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REPLY

Halifax, Nova Scotia

We appreciate the comments on our article¹ and are grateful for the opportunity to reply. As suggested, resources and reality dictate that anesthesiologists and experienced, trained emergency physicians (EPs) may not be available for all non-operating room (OR) airway cases. We further agree that emergency department (ED), intensive care unit and hospital ward intubations will be among the most challenging, for physiologic and sometimes anatomic reasons.

In the case of the EP, obviously skills in resuscitation are core to the discipline, and the ‘A’ and ‘B’ of the ABCs are in turn central to those skills. To suggest that airway management by EPs be limited to only certain of the available techniques [e.g., other than the use of rapid sequence intubation (RSI)] is no more appropriate than suggesting that only cardiologists administer thrombolytics in the ED. Experience is obviously invaluable in choosing drugs and techniques (e.g., awake or RSI) and attempting to effectively teach this as part of any short airway education program is a daunting task. However, as much as an experienced clinician may be able to make management of a difficult situation look like an art, there are still underlying principles and knowledge which must be acquired and applied with reasonable competence by the less experienced.

The AIME program instructor faculty comes from the ranks of both emergency medicine and anesthesia. Collaborating on developing this program has led to a constructive relationship between the two disciplines at our institution, moving beyond ‘turf’ issues which may perpetuate a dated and unacceptable model of airway management for non-anesthesiologists. Continuing medical education offerings and emergency medicine residency rotations in airway management with defined objectives must replace the current ad hoc model of hanging around the OR hoping for ‘intubations’. It is our sincere hope that anesthesiologists will continue to support clinical and educational airway management efforts by non-anesthesiologists.

Reference

1 Kovacs G, Law JA, Ross J, et al. Acute airway management in the emergency department by non-anesthesiologists. Can J Anesth 2004; 51: 174–80.[Abstract/Free Full Text]

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This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Related articles in CJA Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Law, J. A. Articles by Kovacs, G. Search for Related Content PubMed Articles by Law, J. A. Articles by Kovacs, G.