The subject of RSI has recently been mentioned in relation to clinical
governance
within the hospital setting. There are rumours that some anaesthetists may
try and stop emergency physicians from performing RSI in the A+E. (NOT my
present hospital where they appear to have never been upset with our current
actions - generally a good working relationship)
Clearly this can result in a turf war that has two sides. However, if my
understanding
of clinical governance is correct (is anyones?) it may be possible for them
to do this if RSI is considered an anaesthetic task rather than an emergency
one.
Cheery thought for the future (it could happen to many other things we do).
I am aware of the current audit of RSI practice in A+E departments that is
ongoing at the moment - the results should be very interesting.
Simon Carley
SpR in Emergency Medicine
Hope Hospital
Salford
England
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-----Original Message-----
From: Dr Matthew W Cooke <[log in to unmask]>
To: acadae messages <[log in to unmask]>
Date: 24 June 1999 21:09
Subject: Rapid Sequence induction
>To: ACAD_AE_MED
>
>There is a lot of discussion about rapid sequence induction both in
>pre-hospital care and in the A&E department. Here is some
>evidence as to why we need to do it. Of course the next step is
>who should do it - simple answer the first person there who is
>appropriately trained person and can perform RSI safely.
>
>Matthew
>
>
>
>
>Authors
> Li J. Murphy-Lavoie H. Bugas C. Martinez J. Preston C.
>Institution
> Accident Room, Charity Hospital, New Orleans, LA, USA.
>Title
> Complications of emergency intubation with and without
> paralysis.
>Source
> American Journal of Emergency Medicine.
> 17(2):141-3, 1999 Mar.
>Abstract
> Expert and definitive airway management is fundamental to the
>practice of emergency medicine. In critically ill patients,
> rapid sedation and paralysis, also known as rapid-sequence
>intubation, is used to facilitate endotracheal intubation in
> order to minimize aspiration, airway trauma, and other
>complications of airway management. An alternative method of
> emergent endotracheal intubation, intubation minus paralysis,
>is performed without the use of neuromuscular blocking
> agents. The present study compared complications of these
>two techniques in the emergency setting. Sixty-seven
> intubations minus paralysis were prospectively compared with
>166 rapid-sequence intubations. Complications were
> greater in number and severity in the nonparalyzed group and
>included aspiration (15%), airway trauma (28%), and
> death (3%). None of these difficulties were observed in the rapid-
>sequence group (P < .0001). These results show that
> rapid-sequence intubation when compared with intubation
>minus paralysis significantly reduces complications of
> emergency airway management and should be made available
>to emergency physicians trained in its use.
>
>
>
>
>
>Dr Matthew Cooke
>Senior Lecturer in Emergency Care
>Emergency Medicine Research Group
>Primary Care Unit, Univ of Warwick
>Tel 024 76 573005 Fax 0870 055 8087
>
>
>
>
>
>
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