Emergency Rads?

[Pokemon Trainer]

Are there any situations in radiology where one could possibly get their adrenaline going even once a week or month.  I haven't had too much exposure yet but I was wondering if IR ever contains any emergency time-sensitive procedures or if there are any STAT reads for trauma cases that can get your adrenaline going ever.

Thanks!

[rmorelan]

like last night.....when I was on call? or every night I am on call and there are a 100 people trying to get me to read a 100 things all at once?

 

or neurointerventional radiology? Neuro in general actually quite often (stroke code)

 

or trauma IR?

 

just some examples.

[thatonekid]

like last night.....when I was on call? or every night I am on call and there are a 100 people trying to get me to read a 100 things all at once?

 

What?!? I thought the radiology resident loves it when it's 3am and I go to ask them when my non-urgent ?nephrolithiasis image will be read...

[rmorelan]

What?!? I thought the radiology resident loves it when it's 3am and I go to ask them when my non-urgent ?nephrolithiasis image will be read...

 

or the metastatic work up on the person at 4am. What you want to wake them up in the middle of the night to tell them they have cancer? Surprise!

[Lactic Folly]

Well, the patient has already been up for over an hour drinking their oral contrast, so they'll be awake at that point anyway...

 

But to answer the original question.. sure - all IR cases to stop active bleeding are emergent. Putting a drain in a septic patient is also time-sensitive, and something that an interventional radiologist might come in during the middle of the night for. And you don't have to be on call to be doing STAT reads, as acutely ill patients come through the scanner at all hours of the day and night (and everything that comes from ER is by definition STAT with turnaround times tracked).

[rmorelan]

Well, the patient has already been up for over an hour drinking their oral contrast, so they'll be awake at that point anyway...

 

But to answer the original question.. sure - all IR cases to stop active bleeding are emergent. Putting a drain in a septic patient is also time-sensitive, and something that an interventional radiologist might come in during the middle of the night for. And you don't have to be on call to be doing STAT reads, as acutely ill patients come through the scanner at all hours of the day and night (and everything that comes from ER is by definition STAT with turnaround times tracked).

 

hehehe depending on the cancer. We don't use oral routinely for many types but even if you do it is still pointless - you cannot do anything with the information in the middle of the night and the oncology team sure isn't going to go over treatment options at that point.

 

I would say the emerg aspect is one of the most fun parts of radiology - you don't really know what you are going to get on any particular day, and there is time pressure to do it fast and do it right. It is probably one of the most general radiology days you would have (US, CT, plain films....of any and all body parts etc).

[Lactic Folly]

I agree there is no indication for cancer staging overnight, and I cannot remember the last time I have seen it done -- but the argument can be made that it will allow consults, referrals, requests for biopsy etc. to made first thing the next morning if the information is available at the time of morning rounds -- versus if the scan is done the following day, which may not be until the afternoon for a semi-urgent inpatient slot (depending on ER volumes), and not reported until the end of the day -- so an extra day in hospital.

[A-Stark]

I don't think there's any reason to get staging scans done overnight. And I say that as a medicine resident. Now, if there is still uncertainty in diagnosis, the study should be done emergently, but that's not what a staging CT is for. But it would be reasonable for it to be done first thing the next day, so that at least a verbal report is available (e.g. "liver full of innumerable mets" or "bulky mediastinal lymphadenopathy"). 

 

We tend to get a lot of pushback about overnight studies, often very, very inappropriately. For example, we once had an elderly patient on ASA and Plavix who'd fallen a couple days earlier and hit his head. He didn't have any concerning symptoms at that time, but then seized in the middle of the night a few days later. The intern-on-call attempted to arrange an urgent CT head, but the radiology resident refused since it "wouldn't change the management".

 

Except the patient had a subdural and - of course - this wasn't discovered until later in the day as the CT was not done first thing in the morning. He got a burr hole eventually. 

 

Of course, it's also true that we order a lot of imaging that is best characterized as a fishing expedition. But I wouldn't request anything like that at 4am. 

[Pokemon Trainer]

like last night.....when I was on call? or every night I am on call and there are a 100 people trying to get me to read a 100 things all at once?

 

or neurointerventional radiology? Neuro in general actually quite often (stroke code)

 

or trauma IR?

 

just some examples.

is trauma IR big enough to be considered a further fellowship following IR training or is the volume of trauma for IR not big enough to warrant that

 

[Lactic Folly]

Trauma would be a subset of the indications for embolization, which is a skill that is part of the greater world of vascular IR.

http://medical-imaging.utoronto.ca/fellowship/virfell.htm

[keith_015]

I don't think there's any reason to get staging scans done overnight. And I say that as a medicine resident. Now, if there is still uncertainty in diagnosis, the study should be done emergently, but that's not what a staging CT is for. But it would be reasonable for it to be done first thing the next day, so that at least a verbal report is available (e.g. "liver full of innumerable mets" or "bulky mediastinal lymphadenopathy"). 

 

 

It may make a difference if you are going to consider taking someone to the ICU vs. palliative measures.

[A-Stark]

Unlikely to be a relevant consideration in the middle of the night, at least apart from certain heme diagnoses like APL. Otherwise decisions about chemo vs (elective) surgery vs radiation vs palliative care only aren't for 4am. Metastatic disease isn't an intrinsic contra-indication to the ICU.