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Old 01-03-2013, 07:27 AM   #1
saizine
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Emergency Surgery and Anaesthesia

I've done a quick search of these forums and Google, and although there's lots of brilliantly helpful information about anaesthesia, I haven't been able to find much about a rather specific situation that I'm considering.

If someone is rushed into hospital and requires immediate surgery but is already unconscious, what is the protocol regarding anaesthesia? Do doctors have to wait until the patient regains consciousness or can they proceed to surgery and administer an anaesthetic? Is the situation any different if there is a relative/companion with them that can tell doctors about any allergies, reactions, etc? I can't really imagine doctors/surgeons wanting to operate on someone who is unconscious of their own accord and might wake up at any point, but administering an anaesthetic to someone who is already unconscious strikes me as unsafe.

I'm not an anaesthetist and I've never had a general anaesthetic so I'm unfamiliar with the general protocols beyond internet research. If anyone has experience or more information, I would greatly appreciate it. Thanks in advance!
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Old 01-03-2013, 08:14 AM   #2
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Most anesthetics they would use have extremely rare, but well-documented side-effects. I don't know how they all work, but the severe reaction to some anesthetics basically means you stop breathing, and/or your heart stops. So, in case of that rare instance there is always a crash cart on hand.

So, yes, they'd administer the anesthetic. Most people who are allergic don't know they are anyhow, so conscious or unconscious doesn't make much difference.
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Old 01-03-2013, 08:24 AM   #3
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Right, okay. This is what I expected, but I just wanted to make sure I wasn't misunderstanding anything and portraying the events incorrectly!

Thanks for your help!
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Old 01-03-2013, 02:15 PM   #4
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Emergency care - its do the surgery or they die. So they would do what they need to do to keep them alive but they have to stop when they get to the point where it is no longer an emergency (so, to give an extreme example, if in the course of stitching the organs together to stop them bleeding to death they happened to notice a tumour which needed surgery to remove it would be illegal for them to remove it without the patient's consent so they would have to wait for them to recover from that surgery and then consent them for the tumour removal as a seperate surgery later).

So, yes, unless there is a DNR or other note on the file which says not to take action if they are in danger of death, they will do anything they can to save someone in that situation. And there is a reason why anaethnatists need to be qualified doctors - not only are they administering drugs with dangerous side effects they also have to be able to overrule the surgeon in medical decisions and take action to save a life (including injecting other drugs to prevent death) at short notice.
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Old 01-03-2013, 10:51 PM   #5
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Quote:
Originally Posted by areteus View Post
Emergency care - its do the surgery or they die.
When I was 17, I was in a bad car accident, unconscious and rushed to the hospital. They hadn't found my ID yet (it was in my pocket), so between that and the terrible weather outside, there was no "significant other" to tell them if I had any allergies or whatever. Didn't matter - they were prepared to move forward with surgery. I had several local anesthetic injections in the places where they had to stitch various cuts and lacerations, plus I had the IVs and vents so they would be ready to give general anesthetic. (I wound up not needing surgery, bit of a miracle, but they were ready to go!)

One possible variable: In my experiences talking to and getting to know ER doctors, a lot of them lean towards "death with dignity" - i.e. there comes a time when you should focus on your loved one's quality of life, not quantity. They get really annoyed when they have to do "everything possible" to save someone's almost-dead grandma, when they know that they can't really do anything. So in those cases, if there's a semi-legitimate reason they can (legally) just let grandma die peacefully, they might grab on that.
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Old 01-04-2013, 12:08 AM   #6
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Yes, there is a difference between doing all possible and knowing that whatever you do is useless. And you are right, the legal issues do annoy sometimes...
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