In my experience, too few emergency medical and nursing staff are familiar
with anaethetic equipment and "anaethetic gases" to be able to maintain and
safely use them in the emergency setting.
In the situation of status asthmaticus, I agree entirely with the point that
these patients need a "definitive ventilator" and any portable
ventilator(esp the oxylog) are too insensitive to manage tight asthmatics.
In my institution, we have an agreement with the intensivists, that even if
no ICU bed is available, an intubated asthmatic patient will be given a bed
in the ICU even if a current ICU patient must be transferred out. This way,
stable patients are transferred out, whilst the sickest are kept in house.
With the advent of anaesthetic agent like propofol. the maintenance of
sedation in the ED setting has become much easier and I see no need for the
Boyles machine to ever grace an emergency dept corner.....remember, one
intubated, anaesthetised patient on a Boyles machine, requires one nurse and
one doctor at all times!
Beth Christian
>From: Adrian Fogarty <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: anaesthetic machines in A&E
>Date: Mon, 29 Oct 2001 14:40:04 -0000
>
>I would also agree with RC Goat. Although TIVA is getting more popular
>(e.g.
>my anaesthetist brother hasn't used volatile anaesthetics for over two
>years!), it is still not considered routine by most anaesthetists. Volatile
>agents also have a role in the management of bronchospasm in status
>asthmaticus. The ventilation characteristics of an oxylog are rather
>primitive, and especially when it comes to the asthmatics you will need
>fine
>tuning of I/E ratios, waveforms and PEEP etc. Of course a Boyles 'n' Blease
>can't do any of this, but emergency departments should be seen as critical
>care areas, and on that basis we should have ready access to as
>sophisticated monitoring and ventilation equipment as found on intensive
>care units. On with the revolution!
>
>Adrian Fogarty
>
>
>----- Original Message -----
>From: "Rowley Cottingham"
>Subject: Re: anaesthetic machines in A&E
>
>
> > Of course you need anaesthetic machines. As you know, I have equipped
>each
>bay in the new Emergency Unit with
> > its own to ensure best quality care throughout. There are many occasions
>where patients need emergency intubation
> > and ventilation, and must be anaesthetised to facilitate this. They then
>need to be kept anaesthetised, and this can
> > only safely be done with an interlinked modern anaesthetic provision.
> >
> > Best wishes,
> >
> > Rowley Cottingham
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