Yes, point taken Cliff (and Beth!), clearly some ITUs are better than others
when it comes to airway training.
Well, I'm glad someone else is awake at this ungodly hour, I must be on Oz
time again...
Adrian Fogarty
----- Original Message -----
From: "Cliff Reid" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, November 27, 2001 4:07 AM
Subject: Re: Advanced Air Way in Prehospital
> Adrian, I think this depends on the set-up and size of the ICU and its
> relationship with the anaesthetic department. A larger predominantly
> 'medical' (as opposed to full of post-op weaners) ICU will be faced with a
> lot of 'dirty' airways both on and off the unit. Examples include sepsis,
> deteriorating asthmatics / COPDers on the medical wards, APO/cardoversions
> on CCU, failed extubations on the ICU, retrieval of inadequately
> resuscitated patients from peripheral hospitals, and so on. These patients
> often have limited cardiac and respiratory reserve and RSI is potentially
> more hazardous than in theatre and, dare I say it, possibly even than in
the
> emergency department for some cases where RSI can sometimes be
> straightforward in terms of diagnosis (isolated head injury, unconscious
> overdose) and environment (equipment, light, nurses, resus room compared
> with the corner of the renal ward). Some such places now have the ICU
> SHO/Reg on the arrest team rather than the anaesthetist, and on the trauma
> team for RSI in the ED. All my RSI experience comes from 18 months in such
a
> unit, and I found it prepared me well for the REALLY 'dirty airways' in
the
> pre-hospital care environment (although there are plenty of other
> modifications you need to make out there in the 'real world') so I
wouldn't
> rule ICU out as an alternative to anaesthesia - just pick your department
> carefully. You won't learn inhalational anaesthesia though - I still get a
> 'real anaesthetist' to do that for me - but that's irrelevant to this
> pre-hospital thread!
>
> Hope all's well in Hampstead!
>
> Cliff Reid
> Australia
>
>
> >From: Adrian Fogarty <[log in to unmask]>
>
> >A small point Beth, but I've done quite a lot of ITU, and I found that
> >arrests and crash intubations were quite rare in this setting. Most of
the
> >patients are already tubed (from elsewhere) and if extubated correctly
most
> >will not require re-tubing. Crash intubations should really be considered
a
> >critical incident in a modern ITU setting. Arrests too should rarely
> >happen;
> >the patients might have multiorgan failure but they have relatively
stable
> >myocardiums. Some patients do arrest at end-stage but they are not then
> >usually resuscitated.
> >
> >In short, what I'm trying to say is that ITU is not a good place to gain
> >airway experience. Straight anaesthetics is much more beneficial, but if
> >you
> >really want crash intubations and arrests then go to your local A&E
> >department!!
> >
> >Adrian Fogarty
>
>
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