Thinking a career in ED may be for you....want to be convinced? Over the next series of blogs we'll look at the range of career opportunities open to you. First up, Ed James (aka @whitefleece8127) takes us into the world of an ED Registrar.
‘Crash call, resus one, 5 minutes’
The call echoes out from the tannoy.
It’s not long into the start of the day and you’re up. As a registrar in the Royal Infirmary of Edinburgh Emergency Department running resus calls is one of your duties.
By now you have already taken handover, assigned duties to your team of junior doctors, liaised with 4 or more consultants on the shop floor and checked in with the nurse in charge. You’ve reviewed the patients handed over and ensured they have plans in place and are stable.
You head to Resus. A consultant awaits to support you and a junior to help with the resus. It’s an out-of-hospital cardiac arrest. There’s a good chance they will have ROSC because in Edinburgh the ambulance crews have a dedicated unit for this.
The patient comes in. The autopulse is strapped on the patient but it is not running; they have ROSC. You take the airway and call for silence for the handover. An ‘ABCDE’ assessment and an ECG later you know the patient needs a tube, cooling and the cath lab. Anaesthetics attend but stand back and let you intubate – you do this a lot, the department averages one a day and registrars do most intubations - then they whisk them away to the cath lab.
You go and speak to the patient’s relatives, explain what’s happened and what will happen next. They are shocked but relieved he is alive. A nurse will take them up to ITU to see him when he is out of the lab.
Back on the shop floor, the department will be filling up. There will be patients to see primarily, patients to review for the juniors and deteriorating patients who need your attention.
‘Crash call, resus two, seven minutes’.
Another resus. Not unexpected as the department averages one an hour. This time a GI bleed. You opt to let the junior trainee run it with your supervision.
The patient arrives. They are shut down with evidence of haematemesis and the smell of malaena. The junior can’t get access so you grab one of the ultrasound machines and place a couple of large bore cannulae. After a bit of fluid the numbers improve and the patient looks brighter – they are a responder. You call ITU and the GI reg as the patient clearly needs a scope, then pop in an arterial line for better monitoring.
A research nurse appears. The department is active in the HALT-IT trial amongst others, so you consent the patient for the trial and enrol them with the nurse.
‘Request for Medic One, Request for Medic One’
You hand the patient over to the GI and ITU teams and head back to the department. Edinburgh runs a pre-hospital service and as a registrar you are part of the team.
A cyclist has been hit by a lorry and is trapped. A consultant, 2 nurses and you get kitted out in day-glo suits, helmets and boots, grab the kit bags and head for the Landrover. A driver arrives and you head into the city on blues-and-twos. You’ve been fully trained for this role and the consultant and you plan for the possible scenarios.
You arrive amidst a cacophony of flashing lights, spectators and emergency crews. The consultant heads to review the patient and you organise egress with the crews before heading over. The cyclist is talking, it’s the lower half of the body that’s taken the force of the hit, but he is too sore to get out. A little ketamine solves that problem.
The ambulance and fire crews slide them out and you apply the pelvic binder and the splint to the obvious femoral fracture. Airway and breathing are fine for now so you opt for a rapid return to the ED. As the police escort you through the city you reassure the guy and the nurse gives the TXA.
Back at the Royal a full team is ready and waiting to receive the patient, specialties are waiting to review and the radiologists are expecting the patient for a pan-scan. You hand over and leave to change and write up your notes.
In your absence more doctors and ENPs have arrived and are piling into the growing numbers of patients. A quick check to ensure you are not required means it lunch time.
After food, it’s into the anaesthetic room straight away. A fracture-dislocation of the ankle needs reducing. Rock-paper-scissors between the consultant and you decides who sedates and who manipulates. You talk some of the medical students through the manipulation and get them to help with the cast.
It’s a Tuesday so from 2pm you have two hours of protected teaching. You head to the teaching room for a presentation by one of your colleagues and a consultant. The topics vary from core topics from the syllabus, FCEM preparation, pre-hospital training and simulation training. Thankfully it is also tradition for cake and sweets to be provided for some much needed sugar.
Two hours later you are back on the shop floor. It is busy but controlled. You see a patient or two and spend some time supporting the juniors.
‘Can the doctors come to the teaching room for hand over please?’
The best call of the day. It has been busy and tough. You are mentally and physically tired but it has been yet another fascinating day. All the doctors gather and you informally present the Medic One case. Another registrar leads a formal hand over of patients and then you’re free to head home.