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The Resus Room

Should EM clinicians be allowed to RSI?

The Resus Room

Simon Laing

Science, Emergencymedicine, Medicine, Health & Fitness, Em, Ae

4.8678 Ratings

🗓️ 5 December 2016

⏱️ 23 minutes

🧾️ Download transcript

Summary

RSI delivered by EM clinicians is common place throughout the globe, in the UK however it still seems a contentious topic, with recent data showing only 20% of ED RSIs being performed by EM clinicians.

I was lucky enough to be asked to talk at the ICS SoA 2016 conference on the topic of EM doctors carrying out RSI's in the UK and this podcast is a copy of that talk.

I hope it provides some context both to UK practitioners and also to those from other countries, who may not understand what the big deal is all about.

Simon

References

A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance.Randomized controlled trial. Kovacs G, et al. Ann Emerg Med. 2000

Acute airway management in the emergency department by non-anesthesiologists. Review article. Kovacs G, et al. Can J Anaesth. 2004

Achieving house staff competence in emergency airway management: results of a teaching program using a computerized patient simulator. Mayo PH, et al. Crit Care Med. 2004

The who, where, and what of rapid sequence intubation: prospective observational study of emergency RSI outside the operating theatre. Reid C, et al. Emerg Med J. 2004

Rapid sequence induction of anaesthesia in UK emergency departments: a national census. Benger J, et al. Emerg Med J. 2011.

Tracheal intubation in an urban emergency department in Scotland: a prospective, observational study of 3738 intubations. Kerslake D, et al. Resuscitation. 2015

Systematic review and meta-analysis of first-pass success rates in emergency department intubation: Creating a benchmark for emergency airway care. Park L, et al. Emerg Med Australas. 2016

Scottish Intensive Care Society: RSI

Difficult Airway Society Guidelines

RCOA Anaesthesia in the Emergency Department Guidelines; Chapter 6.1

John Hinds on RSI at RCEM 2015 Belfast

Draft; AAGBI Guidelines: Safer pre-hospital anaesthesia 2016

AAGBI Pre-hospital Anaesthesia Guideline 2009

Transcript

Click on a timestamp to play from that location

0:00.0

Welcome to the Recess Room podcast.

0:03.0

So hi and welcome back to the podcast.

0:04.0

So hi and welcome back to the podcast. I'm Simon Lang.

0:17.0

Rob Fenwick isn't with me this time but that's because this is a slightly different episode.

0:21.6

So I was lucky enough to be asked to speak at the Intensive Care Society's State of the Art conference.

0:26.6

On a topic that's dear to my heart, should EM clinicians be allowed to perform EDRSI?

0:34.6

Now there is some evidence-based medicine in here. There are some clinical guidelines,

0:38.1

but it's really food for thought on where the future of emergency medicine lies. Have a listen to

0:43.5

the podcast and make sure you go and check out all the references which are there on the website.

0:48.1

Thanks again to AbPrak, the sponsors of the podcast, for making this all possible. So without further

0:53.1

ado, we'll crack on with the episode and

0:55.0

we'll be back with our normal podcast really soon for you. Should ED doctors be allowed to

1:03.6

intubate? And when I say intubate, I mean perform a rapid sequence intubation in the

1:09.6

emergency department. It's a subject that really vexes me

1:13.6

and a lot of people involved in emergency medicine, but it's a really pivotal question in many

1:20.2

people's minds and it's really going to make a difference to the course of emergency medicine

1:24.7

with it being a key part of critical care of the emergency patient.

1:30.0

So what's the big deal? Why would an emergency medicine consultant want to come and talk to a group

1:34.9

of intensivists about our involvement in emergency airway management and in particular RSI?

1:41.0

Well, not only is an extremely important part of resuscitation and emergency and critical

1:47.0

care, but the UK is an outlier. When compared to countries dotted around the globe, we're

1:52.0

strange in the fact that emergency medics don't perform rapid sequence intubation as routine in the ED.

...

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