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Wed Aug 23 21:56:09 BST 2006

I cannot agree with you more.  It has been a struggle for me to come up with 
a policy that would allow ED physicians to maintain their airway skills 
without jeopardizing patient safety or training of our residents.  It has 
also been difficult to convince ED physicians that anesthesiologist may 
still have an edge with the real difficult airways.  However, there is 
clearly a regional variation.  We are a level 1 trauma center where 
Anesthesiology is always responsible for all airway problems in the ER,  but 
I also know there are places where anesthesiologists never frequent the ER.

Arthur Lam M.D., F.R.C.P.C.
Anesthesiologist-in-Chief
Director, Cerebrovascular Laboratory
Harborview Medical Center
Professor of Anesthesiology and Neurological Surgery
University of Washington
Seattle, WA
----- Original Message ----- 
From: "Avi Roy Shapira" <avir at bgumail.bgu.ac.il>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Monday, August 21, 2006 3:51 AM
Subject: RE: Anesthesia in the ED

>
> Tim,
>
> I disagree with the claims that ED docs or surgeons are just as good as
> anesthesiologists in airway management.
>
> I think it should be obvious that someone who does 4-6 intubations each
> working day is better than anyone who does them only occasionally, however
> well trained.
>
> For the majority of patients, it does not matter. But for the odd patient
> with a difficult airway, short neck, low chin, it does. The reason is that
> the anesethesiologist had encountered many more of these than any ED doc.
>
> Lets assume that 2% of individuals have difficult airway. If you do 5
> intubations a day, 5 days a week, you will see 50X25 or 1250 a year. That
> means 25 patients with difficult airway a year.
>
> I doubt even the busiest ED doc does more than 50 intubations a year, if
> that many. That means that the ED doc, or trauma surgeon will
> have to tackle at most one such patient a year. So, however well trained,
> your ED doc may not know how to deal with one.
>
> I would expect a higher rate of surgical airways, in places that do not
> use anesthesiologists as part of the trauma team.
>
> I suspect that the reason that you don't have an anesthesiologist on the
> team is that you don't have enough of them.
>
> Our trauma team includes a surgeon, who is the team leader, a surgery
> resident, and an anesthesiologist (and a couple of nurses). The latter is
> either a certified one, or a senior resident. It works well, and we are
> very pleased with not having to worry about the airway management.
>
> Avi
>
>
>
>
> , On Mon, 21 Aug 2006, Hardcastle, Tim, Dr
> <tch at sun.ac.za> wrote:
>
>> Hi all
>>
>> In South Africa we have front-room medical officers (GP level - 
>> non-surgeons who choose to only work in Trauma Unit / ER) and since 2004 
>> emergency medicine trainees (new discipline in SA) who do the ER airway, 
>> together with us (the Trauma Surgery attendings and trainee people). 
>> Anaesthetists are available only when not busy in the OR (very seldom).
>>
>> We therefore have to be very skilled at airway options and management. 
>> Additionally, with the excessive workload: often three or four cases 
>> pending for OR at once and only two EOR at night, any remotely stable 
>> cases (e.g. GSW with acute abdo but not active bleeding) will wait their 
>> turn in the holding area in the Unit, they do not go to OR 
>> holding/recovery area. We will moniotr and prioritise as needed.
>>
>> Overall the Trauma Service runs the unit, however.
>>
>> The joys of the mixed first-third world!
>>
>> Tim
>> Dr T C Hardcastle
>> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
>> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
>> ATLS  instructor and DSTC Cape Town Course Director
>> Intern program Coordinator: Surgery
>> Program Manager: Emergency Medicine (SU)
>> Clinical Head (Director): Diana Princess of Wales Trauma Unit
>> Department of Surgery Room 4064
>> Tygerberg Hospital / University of Stellenbosch
>> PO Box 19063
>> Tygerberg 7505
>> Western Cape
>> South Africa
>> e-mail: tch at sun.ac.za
>> Cell: +27824681615
>> Office: +27219389281 or 4911 pager 0302
>>
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org]On Behalf Of
>> bensonblues at comcast.net
>> Sent: Monday, August 21, 2006 5:43 AM
>> To: trauma-list at trauma.org
>> Subject: Anesthesia in the ED
>>
>>
>> At SJH, emergency medicine does the trauma airways (kids and adults) and 
>> anesthesia responds only if requested. The residents receive strong 
>> training in airway management and anesthesia and become quite good, 
>> putting them to sleep and paralyze 'em as necessary. We rarely see 
>> anesthesia in the ED, and it has not been a problem in the residency's 
>> tens year history. DB
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>
> ==========================================================================
> Aviel Roy-Shapira, M.D.              Soroka University Hospital &
> Dept. of Surgery A. and              Ben-Gurion University Medical School
> the Critical Care Unit               POB 151, Beer Sheva, Israel
>
> email:avir at bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390
>
>
>
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> trauma-list : TRAUMA.ORG
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