Emergency Medicine and Anaesthesiology - partners for patients

Emergency medicine and anaesthesiology have much in common - both specialties deal with mostly well patients with specific clinical problems, but a significant amount of our work deals with critically ill patients in need of life saving interventions. There is no clinical area of more paramount importance than the establishment and maintenance of a patent airway, an area pioneered by anaesthesiologists and practised by both specialties as the cornerstone of modern resuscitation¹.

The 'ABC' paradigm of cardiopulmonary and trauma resuscitation was developed by physicians with common knowledge and expertise in emergency medicine (both within and outside the hospital environment) and in anaesthesiology^2,3. Indeed, in many parts of Europe, the emergency physician is often a trained anaesthesiologist working in the prehospital arena⁴ doing what many of us would call immediate medical care or prehospital emergency medicine, such is the degree of overlap between these two disciplines.

Another core area of practice for both disciplines is the avoidance or minimisation of pain through the use of regional anaesthetic techniques and systemic analgesics. Emergency physicians are increasingly utilising regional nerve blocks in the emergency department to facilitate minor surgical procedures and to alleviate pain⁵. With close collaboration between our two disciplines, these techniques will continue to improve in both performance and safety, for example, improved localisation of nerve trunks with ultrasound scanning⁶.

Pain control in the emergency department remains an area requiring improvement, with multiple studies demonstrating poor early analgesic provision in this setting^7,8. Emergency physicians need to take techniques developed by our anaesthesiology colleagues and find better ways to apply these skills in a timely manner to our emergency department patients.

Anaesthesiologists have learned from emergency medicine the importance of accurate triage, and the importance of early critical care in the emergency department in the management of trauma⁹ and sepsis¹⁰ in particular.

It is clear that emergency physicians and anaesthesiologists should work increasingly closely as partners to benefit our patients: saving lives and relieving suffering.

Colin A Graham
Editor, European Journal of Emergency Medicine
Professor, Emergency Medicine, Chinese University of Hong Kong
cagraham@cuhk.edu.hk 

References

1. Graham CA. Emergency department airway management in the UK. Journal of the Royal Society of Medicine 2005;98:107-110. 
2. Nolan J, Chamberlain D, Soar J, Parr M, Zorab J. Peter Baskett - 40 years as a resuscitation leader and mentor. Resuscitation 2008;77: 279-282.
3. Oransky I. Obituary: Peter Safar. Lancet 2003;362:749.  
4. Bey TA, Hahn SA, Moecke H. The current state of hospital-based emergency medicine in Germany. International Journal of Emergency Medicine 2008;1:273-7. 
5. Crystal CS, Blankenship RB. Local anesthetics and peripheral nerve blocks in the emergency department. Emergency Medicine Clinics of North America 2005;23:477-502. 
6. Chin KJ, Chan V. Ultrasound-guided peripheral nerve blockade. Current Opinion in Anaesthesiology 2008;21:624-31. 
7. Shabbir J, Ridgway PF, Lynch K, Law CE, Evoy D, O'Mahony JB, Mealy K. Administration of analgesia for acute abdominal pain sufferers in the accident and emergency setting. European Journal of Emergency Medicine 2004;11:309-12. 
8. O'Donnell J, Ferguson LP, Beattie TF. Use of analgesia in a paediatric accident and emergency department following limb trauma. European Journal of Emergency Medicine 2002;9:5-8. 
9. Wurmb TE, Frühwald P, Knuepffer J, Schuster F, Kredel M, Roewer N, Brederlau J. Application of standard operating procedures accelerates the process of trauma care in patients with multiple injuries. European Journal of Emergency Medicine 2008;15:311-7. 
10. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine 2001;345:1368-77.