Correspondence
Awareness in the emergency department Timothy Dexter and Aimee Manicom
We were interested to read the report of Awareness in the emergency department (ED) by Theresa Finlay and Tim Parke in the May 2016 edition, highlighting the potential for accidental awareness during resuscitation. Additionally, for us, it also illustrated a local issue within our own Trust. The Trust has recently removed and then replaced the anaesthetic machine in our ED resuscitation bay. The removal and replacement with a modern transport ventilator and appropriate infusion pumps was prompted by two factors. First, the existing machine was old and no longer under a service contract; second, the Equipment Leads in our anaesthetic department were concerned that our provision of equipment could be out of line with practice in other Trusts. Our Equipment Leads are skilled HEMS doctors and have significant skills in resuscitating patients prior to transfer out in the field, where there is no handy anaesthetic machine. In addition, they are regular users of total intravenous anaesthesia. Unfortunately, others in the Anaesthetic Department were not as confident in these areas and felt more secure using an anaesthetic machine for resuscitation. Dr Parke’s case suggests that some junior anaesthetists may also struggle to titrate infusion rates correctly in what can be highly stressful situations, where falling back on methods used day in and day out may provide more consistent results. Furthermore, the availability of an anaesthetic machine could also be part of a comprehensive anaesthetic monitoring
Journal of the Intensive Care Society 2016, Vol. 17(4) 359 ! The Intensive Care Society 2016 Reprints and permissions: sagepub.co.uk/ journalsPermissions.nav DOI: 10.1177/1751143716657367 jics.sagepub.com
system that would include BIS or ENTROPY. These monitors, whilst of little proven value in Intensive Care Units, could potentially assist during resuscitation; particularly in patients made tachycardic with beta 2 agonists. In addition, for an asthmatic patient, there could be real advantages in using bronchodilating agents such as Sevoflurane during initial management. We all know that there have also been cases reports highlighting the dangers of anaesthetic machines in EDs, and their use by non-anaesthetists, these reports may have encouraged departments to move anaesthetic machines out of ED resuscitation areas. Discussing this issue with some of our rotating anaesthetists in training suggests we are perhaps an outlier in the provision of an anaesthetic machine in ED. It would be interesting to know what equipment other departments use to resuscitate patients in ED, and if inhalational agents are a regular part of the sedative plan. Declaration of conflicting interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Buckinghamshire Healthcare NHS Trust, Amersham, UK Corresponding author: Aimee Manicom, Buckinghamshire Healthcare NHS Trust, Amersham HP7 0JD, UK. Email: [email protected]
Awareness in the emergency department Timothy Dexter and Aimee Manicom
We were interested to read the report of Awareness in the emergency department (ED) by Theresa Finlay and Tim Parke in the May 2016 edition, highlighting the potential for accidental awareness during resuscitation. Additionally, for us, it also illustrated a local issue within our own Trust. The Trust has recently removed and then replaced the anaesthetic machine in our ED resuscitation bay. The removal and replacement with a modern transport ventilator and appropriate infusion pumps was prompted by two factors. First, the existing machine was old and no longer under a service contract; second, the Equipment Leads in our anaesthetic department were concerned that our provision of equipment could be out of line with practice in other Trusts. Our Equipment Leads are skilled HEMS doctors and have significant skills in resuscitating patients prior to transfer out in the field, where there is no handy anaesthetic machine. In addition, they are regular users of total intravenous anaesthesia. Unfortunately, others in the Anaesthetic Department were not as confident in these areas and felt more secure using an anaesthetic machine for resuscitation. Dr Parke’s case suggests that some junior anaesthetists may also struggle to titrate infusion rates correctly in what can be highly stressful situations, where falling back on methods used day in and day out may provide more consistent results. Furthermore, the availability of an anaesthetic machine could also be part of a comprehensive anaesthetic monitoring
Journal of the Intensive Care Society 2016, Vol. 17(4) 359 ! The Intensive Care Society 2016 Reprints and permissions: sagepub.co.uk/ journalsPermissions.nav DOI: 10.1177/1751143716657367 jics.sagepub.com
system that would include BIS or ENTROPY. These monitors, whilst of little proven value in Intensive Care Units, could potentially assist during resuscitation; particularly in patients made tachycardic with beta 2 agonists. In addition, for an asthmatic patient, there could be real advantages in using bronchodilating agents such as Sevoflurane during initial management. We all know that there have also been cases reports highlighting the dangers of anaesthetic machines in EDs, and their use by non-anaesthetists, these reports may have encouraged departments to move anaesthetic machines out of ED resuscitation areas. Discussing this issue with some of our rotating anaesthetists in training suggests we are perhaps an outlier in the provision of an anaesthetic machine in ED. It would be interesting to know what equipment other departments use to resuscitate patients in ED, and if inhalational agents are a regular part of the sedative plan. Declaration of conflicting interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Buckinghamshire Healthcare NHS Trust, Amersham, UK Corresponding author: Aimee Manicom, Buckinghamshire Healthcare NHS Trust, Amersham HP7 0JD, UK. Email: [email protected]
