Anesthesia in the ED

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Well

I have to say this isnt typically the case.

4-6 intubations a day does not equal one bloody lefort 3 intubation a month 
with teeth in the airway.

That is like saying that the RN who puts an IV in the big juicy AC 4-6 times 
a days is better than the one who does the hardest IV in the ER ONCE a day. 
Its simply not on the same level of difficulty. Your comparing oranges to 
apples.

As for the trauma anesthesiologists, well, lets be honest, 99% of pts who 
need a tube come with one to the trauma room and its rare they have to do a 
difficult intubation there either. I support the ER physician as one of the 
best at difficult airway intubation.

MM
----- Original Message ----- 
From: "artlam" <artlam at u.washington.edu>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Wednesday, August 23, 2006 1:56 PM
Subject: Re: Anesthesia in the ED


>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
>>> --
>>> trauma-list : TRAUMA.ORG
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>>> --
>>> trauma-list : TRAUMA.ORG
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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
>>
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/traumalist.html
>>
>
> --
> trauma-list : TRAUMA.ORG
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> http://www.trauma.org/traumalist.html 

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