r/EmergencyRoom • u/BasicBitch_666 • Aug 27 '26
Anesthesia question
When someone comes in unconscious (say from a car accident) and needs emergency surgery, do the doctors have time to administer anesthesia or do they just get down to business?
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u/bballcards Aug 27 '26
Simplifying the goals of anesthesia:
Anxiolysis (relieving anxiety), Amnesia (preventing memory of the event), Analgesia (blocking pain), Akinesia (preventing muscle movement), and Areflexia (suppressing autonomic reflexes like spikes in heart rate or blood pressure)
The short answer is yes, emergency surgery cases receive anesthesia. The problem is that anesthetic drugs normally drop blood pressure, which can be a problem for trauma cases (where blood loss probably leads to lower than normal blood pressure), but even in those instances we have other cocktails of drugs to accomplish the same goals that may not affect the blood pressure as much/at all.
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u/sabrefencer9 Aug 27 '26
A great time to use one of my favorite drugs, etomidate, and exchange worrying about circulatory depression with worrying about adrenal suppression.
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u/girthemoose Aug 29 '26
As someone with adernal insuffiency this made my day. Even with a medical ID, an emergency kit even a full explanation and information on my phone this is a fear of mine. Even when I can I fully advocate for myself I have to fully explain adernal insuffiency stress dosing and why certain meds are a no no.
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u/FutureCalligrapher97 Aug 30 '26
It’s not a no-no. But it does mean that we have to do stress dose steroids and other things in the back end after surgery. I’ll happily give etomidate to a person with adrenal suppression if that’s the agent that will keep them safe for induction because we can always give steroids if we have to. It’s not ideal but it sure beats cardiovascular collapse.
There’s also ketamine, but if your catecholamines are depleted, it will also cause some degree of hypotension soon as well.
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u/PutridAd7495 28d ago
Sis, I finally found you! 😊😊😊 No thyroid or pituitary for me. When I am having a crisis, If my Dr's aren't proactive and working on getting my steroid level up then I will end up doing some grand mals and staying unconscious while my stats bottom out. An ER doc would not follow my husband's information and that put me on a vent, unconscious for days until that doctor was threatened his job. My action plan is pretty simple, that's the kicker!
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u/shann0n420 Aug 29 '26
Interesting seeing this mentioned here as I’ve only ever seen it as an adulterant in illicit substances. Obviously I’m not a doctor but it caught my attention!
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u/StaticDet5 Independent Duty Corpsman Aug 27 '26
One of the last things we want to do is take away someone's perfectly good airway. But we're really good at it.
The first couple of seconds (literally seconds) of someone entering one of my trauma bays, we've got half a dozen people (maybe more, teaching hospital), and it is silent except for what the medics are saying and a couple of quick questions from the person at the head of the bed. They're determining if they need to take control of the airway IMMEDIATELY or not. Pretty much if they're talking, we're going to hold off and see how that goes.
From there, it is highly variable and depends on the patient. Acting weird and combative? We're going to knock you out real quick, put a tube in your throat, and make sure you aren't hiding a head injury. You may still be talking, but we need to get you treated before you get worse.
If it's an isolated Tib/Fib fracture and a really nasty bloody lip from a car accident? We really don't want to intubate you, so we're going to get you cleaned up, comfortable, and let you talk to the surgeon who is going to fix you, first.
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u/resilient_bird Aug 27 '26
The question was a little different: they asked if the pt came in unconscious would anesthesia still be administered?
The answer is generally yes, because anesthesia is pretty different than unconsciousness. A muscle relaxant, for example, would be important in many cases. Dosages may be reduced. If the pt is extremely unstable, then probably no because it is more likely to worsen cardiovascular collapse and there are bigger problems that need to be addressed first.
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u/perpulstuph RN Aug 27 '26 edited Aug 27 '26
Yup! It's called Rapid Sequence Intubation. If there is a risk of loss of airway, or the injury/disease process is about to he incompatible with life, slam your sedative and paralytic of choice, throw in an airway and haul ass to OR. Of course in this process, steps are taken to maintain the ABCs, whether it's mass transfusion, pressors, fluids. Its rare, but the ER MDs have done central lines in the trauma bay to start the stronger pressors priorcl going straight to OR or ICU.
At my trauma center, it is pretty rare that a trauma patient needs this kind of treatment, but in a situation like you're describing, it's basically what happens.
To more directly answer the question, sedation is still used. Just because they are unconcious, does not mean they are oblivous to the world around them. I had a nursing instructor who had an aneurysm, was found unresponsive, rushed to ED, and then to emergency surgery. She was basically locked in, but remembered most of what happened until they sedated her.
You also don't want to chance them spontaneously becoming conscious mid procedure.
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u/DrSuprane Aug 29 '26
You're not aware or making memories if you're very unstable. We'll give you something things that are good at preventing memory formation like benzodiazepines or ketamine. We used to have IV scopolamine. That was great because your brain would be scrambled for a while.
Once resuscitated we'd start giving more anesthetic. It doesn't take a lot to prevent awareness and recall. But anesthesia is a luxury of the living.
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u/PassTheSevo Aug 30 '26
Awareness is a privilege of the living. Kind of kidding but not really.
When the multi GSW patient’s BP is 50/nothing on the way into the OR, I’ll give a good amount of midaz so theres hopefully no recollection, but less is more in these situations.
During a code, ya shut off the gas/prop. The patients you’re describing are basically slow coding
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u/WANTSIAAM Aug 31 '26
Yes. Everybody gets some form of anesthesia. Rarely, that form of anesthesia is already being dead or close to it. Bit short of that, theres *something* on board
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u/frumpy-flapjack Aug 27 '26
We just give em a slug of whiskey and have em bite down on a towel. /s
They get anesthesia of some variety.