ER doesn't wait for npo time period for elective procedures.... Why do you?

[Planktonmd]

---

Members don't see this ad.

I have no clue if there is a big difference from what we do for moderate/deep procedural sedation vs what anesthesiology does. I do hear alot of complaints about delayed cases from the ED b/c Anesthesiology had to wait their 6-8 hrs.

But There is No way we can run an ED if we had to wait that long. We use Propofol, etomidate, etc all day long in my ED. I don't even ask when they last ate b/c they are never NPO x 6-8 hrs.

What am I to do with my dislocated shoulders, hips, ankles? What am I to do with Pediatric pts that won't hold still for me to suture their lips? What am I to do with my open fractures?

Should i admit all of my shoulder dislocations to the hospital to wait their 6-8 hrs and let the orthos do the procedure? Good luck on this

Should I keep them in my ED for 6-8 hrs until they are past the time limit? Good luck on this.

I have no choice but to do it without waiting.

Exactly... you have to do what you need to do and what other reasonable ER physicians would do, you don't have to do what an anesthesiologist would do because we are held to a different standard than you when it comes to administering anesthesia to patients who are full stomach.
If an anesthesiologist gives a general anesthetic or even sedation to a full stomach patient without protecting the airway or following the ASA guidelines and that patient aspirates there will be no defense.

 

[Mman]

I have no clue if there is a big difference from what we do for moderate/deep procedural sedation vs what anesthesiology does. I do hear alot of complaints about delayed cases from the ED b/c Anesthesiology had to wait their 6-8 hrs.

But There is No way we can run an ED if we had to wait that long. We use Propofol, etomidate, etc all day long in my ED. I don't even ask when they last ate b/c they are never NPO x 6-8 hrs.

What am I to do with my dislocated shoulders, hips, ankles? What am I to do with Pediatric pts that won't hold still for me to suture their lips? What am I to do with my open fractures?

Should i admit all of my shoulder dislocations to the hospital to wait their 6-8 hrs and let the orthos do the procedure? Good luck on this

Should I keep them in my ED for 6-8 hrs until they are past the time limit? Good luck on this.

I have no choice but to do it without waiting.

When in the ED, you are held to the standard of care of an ED. None of us can tell you how to run your department. In our world, though, we are held to a different standard of care. I suspect that the tolerance for risk in the ED outweighs our tolerance for risk.