r/emergencymedicine • u/Former_Bill_1126 ED Attending • Jul 20 '24

Advice US won’t come in if pain >12hrs

Working at a new site, US techs are very picky, will not come in for torsion studies if pain is >12hrs. I talked her into coming in and she’s pissed af, said she knows I’m new and “I’ll learn the protocol”.

Am I in the wrong?

Edit: Does anyone support the US tech or rad protocol and do you have any studies or evidence to support this practice? I’m just wondering if they pulled this out of their ass or where they got the arbitrary 12 hour thing?

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u/DonkeyKong694NE1 Physician Jul 20 '24

Since when does a rad tech decide if a study is indicated?

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u/4883Y_ BSRT(R)(CT) Jul 21 '24 edited Jul 21 '24

Whenever I worked somewhere that had me call them in for the ED at night (I’m CT, not US), it had to be for ovarian or testicular torsion, but there was nothing about how long they’ve been in pain. That’s just the protocol we’re given as the messenger, not us deciding whether or not the scan is necessary. Same with (as a general rule) MRI with spinal cord injuries, and nuc med with VQs.

Management may not be willing to pay them call in pay unless it’s for a patient fitting a certain criteria.

There’s a lot of talk on here about techs refusing exams, when in reality (the vast majority of the time anyway, I can’t speak for every situation) we’re following the protocols presented to us. As in, we get reprimanded for not following them. They’re usually created by the radiologists (the physicians we report to) and/or admin. If there’s ever any doubt, just ask us to show you the protocol or give you the radiologist’s number and we gladly will. Shit, I’ve called my supervisor after hours to speak to an ER doc, I don’t care. Again, we’re just the messenger. Don’t shoot the messenger.

That being said, don’t act like we aren’t a crucial part of patient care with our own valuable skill set. Your jobs would be nearly impossible without imaging, and it’s incredibly demeaning to be spoken about like we just walked in off the street and have no idea what we’re doing. We may not be dOcToRs but we’re an extremely important and vital aspect of the healthcare team. We may not be making patient care decisions, but we deserve respect too.

I say this as a CT tech who has spent their career working almost exclusively with trauma center ER staff on night shift weekends for the past twelve years, scanning nearly every patient who comes through the door, and still has zero desire to go to outpatient land. I love the ER. I consider myself part of the ER team too.

Edit - Love how I got a downvote for literally just adding that we deserve respect. Incredible.

Edit 2 - I posted this in another comment, but I just finished my shift and there was literally an “Ultrasound Call-In Criteria” paper sitting on the counter. I have no part in calling them in at this facility, and had no idea what they were, it just happened to be sitting over by CT/MRI. Posting for anyone interested! 💀

I DID NOT WRITE THESE AND I HAVE ZERO OPINION ON THEM ONE WAY OR ANOTHER AS I AM NOT AN ULTRASOUND TECH. JUST POSTING THE PROTOCOL AT MY CURRENT FACILITY FOR ANYONE INTERESTED.

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u/Rigamoroll Jul 22 '24

Long time MRI tech here. After years of on call service, IMHO it should absolutely be the radiologist on call, after consulting with the attending to determine the acuity of the case, and to determine the appropriate modality for imaging, who informs the technologist to come in and scan the patient. Otherwise, in my experience, we are on multiple phone calls all night and constantly coming in for routine scans, wrong modality choice for optimal imaging, or cases that won’t go to the OR until 3pm the next day, all night long. If it is emergent, then of course it is appropriate. No disrespect to the docs and residents out there, but “emergent” is increasingly becoming confused with “convenient”, and/or “we just want it now”. Please don’t forget we still have an entire shift to work the next day. All we ask is that all ducks are in a row before we are asked to drive in in the middle of the night. 🤷🏻‍♀️

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u/4883Y_ BSRT(R)(CT) Jul 22 '24

Yeah, but they’ll downvote tf out of you for saying that here. 🙃

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u/Rigamoroll Jul 22 '24

Well, if they do, they do. But protocols and policies are there for a reason. I love getting reamed by the radiologist for coming in for a stat MR spine, only to find out that the radiologist wanted a CT instead. You know what I’m talking about. Yeah, so glad I’m running on 3 hours of sleep today for nothing. Communication please! Our experience actually does account for a lot. There’s a lot that we know that you might not know. Most of the time I know what my rad would want but the wrong exam is ordered. So, let’s make this a Radiologist to Attending decision before everyone freaks out. No one is trying to dis you ED docs, and I certainly have NEVER refused to do a scan! We appreciate your knowledge base. Just asking that you respect ours as well, and consult the one who is responsible for the READ first. (Radiologist = My Boss) It’ll save you much time and angst in the long run.

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u/4883Y_ BSRT(R)(CT) Jul 22 '24 edited Jul 22 '24

Couldn’t agree more. Really tired of the disrespect and constantly being put in the middle for doing what we’re supposed to do. Even if we do the scan, there isn’t going to be a dictation unless it’s approved. They make the protocols. 🤷🏼‍♀️