Acute agitation, sedation, aspiration, Cannot intubate/ventilate – lessons from Coroners cases
Hi folks. There has been a lot of online discussion and debate about FOAMEd recently. Peer review, minimum standards, code of conduct, curriculum even..
To be honest, there has always been FOAMEd for the health profession, particularly emergency care professionals, hospital or prehospital. Its called the Coroner’s court. They publish coronial findings into unexpected deaths, all the time. Sometimes, these involve medical issues related to emergency care.
Each state/territory of Australia has its own Coroner’s court and their findings are publicly available on their respective websites. They are not a medical journal. Not a blog site. Not peer reviewed. They have no curriculum. They have no podcast. Their work is legislated and mandated. It is enshrined in public open access. It is free..well our taxes pay for their work. Why? Principles of justice and social good. The needs of the many outweigh the needs of the few..that reminds me of a Star Trek line from Kirk and Spock..gee that was an old movie ;-)
So FOAMEd is nothing new. The Coroner has been doing it for years. We just dont usually pay it any regular attention as a medical community.
Why not? perhaps because the findings sometimes deal with medical errors, patient safety errors..errors. These terms make us squirm as doctors, nurses, paramedics, respiratory therapists ..we like to think we dont make mistakes;-)
From Death we learn. This is true FOAMEd.
Now I am not saying the following cases contain real examples of medical error. I leave it up to you the reader to decide. The Coroner has made their findings known in each case. But if there is something to learn from each case, in regard to management of agitation, use of acute sedation and choice of sedation, aspiration risk and ultimately management of Cannot intubate/ventilate crisis, maybe that helps you think. It certainly has helped me in preparing for similar cases…and dealing with them.
Feel free to email me or post comments here if you want to learn the take home messages I have gained from these cases.