Help – I need somebody!

 

I have to come clean – I borrowed the title of this blog from an editorial in July’s edition of the journal, which is my compliment to the authors. This famous song was not only sung by the Beatles in 1965, but also by John Farnham, Bananarama (another Bananarama song title in one of my blogs – that will get people talking), The Carpenters and many others. Calling for help, or communicating efficiently and effectively, is discussed in the aforementioned editorial on calling for help in the emergency situation, which is really about how we train our medical students and junior doctors to call for help. Knowing who to call and how is actually incredibly important. I was involved in a car accident recently, and it was obvious to me to call the police immediately, but everyone else was telling me not to bother. It was clearly the right decision, and we all know to call 999, outside of a hospital at least, but if an anaesthetic emergency is brewing, who should you call and how?

This excellent study compares two methods of urgent communication in theatre; one that is current teaching and a new Traffic Lights tool (‘red alert’, ‘amber assist’ and ‘green query). In a simulated theatre environment, the trainee anaesthetists instructed the go-between to relay information much quicker and more effectively using the Traffic Lights tool, and everyone involved preferred it to the situation, background, assessment, recommendation (SBAR) tool. Studies such as this one examining the effect of different communication styles and tools in the emergency setting are novel and, in my view, important. All the algorithms we refer to say “call for help”, but not who and how.

Understanding and communicating the risks of surgery to our patients is an important facet of healthcare, and this month we have published an interesting study linking caudal anaesthesia in children having hypospadias surgery with postoperative surgical complications. This was a retrospective, observational study, and the authors are not implying causation, only association, but it raises a number of interesting issues, such as mechanism (?swelling) and the need for a randomised controlled trial.

Pre-hospital treatment, communication between helicopter physicians and their patients about analgesia, is the subject of another article from the Swiss Alpine Helicopter Emergency Medical Service. Patients who clearly had a fractured limb most often received intravenous fentanyl, but the physicians who were trained anaesthetists used ketamine more frequently, especially for patients with reported severe pain or who had more severe injuries. This brings up up a number of questions: is ketamine better?; should non-anaesthetists be trained to use ketamine?; should ketamine be first-line for injured patients? I look forward to further research in this area of practice.

Finally, an editorial about the new NICE guidelines for the peripartum management of diabetes begs the question – how much did NICE actually communicate with anaesthetists who look after pregnant patients when drawing up these latest guidelines? The authors of this editorial certainly believe that the new guidelines are at best controversial, and that NICE should re-examine them as a matter of urgency as they confict with other recent NICE guidance. They pointed out that the new advice seems to follow historical strategies and does not give sufficient weight to more recent work, and that the recommendations will lead to an increased risk of maternal and neonatal hyponatraemia, as well as maternal hypoglycaemia. The authors of this editorial go as far as suggesting that obstetric anaesthetists should target a capillary blood glucose of 6 – 8 mmol.l−1 and use dextrose 5% in saline 0.9% with premixed potassium chloride 0.15% as the recommended initial substrate solution to run alongside the variable rate intravenous insulin infusion. There is clearly an urgent need for more and better communication between NICE and experts in this field. On that note, I am off to ring my insurance company and try and find out where my poor car is….

 

Andrew Klein

Editor-in-Chief

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