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About 2 years ago, our department actually assumed primary responsibility
for this condition and are now accepting these transfers from community EDs
unable to perform the procedure. We most often drain via needle aspiration;
occasional open drainage. Most of our patients are young adults and don't
require sedation. Occasionally there will be a young child and we will
sedate and consult ENT to perform the procedure to ensure there is an
someone attending to the airway. We have adult and pedi ENT 24/7.
-Sam

Samuel J. Prater, MD, CMQ, FAAP, FACEP 
Assistant Professor of Emergency Medicine
Medical Director of Emergency Services, Memorial Hermann Hospital - TMC
	

		
Department of Emergency Medicine 
6431 Fannin Street | Suite JJL 4th Floor | Houston, Texas 77030 
713 704 5007 tel | 713 704 5226  fax
https://med.uth.edu/emergencymedicine/

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Halim Hennes
Sent: Tuesday, August 01, 2017 6:49 PM
To: [log in to unmask]
Subject: Re: sedated peritonsillar abscess drainage in PED

Nicely stated Doc. Regardless of how good we are in sedation one has to
think what is best for the patient. When we do these in the ED it is pain
control and local anesthesia. If sedation is required for any reason they
are taken to the OR by our ENT surgeon

Halim
Sent from my iPhone

On Aug 1, 2017, at 5:48 PM, Doc Holiday <[log in to unmask]> wrote:

From: Rachel Tuuri <[log in to unmask]>

> ...interested in knowing if your institution does sedate in the PED 
> for PTA drainage

--> Discouraged at our place... On principle... We have an anaesthesia
department who provide such services for a living and an operating theatre
suite where an environment has been set up to the best standard our
institution can currently achieve for the provision of safe sedation and
surgical environment... To have someone who "also" does sedation provide
this service instead and do so in whichever room in the ED is best at the
time, but not as good as the one built for the purpose, simply appears to be
a step in the wrong direction for us.

This is not a judgement on other places. At our place there is simply always
more EM work that needs to be done than there are EPs who can do it, so it's
not as easy to justify pulling one away to provide some other service
instead of dealing with emergencies. The ED facility is also not set up to
provide on-going and follow-up care should complications ensue - the care
would have to be handed over.

We have less experience with litigation here, but where litigation is more
prevalent, should a complication happen, how does one answer the question of
"there is an anaesthesia expert, whose career is to do these things, working
right next door. He/she provides sedation/anaesthesia for pretty much 90+%
of his professional clinical time. Why did you, who spends 1% or so of your
time providing sedation, decide to spare this patient his/her expertise?"

Before anyone asks, of course, I am fully aware that there are EPs who are
really really good at sedation and there have been studies which showed that
EPs can provide sedation at the same standard... I know quite a few EPs who
are not that good. For a few years now, I quite confidently count myself
among this latter group, but I am completely uncertain when it was that I
dropped out of the "doing enough of it to keep my skills up" group...





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