Cardiac Arrest Team
The ICU Trainee has the responsibility of attending cardiac arrests outwith ICU. Equipment for intubation is available on the Arrest Trolleys in each ward.
The resuscitation room in the ED has 4 bays. There are no anaesthetic machines. There is a transfer monitor in resus but is preferable to use the ICU oxylog 3000 ventilator.
There is a dedicated paediatric bay with a Broselow Cart. Requests may be made to attend “stand-by’s” in the ED, in addition to requests for potential admissions to ICU and assistance with airway management and resuscitation in the unconscious patient.
Trauma calls have also been recently introduced. There will inevitably be a proportion of calls where our services are not required but these should be seen as an opportunity to familiarize yourself with the resus room and get to know the ED staff to facilitate good team working when a major trauma case does arrive. Polytrauma is relatively common here and if there is any doubt concerning management of such cases, senior assistance should be sought. Head injured patients are also relatively common in Raigmore; care must be taken to exclude spinal injury.
Patients with a reduced conscious level, for whatever cause, may require an Anaesthetic transfer. Occasionally, patients are transferred ventilated to Edinburgh or Aberdeen for PCI. The ICU trainee usually accompanies such transfers, but this depends on level of experience and the consultant intensivist must organise all transfers. Leave the 4002 page with the on-call consultant.
There is a dedicated transfer trolley (CCT6) for inter-hospital transfers. It is kept in ICU. It is fully equipped with an oxylog 3000 ventilator, mini Phillips monitor and 4 syringe drivers.
There is also a dedicated transfer bag for adults. It is important that all equipment is assembled and checked prior to transfer. It is important to familiarise yourself with both the bag and the trolley as soon as possible. It is also the responsibility of the Trainee on call for ICU to check this equipment. If used it is mandatory that the trolley is set up again as soon as it returns. Dr Marian MacKinnon is the consultant responsible for transfer training at Raigmore and will ensure that you are aware of all the equipment and maintenance issues.
There are also paediatric transfer bags in the ICU and the children’s ward and these are maintained by their nurse educationalist. It is not uncommon for sick children to be admitted to the adult intensive care unit for stabilisation prior to retrieval by the Scotstar service – due to geography we may have to keep children up to 6 hours or overnight on some occasions.
The ICU Anaesthetist may be asked to provide anaesthesia for emergency cardioversions. These are usually carried out in the Coronary Care Unit. There is no anaesthetic machine on CCU. In haemodynamically stable cases, it may be advisable to transfer the patient to theatre for their cardioversion. Ensure that the defibrillator being used can also pace. Full AAGBI monitoring should be employed and a full anaesthetic and medical history should be checked before the procedure, in addition to review of appropriate investigations. An anaesthetic chart should be completed. Ideally have anaesthetic assistance and consider taking the “out & about” trolley.
The anaesthetist should not leave the patient until the patient is in control of his/her own airway and the vital signs are stable.
During the day the on-call consultant will be available to help. If you require assistance in the Emergency Department out of hours, it may be possible to call the theatre staff for help. They will do their best to help as long as they are not in theatre with a patient. Page no 5063
Acute Pain Service (APS) and review of patients on SHDU
Outwith office hours it is the responsibility of the ICU anaesthetist to deal with any problems pertaining to patients known to the APS. These will usually involve patients receiving epidural infusions or patient controlled analgesia. In addition you may be asked to review patients on the surgical HDU who may be causing concern. Referrals to attend epidural patients or PCA patients are protocol driven and may come from nursing staff. However, direct referrals by the junior doctor or nursing staff are not acceptable unless it is apparent that the patient is extremely ill and in danger of cardio-respiratory collapse as discussed previously. They should follow the protocol on the NEWS chart. NEWS is a means of early detection of clinical deterioration and its goal is to ensure timely, appropriate intervention by a suitably senior clinician.
Placing epidurals for labour is the duty of the theatre trainee out of hours. The primary responsibility of the ICU trainee is to the intensive care. However, there are 2 resident anaesthetists out of hours and it is anticipated that there will be a team approach to the work needing done; should the theatre anaesthetist be busy, then the ITU junior may assist with siting epidurals or managing the theatre case to free up the theatre anaesthetist as long as this does not compromise the care of the ITU patients. Any issues pertaining to obstetrics/epidurals should be directed to the consultant anaesthetist on call not the consultant intensivist.