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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 _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp