|| Anaesthesists in the ER
||Date: Wed, 21 Aug
From: Eran Tal-Or M.D.
After several post that I saw on the list.
I want to rise the question about the roll of the Anaesthetist
in the E.R.. In our center in the past the E.R. physician was
the one that had the first try of intubation whether it was adult
or a child. If he didn't succeed the anaesthetist was called from
the O.R. to help. This protocol cost in time and in difficulty
intubation on the third and fourth try. Today the protocol change
if intubation is anticipate before the patient arrive or if it
is a child. The anaesthetist call before the patient arrive. If
the patient arrived without announce and there is time before
the intubation, again the anaesthetist is calling. The E.R. physician
do the intubation on emergency when ther is no time to call the
anaesthetist. In the mean while a call for the anaesthetist is
going to the O.R.. I will like to know what are the protocol in
||Date: Thu, 22 Aug 1996 14:44:54
From: Nick Macartney
In our unit, when the hospital is notified
that a serious trauma is arriving, the anaesthetist is called.
In fact two are, to ensure that one can respond. They look after
the airway, and intubate if they think necessary. Also, my hospital
bleep also goes off, and I normally respond to keep an eye. I
regard the only people as competent in intubate in an emergency
are those doing it regularly. This means anaesthetists or ICU
||Date: Thu, 22 Aug 1996 20:44:04
From: Kimberly Nagy MD
We had an anesthesiology fellow on our
Trauma service for 9 months. He was invaluable. Not for intubations
but for pain control. He was great at regional anesthesia for
fracture reduction, etc. In our ICU he had all of our chest trauma
patients on continuous epidural and they loved him. He was also
a good resource when it came to sedation of our agitated patients.
||Date: Fri, 23 Aug 1996 18:31:56
From: Randy Cordle MD
I must disagree strongly with the posts
I have read so far on this topics. What letters follow ones name
does not make them proficient. What matters is skill training
and skill use. Pediatric intubations were critically looked at
by our pediatric trauma surgeon. The Emergency Medicine Specialists
and residents in our large emergency department had a 100% success
rate with NO significant adverse outcomes from the intubation.
As I recall, no intubation required more than two attempts. I
can easily say that during my training I have intubated more premature
babies than any anesthesia resident in the hospital. The residents
and staff in the emergency department at my hospital also intubate
far more trauma patients than do the anesthesiologists or ICU
staff. Once again it does not come down to what letters you have
after your name, but rather to what experience, training, and
practice environment you have been a part of. If the doctors in
your emergency department have not been trained and / or do not
get experience, is it really surprising that their skills might
not be up to those who have and do. Titles do not open airways,
training and experience do.
||Date: Wed, 28 Aug 1996 00:14:03
From: Eran Tal-Or M.D.
The only reason that one can have 100%
SUCCESS in intubation is not doing enough.
Any one that work in the OR. know that
there is always the patient that is difficult and some time cannot
be intubate. If the intubation was no problem, there was no nee
for the crycotomia or other surgical air way management. You just
have to see how many books was written about air way management
to understand that there is no 100% SUCCESS.
||Date: Wed, 21 Aug 1996 17:01:59
From: Gael Whetstone RN
One anesthesiologist evaluates every patient
( 2 are present if the patient is known to be unstable ie gunshot
wound to the chest) at the University of Maryland Shock Trauma.
||Date: Wed, 21 Aug 1996 20:40:18
From: John Trickett
All patients meeting the criteria for
a "trauma code" are intubated by an anesthetist (in house) who
is part of the "team" , unless the patient arrives before the
anesthetist and the ER physician then intubates as required.
||Date: Fri, 30 Aug 1996 22:24:41
From: Randy Cordle MD
I am sorry you have misunderstood the
post that I placed on this server. It simply states that in one
study, over a ? 4 year period, no intubations were unsuccessful
in this specific population. Anyone who intubates knows that there
will be patients who are very difficult or impossible to intubate.
These are the patients who need more advanced airway procedures.
I would hope that you would agree that these advanced procedures
should be performed by caregivers who are properly trained and
experienced. This is the point I was making: Training and experience
are important, letters after one's name are not. Where you get
your experience is less important than the quality of that experience.