Don’t Crap Yourself
I think the most important aspect of being in emergency physician is being able to maintain one’s cool while stuff is crashing all around you.
Yes you need a broad knowledge base. Yes you need to be able to do procedures. Yes you need to be able to communicate well with patients and with other physicians. Yes you need to be able to multitask.
However all this is pretty moot if you can’t keep it together when someone’s going south. Is very easy to panic when you realize someone is having some unexpected situation and starts to become unstable. Is especially the case with young people since you don’t usually expect them to die unlike the ultra elderly.
Anyway, the other day I was called in urgently to see patient was only in his 40s who is complaining of shortness of breath. When I first walked in he didn’t look that bad. Not great but not bad. His blood pressure was a tad low and his heart rate was basically normal. However in for my icy begin to look worse he became more diaphoretic he had this look of impending doom on his face and his blood pressure dropped and his pulse rate dropped down into the low 40s. He complained of some vague chest discomfort. So quickly get the crash cart and get a repeat EKG. Turns out he was having a very large inferior wall myocardial infarction.
Bradycardia and hypotension can occur in the patient can look awful. Complicating this case was the patient’s recent history of lower intestinal bleeding. The low blood pressure meant he could not get nitrates and he could not get anticoagulated because of the bleeding. Lack of response to atropine further increased my pulse rate. Meanwhile all around were panicking family members. Finally I had to put him on a dopamine drip and send him off to the Cath Lab looking only marginally better (which for some reason took longer than usual time to get ready for the patient). He wound up doing well but that was a half an hour of some serious anxiety.
Wednesday, January 9th 2013 at 4:58 pm |
God, I hate it when that happens; especially when it happens more than once in the same night.
Wednesday, January 9th 2013 at 9:43 pm |
So scary and unusual. Glad he made it outta the cath lab intact.
Wednesday, January 9th 2013 at 11:20 pm |
Darn. I thought you actually pooed.
Thursday, January 10th 2013 at 6:16 am |
You should wear a leather jacket. Like the Fonz.
Thursday, January 10th 2013 at 7:22 pm |
That’s a good idea Dr Grumpy. Now if only I can perfect the snapping my fingers and having the nurses’ bras fly off thing….
Saturday, January 12th 2013 at 2:48 pm |
Even better–
“ayyyyyyy” (snap)
EKG: [NSR]
Sunday, February 3rd 2013 at 11:08 pm |
I am an ER PA, but have worked rural ER’s without backup for years. I remember early in my career I got outstanding advice from one of my Attendings when a patient coded. I don’t remember how old the patient was, but he was young (around 40). Everyone was running around frantically until the Doc finally called out, “Everyone relax! He is already dead. We can’t fuck this up any worse. In fact we can only go up from here. So calm down and do our jobs.” He then called out orders and everyone followed like professionals. In fact the patient made it. I remembered that moment every time a critical patient came through my doors. In rural medicine the staff rarely experience those situations, so when they do present themselves, they often get nervous. Someone needs to stay calm and in control. Hopefully it is the Doc in charge.