Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesThe anaesthetist is responsible for ensuring that this transfer isaccomplished safely.Induction of anaesthesia in emergency departmentSave in the direst life-threatening circumstances such as acuteairway obstruction, induction of anaesthesia in the emergencydepartment is to be conducted to the same high standards as in anyother setting. This mandates the following:• The anaesthetist or emergency physician is to have a dedicatedcompetent assistant (ODP, ED nurse or ED paramedic).• Induction takes place after establishing appropriate monitoring(In ED this should include ECG, S pO 2 and NIBP/ABP as aminimum).• Immediately after intubation, tube position is to be checked bycapnography or capnometry and auscultation. (In ED,capnography is available in all resuscitation bays, but takes afew minutes to warm up. Capnometry is available as “Easycap”whilst capnography is warming up).Failure to adhere to these very simple principles could be construedas falling below minimum accepted AAGBI standards and wouldautomatically lead to interview with one of the clinical directors.(Recommendations for Standards of Monitoring during Anaesthesiaand Recovery 4, AAGBI, March 2007).Perioperative fluid management[Dr Soorly Sreevathsa, June 2009]This guideline is based on the GIFTASUP recommendations. You willneed to read the full guideline, but the basic philosophy is not to usenormal saline (or colloids made up in normal saline) unlessspecifically indicated.Traditional practice carries the risk of inducing hyperchloraemicacidosis. GIFTASUP recommends use of balanced salt solutions222 Anaesthetists Handbook January 2010