Non anesthesia provider providing anesthesia

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I overheard an ED attending discussing a policy regarding the administration of propofol w/ an RN at work today. Apparently the policy states that propofol or any other medication may be administered to a non-intubated pt if an attending ED/Pulmonary physician is in the room. This would be done for a procedure ie: reduction of a fx....etc. I asked him why anesthesia personnel would not provide the anesthesia. He responded that the ED/Pulmonary physician is able to provide all services that anesthesia could. What do you guys think about this?

what i am suggesting is that er physicians in the majority of hospitals are the only providers whom intubate in the er and at night.

so how many hospitals have you worked in that you know so much about this? where are all these hospitals which you know so much about?

first you are an expert on bsn and adn programs in the us, now you are an expert on this.

you seem to enjoy stirring the pot, but there are more ways to keep this board alive than that.

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mmacfn..... i too was an experienced ER/Trauma RN - worked in at least 15 different ER/trauma centers... ignorance may be bliss - but you are arguing with those of us who have been where you are - have moved on and realized we had the same misguided arguments...

first of all - most clinical sites i have been WE trained ER residents... and who gets called when the ER docs FUBAR the airway... oh, anesthesia...

just because your hospital states you can give propofol... do you think when you and the hospital are getting sued and the lawyers pull out... "the package insert clearly states should only be given by trained anesthesia person..." that your hospital will pay what you will owe?? they will sell you up the stream my friend...

due to its miminam effects on cardiac and respiratory systems.

ketamine has the worst of all cardiac effects... that is unless you are referring to the 20 y/o trauma patient who has no underlying heart disease... and even then...it will only cause them to bleed out more.

just for the record... rn's learn how to intubate a dummy in ACLS/ TNCC etc... however, they are not trained in airway evaluation or management.. you may be - but the general ED RN is not.

i will repeat what another poster stated... as a senior SRNA - look back - your views will have turned 180 degrees and it has nothing to do with territorialism... it has to do with not knowing what you don't know... and you can't know it until you have been there... and there is no arguing that.

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Specializes in I know stuff ;).

hey

well im suggesting that because of the AANA statement that 80% of CRNAs work in metropolitan areas. Since that is the case it would stand to reason that most hospitals in the USA are not staffed by CRNAs.

Im sorry if what i had to say about the ADN program upset you, clearly your still carrying it around. If im wrong, please refute my statements with evidence. I have never had a problem admitting im wrong i just want people to prove it as opposed to simply having an opinion.

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Also, i would suggest that "difficult" intubation is a skill that is learned over time with experience. Since the majority of anesthesia intubation is elective (read: the OR) these are not, by definition, crash airways. Obviously those anesthesia providers who also do the crash intubations in the trauma room will be the top experts, i just think thats the minority in anesthesia in general.

I may be wrong, but in my experience ER physicians do more difficult intubations (crash) than anesthesia. Then there is the other subset of difficult airways we see prehospital which most ER and anesthesia providers never see at all.

Is that different from the majority of peoples experience?

Mike - again, you just don't know what you don't know. Your "experience" is limited to the ER and flight nursing. Granted, flight nurses get a lot more experience than ER nurses. But anesthesia providers, in ANY hospital, are THE airway experts - period - hands down - end of story. If not, they shouldn't be giving anesthesia. Really, if you go into anesthesia school with this "I've seen it all and I know what the studies show" attitude, they will eat you for lunch. You're changing professions, but you're sure holding on real tight to the old one.

Maybe you're just stirring the pot to keep it interesting...

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Diprivan can have profound cardiac effects also, especially in a pt with many comorbidities. Or, the pt who has just had a huge bowel prep and is dehydrated.

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hey

well im suggesting that because of the AANA statement that 80% of CRNAs work in metropolitan areas. Since that is the case it would stand to reason that most hospitals in the USA are not staffed by CRNAs.

Im sorry if what i had to say about the ADN program upset you, clearly your still carrying it around. If im wrong, please refute my statements with evidence. I have never had a problem admitting im wrong i just want people to prove it as opposed to simply having an opinion.

It has not upset me. I'm just pointing out previous posts by you. I'm intrigued by all this knowledge you have and wonder what sort of experience you have with all these different nursing programs and ED departments. Please share.

If you can share the majority of hospitals which you know so much about...how many states have you worked in since moving from Canada? You seem to know a lot, but I'm wondering what exactly your experience is? And I'm not referring to your mile long list of specialties. Each state has it quirks as does each states board of nursing. You may be familiar with the Arizona BON, but what about the other 49 states?

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Specializes in I know stuff ;).

The Athomas

I have alot to learn and im excited to do it. The only reason im even arguing this is the fact that people are refuting saftey of a simply procedure with a physician present yet cant produce a shred of evidence to prove it. Come on, regardless of my ignorance, with all the knowledge on this list you should have evidence to back up what you say.

as for ketamine, the question, i thought was "has the greatest cardiac and respiratory depressive effects". In that case, ketamine would not be the answer, correct?

mmacfn..... i too was an experienced ER/Trauma RN - worked in at least 15 different ER/trauma centers... ignorance may be bliss - but you are arguing with those of us who have been where you are - have moved on and realized we had the same misguided arguments...

first of all - most clinical sites i have been WE trained ER residents... and who gets called when the ER docs FUBAR the airway... oh, anesthesia...

just because your hospital states you can give propofol... do you think when you and the hospital are getting sued and the lawyers pull out... "the package insert clearly states should only be given by trained anesthesia person..." that your hospital will pay what you will owe?? they will sell you up the stream my friend...

ketamine has the worst of all cardiac effects... that is unless you are referring to the 20 y/o trauma patient who has no underlying heart disease... and even then...it will only cause them to bleed out more.

just for the record... rn's learn how to intubate a dummy in ACLS/ TNCC etc... however, they are not trained in airway evaluation or management.. you may be - but the general ED RN is not.

i will repeat what another poster stated... as a senior SRNA - look back - your views will have turned 180 degrees and it has nothing to do with territorialism... it has to do with not knowing what you don't know... and you can't know it until you have been there... and there is no arguing that.

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Specializes in I know stuff ;).

hey jwk

Well, i cant only reference what i know so i have to fall back on my experience. I agree that anesthesia providers are the airway experts.

What i was saying was that if a patient in the ER getting diprivan needed to be intubated, an er physician could manage the airway. I did not say that er physicians or FNs were better than anyone. I have no plans to goto anes. school with an attitude, we are having a discussion here and that is all.

I am trying to force people to back up their opinions with research. Instead i get alot of people attacking me (personally in some cases) in an attempt to dis-credit me. That is OK.

Now argue about how AAs are unsafe and im sure youll be boasting about the "studies" that were done showing similar outcomes between CRNA and AA (you have on numerous occasions).

Or, suggest MDAs are better than CRNAs and quickly the AANA study showing no difference in patient outcome is brought up.

Im challenging you(and others) to prove what your saying yet ive seen nothing but opinion and ego. Comon, meet the challenge!

Mike - again, you just don't know what you don't know. Your "experience" is limited to the ER and flight nursing. Granted, flight nurses get a lot more experience than ER nurses. But anesthesia providers, in ANY hospital, are THE airway experts - period - hands down - end of story. If not, they shouldn't be giving anesthesia. Really, if you go into anesthesia school with this "I've seen it all and I know what the studies show" attitude, they will eat you for lunch. You're changing professions, but you're sure holding on real tight to the old one.

Maybe you're just stirring the pot to keep it interesting...

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Im challenging you(and others) to prove what your saying yet ive seen nothing but opinion and ego. Comon, meet the challenge!

Prove what you have written and meet your own challenge. Back up your claims. Or stop making them. It goes both ways.

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Specializes in I know stuff ;).

Jenniek

Thanks for the sarcasm. Im not about to lay out my bio here on the internet. Please, PM me and i will call you and answer your questions.

As for states, ive managed to only work in 5. However, all the information about hospitals, % of providers in each, and BONs is freely avaliable on the internet and through Pub med.

I did not suggest every hospital was the same. The discussion was in regards to if it was safe for an RN to give diprivan in the ER setting with an er physician in the room for procedures such as closed reduction and cardioversion. (which i presented evidence for) The discussion quickly went off topic which i can only assume was because noone had evidence to back up their claims about the saftey of an RN giving diprivan in the ER.

It has not upset me. I'm just pointing out previous posts by you. I'm intrigued by all this knowledge you have and wonder what sort of experience you have with all these different nursing programs and ED departments. Please share.

If you can share the majority of hospitals which you know so much about...how many states have you worked in since moving from Canada? You seem to know a lot, but I'm wondering what exactly your experience is? And I'm not referring to your mile long list of specialties. Each state has it quirks as does each states board of nursing. You may be familiar with the Arizona BON, but what about the other 49 states?

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Specializes in I know stuff ;).

Uh

I did. In both discussions. with research and evidence.

Prove what you have written and meet your own challenge. Back up your claims. Or stop making them. It goes both ways.
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RN

ER calls at our facility. CRNA and student go to the ED.

Now that is cool! This hasent been the norm anywhere i have ever worked. Maybe only at large teaching hospitals?

I work at a large teaching hospital. When there is code the code team that responds along with so many residents that you are lucky to be able to get a enough room in there to have a nurse to push drugs. Usually a respiratory terrorist handle the airway after it has been established. At the private hospitals in town a crna does ALL the intubations except maybe for an especially emergent ER case. CRNA=all intubations.

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