Anaesthesia
-
Long-term venous access is widely used in hospital and in the community for cancer chemotherapy, total parenteral nutrition and long-term administration of antibiotics. There is a large variety of catheters, ports and other devices designed to facilitate these treatments. A postal survey of anaesthetic departments in England, Wales, Scotland and Northern Ireland was undertaken to assess the role of anaesthetists in this area of clinical practice. ⋯ Forty-three percent of departments (92 out of 215) provided some form of long-term vascular access service. Twenty-two percent of departments which provided this service (20 out of 92) had anaesthetists with sessional allocation for such procedures. Such work represents a significant workload for anaesthetic departments which is likely to increase over time.
-
Determining the best method for excluding cervical spine injury while a polytrauma victim is unconscious remains a controversial topic despite a number of published guidelines. A structured questionnaire demonstrated major differences between intensivists, neurosurgeons, orthopaedic surgeons and spinal surgeons with regard to the imaging modalities requested, the perception of their performance, the relative risks of missed injuries and the complications of immobilisation. ⋯ Advanced Trauma Life Support and Eastern Association for the Surgery of Trauma guidelines can reinforce and even contribute to non-standardised care. Having performed this clinician survey, we have now developed a multidisciplinary management protocol appropriate for Northern Ireland.