lattimer13.... find better data...
study #1 is a well known study that is poorly done... but let's discuss the finer point: ER intubations led to 2 crics with Anesthesia intubations led to ZERO (0) crics.... i think while not statistically significant in that poorly powered study, if i were the patient i would much rather be in the NO cric group
study #2... did YOU read that study? it is sooo poorly written that in the results and discussion section it discusses the results of other studies (not even its own results), and then to top it off they ADMIT that they were unable to compare anesthesia to EM... come on...
bottom line... when there is an airway emergency in the OR, do you ever hear anesthesiologists scream for an EM consult STAT???? while EM residents are definitely taught techniques for managing difficult airways it don't mean diggity-shyte if they only used that technique on a real person ONCE or TWICE... during residency I performed over 100 emergency intubations on the floors and in the ER to bail out the ER attendings who tried 4 times after 3 of the ER residents butchered the airway... and that doesn't include the 2500-2800 intubations i did in the OR.
In FACT - the ATLS guidelines clearly state that the "most experienced" laryngoscopist is to assume the airway, which means the CA-2s I supervise clearly outrank anybody else in the ER.... However at my old institution we usually let ER try to do their thing before we bailed them out in a nice courteous way... And then after we take over the airway and successfully intubate, I always hear them whispering between each other "oh, I could have gotten it too if he had let me try one more time".... right
propofol in the ER? sure, as long as there is somebody available to provide immediate control of the airway, and the patient consents to GENERAL ANESTHESIA which is what it is....
