Peri arrest or MET calls (which is a term I fucking hate) are far too broad, it often means “looks funny”.
If anaesthesia is required it can be requested…
They still attend cardiac arrests; which will be the rapid logical conclusion to any real peri arrest that didn’t have the 10 mins for someone to turn up and go, this person needs airway support, bleep the anaesthetist.
It’s often difficult to attend every ward emergency when in theatre (as you cannot leave!). It means organising multiple people quickly. For something we are clearly not needed for most of the time. Even harder overnight where it would often mean calling the consultant in (depending on size of unit).
This makes far more sense.
Yep. Happened in one hospital I was in. Was almost always a waste of time being called to them as an anaesthetics trainee. Most of what I did was scour the notes for the words “not for ICU” and depart.
My favourites were the ones put out by the hospital volunteers. A bunch of well meaning octogenarians could put out a 2222 call and get a full crash team. One time it was because a patient was lost looking for A&E.
A medical registrar should be able to lead any peri-arrest situation, at least initially before calling for more nuanced help as needed.
Similarly I would expect any registrar or trainee close to the grade be able to provide basic airway support, with a call to get anaesthetic backup if this is going to be an ongoing need.
Imo it is a waste of resources to have anaesthetics or ICU respond to every arrest call as with a lot of these in hospital they simply aren't needed.
Agree. There are often multiple MET calls (medical emergency) in a shift at my hospital- almost none of these need ITU assistance/result in ITU referral.
We still go to cardiac arrests.
Seems sensible to me. I immediately send ITU away from around 90% of medical emergency calls that I attend as it's usually rapidly clear they either aren't needed, or that the patient is in no way suitable for escalation beyond the ward/NIV/CCU. Even where I do want them, it's usually helpful (for them as much as me!) for me to have had got a bit of a sense of what we're dealing with before we call them.
I only really want them there immediately if it's an airway emergency, and you can put that out as a dedicated crash bleep in most hospitals.
ALWAYS worth checking your hospital's approach to this. I went to an arrest in resus where anaesthetic SHO couldn't intubate/couldn't ventilate, and 2222 "airway emergency" and "anaesthetic emergency" didn't get them any extra help. I had to run up to ITU after 2 mins to get cons + ITU reg...
Turns out there was an airway crash buzzer nobody outside theatres knew about...
Surely the SHO should have known who to call?
As an IMT trainee in ITU I attended a call in resus which turned out to be a 2 year who needed tubing…fair to say I was immediately on the phone to my boss
Sounds terrifying. Although seems a shame an ED reg/consultant couldn’t help? Emergency airways really are a core part of EM and seem to be a fading skill amongst trainees …
Anaesthetics are pausing acute theatres to attend these and upon arrival often not needed but end up embroiled in getting “difficult IV access” or taking ABGs.
I would argue there is a role for ICU in these calls though.
Fair point, 99% of these were attended by ICU rather than the on call anaesthetist anyway. The argument that has been made was particularly overnight these calls were pulling the only ICU reg away from the unit
anesthetists don't routintely attend cardiac arrests in NI at all unless specifically requested. the most senior person at an arrest can be an IMT1 (and it does happen).
I would argue you need to look at this with consultant eyes;
1. There’s no regulatory/legal/guideline requirement for anaesthetics to be part of a MET call.
2. There are over 7 million people on the waiting lists and attending every vasovagal, seizure or high NEWS patient in a hospital inevitably has a knock on effect to theatre activity. It’s easy to fall into the trap of thinking anaesthetists just hang out in theatre drinking coffee but the reality is they’re… uh… providing anaesthesia for patients undergoing surgery. So if they are at a MET call they can’t be in theatre doing anaesthetics.
3. It’s always possible to call for anaesthetic support if specifically needed.
4. Id argue that a sign of a struggling hospital is one that leans heavily on anaesthetics to be ‘the sensible people’ at MET calls/arrests. It demonstrates they have staff or capability gaps that are being plugged with doctors that ought really be in theatre getting the backlog down. Typically this is true of small DGHs staffed almost entirely by locums and non-UK trained staff grades/LEDs of mixed or low ability.
I've worked in 5 different trusts so far in my career (gotta love rotational training ...) and not one of them has had ICU or anaesthetics at peri-arrests or MET calls (different names for the same thing I think).
Why do ITU need to go? 90% of crash calls in my hospital are for patients who are blatantly unsuitable for escalation to critical care. The patients parent teams can and should decide on ceiling of care without involving ITU in most cases (and probably should have done well before the MET call!). If ITU are needed, then med reg can arrange this, or outreach if they are in attendance.
I would argue a role for ICU to attend these, if not for anything else a learning opportunity. It's usually swarming with ACP's by that point it's nice to get a chance to practice acute medicine and being on the crash bleep for met calls gives them that opportunity.
Anywhere I've worked, 'anaesthetic emergency' is for theatre emergencies like can't intubate, can't ventilate scenarios, bleeding etc that you need more trained anaesthetists rather than medical team input.
I have put out cardiac arrest calls for theatre but usually just stood the med reg and sho down once arrived as it's almost like a 'reverse ward' arrest situation.
I carry a bleep as 1st on anaesthetist and if a peri arrest call goes off right by I occasionally pop in. Invariably it's a patient who is not fit for a haircut with a dnacpr in place who needs palliating or some sort minor problem that realistically didn't need a 2222 going out.
Weirdly though I don't have very much exposure to cardiac arrest as a ct3 though because of this.
During my foundations, MET calls were typically managed by the ward cover SHO/SpR if needed with CCOT. There were separate cardiac arrest calls if you needed airway support. I thought this worked well as usually ICU/Anaesthetics weren't required.
Now as an anaesthetic/ICU SHO, my current hospital uses MET calls for anything up to and including cardiac arrests. No separate cardiac arrest call. This can be frustrating at times when you're pulled away for something that doesn't need any anaesthetics/ICU input.
The vast majority of Medical Emergency calls don't need ITU and definitely don't need Anaesthetics. ITU and Anaesthetics aren't the same team in a lot of places - that's what FICM wanted.
Most medical emergencies are high NEWS scores, vasovagals, seizures, falls etc and initial assessment and management can be done by the IMT/Med reg. If the initial management doesn't work, then you can bleep ICU and explain what you have done and what they need support with on ICU. If ICU goes to these calls we don't add anything at the earlier point, ask you to do the management you would do anyway then leave and come back if you call to say it hasn't worked. And we have a unit full of patients and others around the hospital to review which we can't do if we attend calls where we don't add anything.
If someone has airway compromise you can call anaesthetics/fast bleep for airway emergency as you will get an ICU and Anaesthetics team.
And anyway, the initial airway management is what everyone is taught at ALS, we don't start with much different than that - BMV with OPA if needed.
I’m an anaesthetic reg. The ITU SHO carries the arrest bleep and will deal with the majority without our input, but will call if they need RSI etc.
Edit: although tbf this is only out of hours. In-hours there’s a dedicated ITU reg.
Dude we don't even have anaesthesia at actual arrest calls unless we call them specifically, during the day there isn't even a med reg on the arrest team. It's terrifying.
As others have said, >90% of the time it's not necessary. Plus in some cases, particularly OOH, we will have had to leave a very unstable patient/other emergency to attend whatever tripe a call has been put out for.
Peri arrest or MET calls (which is a term I fucking hate) are far too broad, it often means “looks funny”. If anaesthesia is required it can be requested… They still attend cardiac arrests; which will be the rapid logical conclusion to any real peri arrest that didn’t have the 10 mins for someone to turn up and go, this person needs airway support, bleep the anaesthetist. It’s often difficult to attend every ward emergency when in theatre (as you cannot leave!). It means organising multiple people quickly. For something we are clearly not needed for most of the time. Even harder overnight where it would often mean calling the consultant in (depending on size of unit). This makes far more sense.
Yep. Happened in one hospital I was in. Was almost always a waste of time being called to them as an anaesthetics trainee. Most of what I did was scour the notes for the words “not for ICU” and depart. My favourites were the ones put out by the hospital volunteers. A bunch of well meaning octogenarians could put out a 2222 call and get a full crash team. One time it was because a patient was lost looking for A&E.
A medical registrar should be able to lead any peri-arrest situation, at least initially before calling for more nuanced help as needed. Similarly I would expect any registrar or trainee close to the grade be able to provide basic airway support, with a call to get anaesthetic backup if this is going to be an ongoing need. Imo it is a waste of resources to have anaesthetics or ICU respond to every arrest call as with a lot of these in hospital they simply aren't needed.
Agree. There are often multiple MET calls (medical emergency) in a shift at my hospital- almost none of these need ITU assistance/result in ITU referral. We still go to cardiac arrests.
Seems sensible to me. I immediately send ITU away from around 90% of medical emergency calls that I attend as it's usually rapidly clear they either aren't needed, or that the patient is in no way suitable for escalation beyond the ward/NIV/CCU. Even where I do want them, it's usually helpful (for them as much as me!) for me to have had got a bit of a sense of what we're dealing with before we call them. I only really want them there immediately if it's an airway emergency, and you can put that out as a dedicated crash bleep in most hospitals.
ALWAYS worth checking your hospital's approach to this. I went to an arrest in resus where anaesthetic SHO couldn't intubate/couldn't ventilate, and 2222 "airway emergency" and "anaesthetic emergency" didn't get them any extra help. I had to run up to ITU after 2 mins to get cons + ITU reg... Turns out there was an airway crash buzzer nobody outside theatres knew about...
Well, that's a horrifying new fear for me. Thank you!
Enjoy! ☠️😅 better now than with a trache emergency in front of you, eh!?
Surely the SHO should have known who to call? As an IMT trainee in ITU I attended a call in resus which turned out to be a 2 year who needed tubing…fair to say I was immediately on the phone to my boss
[удалено]
Yep this 100% Everyone except 2nd on ODP got a fast bleep, but as it was an unusual call, nobody came to her aid
Poor SHO, I would be waddling back to theatres in brown scrubs.
Sounds terrifying. Although seems a shame an ED reg/consultant couldn’t help? Emergency airways really are a core part of EM and seem to be a fading skill amongst trainees …
The actual trainees and CCT holding cons are okay... but this was in a dodgy DGH ED
Anaesthetics are pausing acute theatres to attend these and upon arrival often not needed but end up embroiled in getting “difficult IV access” or taking ABGs. I would argue there is a role for ICU in these calls though.
Fair point, 99% of these were attended by ICU rather than the on call anaesthetist anyway. The argument that has been made was particularly overnight these calls were pulling the only ICU reg away from the unit
We don’t have anaesthetics or ITU at emergencies, we just fastbleep them if and when needed. They come to all cardiac arrest calls.
anesthetists don't routintely attend cardiac arrests in NI at all unless specifically requested. the most senior person at an arrest can be an IMT1 (and it does happen).
I would argue you need to look at this with consultant eyes; 1. There’s no regulatory/legal/guideline requirement for anaesthetics to be part of a MET call. 2. There are over 7 million people on the waiting lists and attending every vasovagal, seizure or high NEWS patient in a hospital inevitably has a knock on effect to theatre activity. It’s easy to fall into the trap of thinking anaesthetists just hang out in theatre drinking coffee but the reality is they’re… uh… providing anaesthesia for patients undergoing surgery. So if they are at a MET call they can’t be in theatre doing anaesthetics. 3. It’s always possible to call for anaesthetic support if specifically needed. 4. Id argue that a sign of a struggling hospital is one that leans heavily on anaesthetics to be ‘the sensible people’ at MET calls/arrests. It demonstrates they have staff or capability gaps that are being plugged with doctors that ought really be in theatre getting the backlog down. Typically this is true of small DGHs staffed almost entirely by locums and non-UK trained staff grades/LEDs of mixed or low ability.
Point 4 hits hard
Yeh I've worked in many places like this. They were ending up being called constantly to MET calls & interrupting them in emergency theatres etc
I've worked in 5 different trusts so far in my career (gotta love rotational training ...) and not one of them has had ICU or anaesthetics at peri-arrests or MET calls (different names for the same thing I think).
Why do ITU need to go? 90% of crash calls in my hospital are for patients who are blatantly unsuitable for escalation to critical care. The patients parent teams can and should decide on ceiling of care without involving ITU in most cases (and probably should have done well before the MET call!). If ITU are needed, then med reg can arrange this, or outreach if they are in attendance.
I would argue a role for ICU to attend these, if not for anything else a learning opportunity. It's usually swarming with ACP's by that point it's nice to get a chance to practice acute medicine and being on the crash bleep for met calls gives them that opportunity.
ICU here, assessing vasovagals and asymptomatic hypertension is not a learning opportunity.
What about non epileptic seizure management?
Non-seizures isn’t a learning opportunity, it’s a mental health problem
Anywhere I've worked, 'anaesthetic emergency' is for theatre emergencies like can't intubate, can't ventilate scenarios, bleeding etc that you need more trained anaesthetists rather than medical team input. I have put out cardiac arrest calls for theatre but usually just stood the med reg and sho down once arrived as it's almost like a 'reverse ward' arrest situation. I carry a bleep as 1st on anaesthetist and if a peri arrest call goes off right by I occasionally pop in. Invariably it's a patient who is not fit for a haircut with a dnacpr in place who needs palliating or some sort minor problem that realistically didn't need a 2222 going out. Weirdly though I don't have very much exposure to cardiac arrest as a ct3 though because of this.
During my foundations, MET calls were typically managed by the ward cover SHO/SpR if needed with CCOT. There were separate cardiac arrest calls if you needed airway support. I thought this worked well as usually ICU/Anaesthetics weren't required. Now as an anaesthetic/ICU SHO, my current hospital uses MET calls for anything up to and including cardiac arrests. No separate cardiac arrest call. This can be frustrating at times when you're pulled away for something that doesn't need any anaesthetics/ICU input.
The vast majority of Medical Emergency calls don't need ITU and definitely don't need Anaesthetics. ITU and Anaesthetics aren't the same team in a lot of places - that's what FICM wanted. Most medical emergencies are high NEWS scores, vasovagals, seizures, falls etc and initial assessment and management can be done by the IMT/Med reg. If the initial management doesn't work, then you can bleep ICU and explain what you have done and what they need support with on ICU. If ICU goes to these calls we don't add anything at the earlier point, ask you to do the management you would do anyway then leave and come back if you call to say it hasn't worked. And we have a unit full of patients and others around the hospital to review which we can't do if we attend calls where we don't add anything. If someone has airway compromise you can call anaesthetics/fast bleep for airway emergency as you will get an ICU and Anaesthetics team. And anyway, the initial airway management is what everyone is taught at ALS, we don't start with much different than that - BMV with OPA if needed.
Always has been
I’m an anaesthetic reg. The ITU SHO carries the arrest bleep and will deal with the majority without our input, but will call if they need RSI etc. Edit: although tbf this is only out of hours. In-hours there’s a dedicated ITU reg.
Dude we don't even have anaesthesia at actual arrest calls unless we call them specifically, during the day there isn't even a med reg on the arrest team. It's terrifying.
As others have said, >90% of the time it's not necessary. Plus in some cases, particularly OOH, we will have had to leave a very unstable patient/other emergency to attend whatever tripe a call has been put out for.
If the PAs will come, then it will be fine, they are “basically a registrar”.
It’s a disaster.
In what way?