. Like most surgeons could care less about the man behind the book/newspaper/sudoku/laptop. CordMcNally. While you do get some really cool cases, and I liked being the first to workup a patient, I could tell after a month that I was getting jaded and cynical. I get on well with my ED colleagues and feel like we have a lot in common - but I don't envy them their jobs! Rads vs Anesthesia vs IM vs EM [clinical] Clinical. Topical anesthetics are available in creams, ointments, aerosols, sprays, lotions, and jellies. Rumble Roses XX … EM vs Anesthesia vs General Surgery. Stats will vary with locale and institution, but to my knowledge, everyone in EM has a large non-emergent caseload on any given day. My EM buddies all 100% belong in that field and it is a true calling to some. STAT CT Head. It is a very well travelled path.). Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. I was deciding between surgery, anesthesia, or EM. Do you prefer working hard or playing on your phone? Anesthesia is a highly specific consultant specialty. I'm a medstud debating between EM and Gas and am about to start my EM clerkship (already did Anesthesia and loved it), but was unsure if I wanted more variety/would get bored of it over time. I always figured worst case scenario is our salary drops closer to CRNAs for doing a similar job, lower 200k range is fine with me if it’s worst case scenario. One is the incredible diversity of size and age of pediatric patients. The unpredictable (and highly litiginous) nature of the ED kinda lends itself towards MD/DOs not being replaced anytime soon. EM seems to have the better job market and fewer shifts, anesthesia seems to pay better and keep you up fewer nights but has call. frequent call, often in-house. You're going to have a demanding career as an anesthesiologist or as a surgeon. Viewing 13 posts - 1 through 13 (of 13 total) Author. You have to accept that level of risk when dealing with undifferentiated patients. So, we're talking a LOT of primary care...with the added bonuses of having no history or rapport with your patient, and unfortunately, a lot of subversive bullshit that people will pull at an ED that they would never try with their own PCP (drug seeking, malingering). I wasn’t really sure where the best place to post this would be, but figured I would try a couple different spots to hopefully get some advice and maybe some new perspectives. Collapse. Going into med school I was 100% stuck on EM. Broad scale, somebody would eventually fuck up a few patients and all it takes is a couple big news stories and the whole “do I want a nurse or doctor keeping my parent alive during surgery” argument will become mainstream.. Going from a surgicenter job to applying to a job in a hospital isn’t as easy as you’re making it out to be. Anesthesia is a highly specific consultant specialty. New comments cannot be posted and votes cannot be cast, More posts from the medicalschool community, Press J to jump to the feed. Spinal anesthesia is preferred by many practices but can delay ambulation, especially with bupivacaine. It all begins in how you see yourself and what you call yourself. Anaesthesia. It seems like a sweet gig with mid levels functioning more for intended role. Background: Endovascular therapy is the standard treatment for acute ischemic stroke (AIS) patients caused by a large vessel occlusion in the anterior circulation, whereas the impacts of general anesthesia (GA) vs. conscious sedation (CS) for such procedures remained as a continued debate.Methods: We systematically searched PubMed, Embase, and ClinicalTrials.gov. EM vs Anesthesia. I applied at the next opportunity and never looked back. Moderate sedation, also referred to as conscious sedation or twilight sedation, is drug-induced and: A patient can still respond to verbal commands; Breathing is not affected and patients can breathe on their own; Cardiovascular function is usually unaffected ; Procedural sedation differs from general anesthesia, … I was pretty intent on doing anesthesia but after doing some research and speaking with some attendings, I'm not so sure. STAT X-ray of course. Often, the consultants for the 20% are pissed at your 2AM phone call and judging your workup/initial intervention. General anesthesia is a combination of medications that put you in a sleep-like state before a surgery or other medical procedure. A physician and an anesthesiologist. Maternal mortality ratios due to anesthesia in the United States are currently estimated at 1.0 per million live births—a 59% reduction from the period of 1979 to 1990. But the sad reality is, on both of my rotations nowhere near 50% of patients had any indications warranting an ER visit. the much better work-life balance, and the fact that the consultant anaesthetists seemed like a chilled, cheerful bunch on the whole. The maximalist algorithms that result can make some of it mind-numbing..... if everyone gets a CT and a rainbow of blood work, what are the puzzles you're solving? On a positive note, though, we are seeing positive changes in this arena; many groups are incentivizing UC referrals over ED, and some health systems are opening same-day/walk-in clinics for doc appointments. I spent my pre-med school life in the ED and loved it (three years as an ER tech in a large community hospital). Also important notice is that in lot of countries anesthesiologists double as intensive care specialists. I have also heard mutterings of the "ultra kush gas jobs" that apparently are amazing pay with low hours. Anaesthesia, on the other hand, suits me much better - the point when I started considering changing was when I came home one day (during the aforementioned anaesthesia rotation) and said to my partner, "I think this is what it's like to enjoy your job." I do somewhat miss the diagnosis aspect of EM, but what I get in return is something I value more. By using our Services or clicking I agree, you agree to our use of cookies. It’s nice to think of an ideal world, but ignoring certain aspects of reality isn’t going to help anyone. And don’t even get me started on the insane number of mild URIs that all got antibiotics despite virtually certainly being a viral etiology. So i guess in theory some gas jobs could provide you with a great lifestyle that would gas>EM, but I think on average you're working less hours per week in EM than you would in gas, which IMO is the most important factor for lifestyle. Do you like the OR? (Big fan of PainMed in general too). this may sound fun, but when you're older and have been sued multiple times i think you'd just become overly stressful and worried about the liability of doing risky procedures all day. Press J to jump to the feed. EM wasn't for me. I am a 4th year EM resident in NYC and just received word that an Anesthesiology 1-year critical care fellowship is looking for EM applicants. I can’t imagine how dark I would become after a whole residency. Local Anesthesia vs. Digital Block For Finger Lacerations. As far as … Here's a guy that's never seen a real anesthesia case. this seems to be a myth that keeps getting perpetuated. For example, Tuman et al. Also, about 75% of the people don't need to be in a hospital, ~20% need some sort of care/consultation, ~5% of people need something you can provide. All Discussions only Photos only Videos only Links only Polls only Events only. one patient at a time, who you can really devote your attention to properly, superb training (it was basically a one-to-one apprenticeship, particularly in the early years of training), and supportive seniors who didn't bollock me if I needed to call them at 2am, applied physiology really coming to life in ways I'd never found in other specialties, feeling skilled and useful at an early stage of training (having skills that more senior people in other specialties, including EM, didn't really have), the nature of the teamwork, in particular having an ODP all the time (I know this isn't the case everywhere). All of that being said, if you honestly don’t mind the high percentage of people who waste resources and time (see... I’m already cynical just talking about it) it is a really cool field. We have a daily grasp of acuity that other specialties never see. The key difference is primarily clinic based work vs primarily procedure based work. Hey guys! X. Several variables make pediatric anesthesia different from adult anesthesia. I never understood why — never considered EM. Ryan Dick-Perez, DO Clinical Assistant Professor Department of Emergency Medicine Division of Critical Care, Department of Anesthesia Natalie Htet, MD, MS Critical Care Fellow Stanford Hospital Ann Tsung, MD Recent Graduate of Anesthesia Critical Care Medicine Fellowship at Barnes Jewish Hospital - Washington University in St. Louis Board Certified in Emergency Medicine and Anesthesia Critical Care Medicine The lifestyle between the two isn't going to be that much different, depending on where you work. Once I did my MS4 rotation in EM, however, I _really_ disliked it. 16y/o with 1 week history of mild left leg pain after starting a new sport? Of all the things that make EM unique as specialty I'm curious as to why you zeroed in on being attacked. And surgicenters/gi suites are businesses, they may go under. Most of the job consists of ensuring that you pick the right 25%, getting that 25% the right treatment/service and ensuring that the other 75% think you're taking them seriously. Home › Forums › General Discussion › EM vs. Anesthesia — MSIV needs real advice. Epidurals block the nerve impulses from the lower spinal segments. 31:09. Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events: ... (perioperative respiratory adverse event: 39/149 [26%] vs. 64/149 [43%], relative risk [RR]: 1.7, 95% CI: 1.2 to 2.3, P = 0.002, respiratory adverse events at induction: 16/149 [11%] vs. 47/149 [32%], RR: 3.06, 95% CI: 1.8 to 5.2, P < 0.001). They may fire you in lieu of cheaper labor. Previous 1 2 3 template Next. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to a total lack of feeling. pay is very good though. Anyone ever in this position and what made you decide which field? All that said, I know EM docs who didn't enjoy their time in anaesthesia and don't see the appeal. Subreddit for the medical specialty dedicated to perioperative medicine, pain management, and critical care medicine. Also wondering if it matters if I only do 1 year of fellowship vs doing a 2 year fellowship. Tons of pain docs in CA are going back into anesthesia because of oversupply (and many of them realize you can make same/more just doing general anesthesia in some parts). Interested in any subspecialties/fellowships? Due to mega-groups, most of us have less agency / ownership power than our predecessors had 20 years ago. The difference between sedation and general anesthesia is degrees of consciousness. 4th year cardiac attending here.There is no similarity. 11 COVID-19 positive or suspect patients in need of preoperative anesthesia assessment should be visited by the primary anesthesia attending. Agreed, I see midlevels as working as intended in the EM setting (relieving the burden of high-volume, low-acuity patients). Compared with non-full professors, full professors had a significantly higher h-index (p<0.001), m-index (p<0.001), total number of citations (p<0.001), total number of publications (p<0.001), and a longer career duration (p<0.001). The big difference I felt was I found myself (even as a med-student) getting frustrated by the healthcare system of which EM is in. lifestyle-wise, how is anesthesia better? feeling really exposed all the time, and worrying about the one bad discharge decision that would have dreadful consequences, the immense pressure to get lots done in a short space of time (in the UK, the four hour target meant everyone had to be discharged or admitted within 4 hours of arrival, which made life very difficult when it was busy, which was most of the time), constantly juggling multiple patients, and as a result feeling like I was not giving any of them my full attention, the punters (understandably) being often angry before we even got started, the horrible shift patterns and the immense difficulty in having a life outside work (which would have improved as I would have got more senior, admittedly). and when you're on call, you best believe you'll be working because they will always need an anesthesiologist for whatever c-section/appendectomy/subdural hematoma drainage comes in at 3am in the morning. IVL and EA were associated with similar reductions in numeric pain scores within 0–24 and 24–48 hours (mean −2.9 for IVL vs −2.3 for EA during both periods, p=0.19 and p=0.17 respectively) . A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. In talking with peers who went into anesthesia they are getting offers 30-60k more than EM out of residency. As far as acuity we have cardiac, crit care and peds cardiac. And I still get to go to the ED and help with the really sick ones, which was the bit of EM I found most rewarding anyway. One reason I ruled out Anesthesia was because I felt like you weren't actually part of the surgical team. ... Rumble Roses XX Dr Anesthesia vs Reiko - Duration: 31:09. bwagner2013 514 views. For them, it is too slow and boring, and they'd rather be in the ED fighting fires. I think a lot of this comes from the application of critical care in less of a longitudinal setting and more of an acute way of practicing. 09-14-2018, 03:30 AM. Do you prefer working hard or playing on your phone? If you want to be respected as a professional and a leader in perioperative care, then carry yourself professionally. General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study. Mepivacaine, an intermediate-acting local anesthetic, could enable earlier ambulation than bupivacaine. Appropriate anesthesia of the airway and sedation can enable any of these techniques to be used successfully.The commonest method used to perform an awake endotracheal intubation is with a flexible fiberscope, and an awake fiber-optic intubation is regarded as the gold standard for the endotracheal intubation of patients with an anticipated difficult airway. Results Numeric pain scores differed at baseline (mean 5.6 for IVL vs 4.5 for EA, p=0.01), while age, injury severity, and number of fractured ribs were similar. Midlevel creep is an issue in EM, but it's nowhere near the scale that it is in gas. Now, if you're in BFN, there's a chance you're the only doc for an hour and you may end up doing more diagnosis and treatment than you might in an academic center. EM is an inch deep and a mile wide. also you get stuck with all the hard and complicated cases. Do you like working up undifferentiated patients? Can't you find something like this in the USA so you can combine the best of both? All of this is the bread and butter of EM unfortunately. call an orthopod..... etc etc). They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Little bit unrelated but in Belgium, after specializing as anesthesiologist you can do a 1 year program to get a special title as EM physician. Testando Trainer em Resident Evil 5 Gold Edition XBOX360RGH - Duration: 26:40. 30y/o with 6 month history of migraines? A lot depends on hospital strategy for each field - for example post-communist European countries rely heavily on anaesthesiologist to perform intra-hospital reanimation team duties. Would you consider going back to work? Yet they all got expensive workups. If you like action and challenging cases, you might prefer becoming an Intensivist, or pursue one of the more challenging Anesthesiology subspecialties (peds, cards). EM vS Anesthesia (for the millionth time) Both are shift work, both deal with critically ill patients, both have mid-level creep/autonomy, both pay well. Horses for courses. I think that they tend to work more hours for that salary but they are more predictable hours. Sedation is a sleep-like state where patients are generally unaware of surroundings but may still respond to external stimuli. One of the best EM doctors I know did this as he was a bit of an adrenaline junkie and preferred the high pace work environment. I got 2 years into EM before switching to anaesthesia (UK EM trainees spend a year in anaesthesia/ICM as a standard rotation). Show. Emergency Medicine Cases (EM Cases) is a free online medical education podcast, medical blog and website dedicated to providing online emergency medicine education and CME for physicians, residents, students nurses and paramedics. Also, for raw number of hours worked, your average Emergency Medicine Doc has us beat. Press question mark to learn the rest of the keyboard shortcuts. That’s a pretty negative take but everyone is entitled to their opinion. Filter. Went so far as to apply for both EM and Surgery, ended up doing two years of surgery and switching to anesthesiology. Both sedation and general anesthesia are used for different types of medical and surgical procedures. Just being board certified doesn’t necessarily mean you will be competitive, especially in a tougher market. To me the biggest difference EM is a lot more patient contact, much more of a clinic feel, while anesthesia is obviously in the OR with a focus on one patient at a time. also for me i don't get along well with surgeons. Children have significant differences in growth and development both physically and emotionally. Hahn RT, Kodali S, Tuzcu EM, Leon MB, Kapadia S, Gopal D, Lerakis S, Lindman BR, Wang Z, Webb J, et al.. Press question mark to learn the rest of the keyboard shortcuts. I can’t disagree about ER though. plus in-house call at a lot of places. New comments cannot be posted and votes cannot be cast, More posts from the anesthesiology community. Collapse. Search. average work week of an anesthesiologist is about 60hrs/wk. Also considering EM vs. gas but I don't really get this gas>EM for lifestyle. What would you do if a patient attacked you. new posts. The mission of the Johns Hopkins Combined Emergency Medicine and Anesthesiology Residency Program is to foster the clinical, humanistic and professional development of a distinctive graduate, able to amplify the strengths of both fields and positively impact change in the field of medicine through innovation and national leadership. The worst thing I can say about it is that by my 4th med school year, I saw EM in a "call doc" fashion...... ie: there's a problem, you call a doctor (problem with heart? All Time Today Last Week Last Month. I liked both, but it fundamentally came down to me wanting more options in how I practice, and not wanting to deal with some of the sillier stuff people come to the ED for. These are some very critical components that I am looking for in a speciality and that has lead me to heavily considering both EM and gas. It’s the general work structure. On/off, shift work, little to no continuity of care, similar earning salary? a couple of specific, horrible incidents. Join Date: Jan 2017; Posts: 5353; Share Tweet #31. A 6-pound infant will have vastly different anesthesia needs than will a 180-pound teenager. Surprised that anesthesia residencies are asking that stuff of you. Each black dot represents a study. How do you guys not see the most obvious parallel? 4/21/2016 EM Resident . #Dr_Anesthesia_vs_Evil_Rose_REMATCH Rumble Roses XX é um jogo profissional de luta livre desenvolvido pela Konami para o Xbox 360 como a … Under general anesthesia, you don't feel pain because you're completely unconscious. Both are shift work, both deal with critically ill patients, both have mid-level creep/autonomy, both pay well. I felt this way for a bit during third year. Im seriously considering the above 4 things but am open. ABA, ABEM Announce Combined Residency for EM/Anesthesia. I’m currently a 3rd (4th?-who knows anymore) year US MD student who will be applying to residency programs this fall. In terms of lifestyle, however anaesthesia for the win. Some overlapping procedures but the rest of the patient care responsibilities are very different. doi: 10.1111/anae.13522 Crossref Medline Google Scholar; 31. call the cardiologist..... problem with a bone? And if you find the OR isn't your thing, hang your hat and go into pain for an outpatient clinic or go the ICU route with just a 1 year fellowship (all fellowships are one year). Thoughts?? I got asked “why anesthesiology over EM?” a fair amount during interviews. Posts; Latest Activity; Photos . Epidural anesthesia and analgesia appears to significantly reduce the incidence of thromboses of vascular grafts in patients undergoing lower extremity revascularization. Page of 3. Safe and effective anesthesia of dogs and cats rely on preanesthetic patient assessment and preparation. Ultimately it was the BS I couldn’t deal with. (When I left EM, so did half my cohort in my training region. I have to do the military match in addition to the civilian match and have to stress way earlier than everyone which means I need to know what I want to do before too. I looked into both and settled with EM. Not being facetious, just generally curious because that seems like a small, albeit serious, but still small part of the job. HPSP MS3 here. In all specialties there is a chance for sustaining bodily harm from patients (patient violently waking up from sedation), but EM is on a level of its own. Please do not use the term “gas” to describe the specialty we love and work to make better. Posts. But my gut tells me that those jobs aren't as common as this subreddit makes it out to be as the averages for gas would reflect that. Cookies help us deliver our Services. The American Board of Anesthesiology (ABA) and the American Board of Emergency Medicine (ABEM) have announced the launch of a new option for combined residency training in emergency medicine and anesthesiology.
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