The key point I think is the recommendation that each speciality develops its own specific guidelines on sedation - EM needs to be proactive in developing these and needs to include ketamine. It is a unique agent, and there is plenty of data supporting its use as a procedural agent in the ED.
Its going to be a losing battle with some anaesthetic departments, because despite the evidence some refuse to except that having a dissociated patient on ketamine is not a general anaesthesic - we need to really push for the adoption of the phrase " dissociative sedation and analgesia" to describe the effects of ketamine - that is the state that is produced - it is unique and its is not the same as giving someone an induction dose of thio or propofol
I know this was a mulit-speciality working party - but given the vast EM literature on sedation it was disappointing to see only 2 references drawn from it - especially given this is where all the ketamine work has been published - not a single ketamine ref. I think this is part of the problem with ketamine - it is Emergency docs who are using it purely as a procedural agent ( as opposed to part of an anaesthetic cocktail ) and the research is being published in our literature, which by and large is not read by most anaesthetists.
Is 3 months of anaesthesia enough ? The answer has to be probably not - but what is ? My personal view is 6-12 months. The key points being that you are not trying to learn anaesthesia in that time, which is the usual criticism from the anaesthetists - you are trying to learn ( or more usually consolidate) specific skills relevent to EM. Subsequently you spend 4-5 years in the ED further learning and developing skills. So to say that we do "3 months" (or 6 or 12) of training for sedation or airway management is grossly misleading - we spend 5 years training in sedation and airway management - during that time (or before) we spend some of it working with anaesthetists, but we dont just learn from them or in OT - we learn in the ED
cheers
Craig
>>> [log in to unmask] 11/16/01 03:00 >>>
lets wrap this thread up by referring to the recently published document "Implementing
and ensuring Safe Sedation Practice for healthcare proceedures in adults" now
on the Royal College of Anaesthetists website:
www.rcoa.ac.uk
and start a different tack - what people think the "methods appropriate to clinical
practice in (A&E)"
are and how they may differ from the Report's framework guidelines.
I would offer that verbal contact is not always maintained in A&E sedation because
pain levels often necessitate large doses of analgesics; therefore conscious
sedation is not always the target. Is this safe practice? And what about ketamine
"sedation"? The clinical picture is different, the physiological responses different
to the usual anxiolytic/hypnotic states. Do emergency physicians in this country
have appropriate training - is the 3 month Anaesthetic secondment enough?(see
RSI discussions)
sorry Im going on a bit - its a topic of interest to me!
Marten C. Howes MRCP(UK)
Specialist Registrar
Accident and Emergency Medicine
Royal Preston Hospital
Lancashire
PR2 9HT
CC DHB Secure Mail Server
********************************************************************************
[INFO] -- Virus Manager:
No Viruses were detected in this message.
********************************************************************************
CC DHB Secure Mail Server
********************************************************************************
This email or attachment(s) may contain confidential or legally privileged information intended for the sole use of the addressee(s). Any use, redistribution, disclosure, or reproduction of this message, except as intended, is prohibited. If you received this email in error, please notify the sender and remove all copies of the message, including any attachments. Any views or opinions expressed in this email (unless otherwise stated) may not represent those of Capital and Coast District Health Board. (AC_S001)
[INFO] -- Virus Manager:
No Viruses were detected in this message.
********************************************************************************
|