Emergency department sedation

Abstract

Recently I forwarded the Canadian Association of Emergency Physicians' (CAEP) procedural sedation and analgesia guidelines 1 to the anesthesia department in our hospital. I felt that they would have a harder time arguing against these guidelines than our policy, and therefore that this might be a prudent first step. I was also careful to explain that we were looking for feedback (not permission). There must have been some pent-up frustration because the letter that we received is anything but cooperative (the language notwithstanding). The premise of the letter is that we are currently providing general anesthesia in the ED and of course should not be. I disagree with the former point and agree with the latter. There is a great deal of ignorance out there ("Why don't you just use midazolam for induction of head injuries?"), and there is always the inter-professional rivalry factor. Our Chief of Anesthesia states that he contacted the Canadian Anaesthetists' Society (CAS), who indicated that the "CAS did not contribute to the development of the CAEP guidelines and has no comment on it." The impression I got was that CAS was involved. Could you clarify this for me?

Emergency department sedation guidelines: a tale of two specialties

“…Dr. Del Donald's letter in this issue 1 is representative of several communications I've had with Canadian emergency physicians over the last few months.…”

Correction

“…In the July issue of CJEM, Innes stated that he was unaware of any Canadian emergency physicians who are permitted to use propofol. 1 In fact, we have used propofol for procedural sedation and as an induction agent for intubation since 1995. Among our emergency physicians it has become the agent of choice (in combination with appropriate analgesia), particularly for orthopedic procedures.…”

Specialists, guidelines and turf battles

“…Thank you for a thought-provoking and diverse spread of articles. I found the discussions [1][2][3][4][5][6][7][8][9] about guidelines and "turf battles" fascinating and, in many ways, familiar. The Australasian College for Emergency Medicine (ACEM) has faced similar issues and processes.…”