Wednesday, 23 July 2014

Speaking up to your senior consultant

Imagine this scenario:
You are seeing this sick patient with acute respiratory failure. It appears intubation is imminent as the patient is hypoxic and mentally obtunded despite high flow oxygen. Your consultant comes in and make a quick assessment:
Consultant: "Ok, looks like we need to intubate this patient. MO, get an ABG right now! Quick quick!"
You: "Errrmmm, really? Do an ABG now? I thought we're going to intubate..."
Consultant: "NO! Don't argue. I want an ABG now. Just do it..."
You: "Ooookkkkaaayyy....."

Sounds familiar? Have you ever been in a situation where you were told to do something by your senior that you felt was not right at that time? Did you just keep quiet and do as you were told? Did you just do it because it was your senior who said it and that was ok?
I would say, that the right thing to do, would be to speak up, and point out the mistake to the senior. This is even more important if you think the error might result in patient harm. In this day and age, when we function in teams and go for team simulation training, the value of each team member cannot be undermined. Every member of the team, no matter how junior, has a role to play. It is important to feedback all information to the team leader, and to point out mistakes or errors promptly, tactfully and with respect. This is vital to the team's success. Therefore, the days of authority based medicine, or "my consultant said so" should be over and done with.
MOs and Residents, learn how to give feedback to your seniors. This can be learnt throughout your residency, or even in the Resus room. And seniors, learn to take feedback from your juniors without pride or prejudice. The communication is important for team function, and patient safety.
Our senior registrars are great examples. They have been through residency and AST, and may know more than their senior consultants in terms of the latest updates and evidence. Seniors can sometimes be wrong too.
Take this scenario for example:
A male presenting with DKA, had now developed worsening SOB and hypoxemia. It appears acute pulmonary edema was developing after the fluid boluses, and repeated ECG showed a possible STEMI. Patient had been intubated successfully and we're about to adjust the ventilator:
Me : "OK, patient's doing well, SPO2 is up, let's cut down the FiO2 and the respiratory rate."
Registrar : "Errrmm, are you sure Dr Ang? I would keep the respiratory rate high; above twenty if possible..."
Me (testily) : "Why, may I ask?"
Registrar : "Don't forget about the acidosis... that's one of his primary problems."
Me (roll eyes) : "OMG, you're right. I'm such an idiot! Thanks for pointing that out..."

Sunday, 20 July 2014

SEMS 2014: Benjamin Leong - Dispatch assisted CPR

Dr Benjamin Leong gives a comprehensive account of challenges and triumphs in the Singapore EMS - specifically the intervention of dispatcher CPR.

The slides are here:

Wednesday, 16 July 2014

SEMS 2014: John Tobin - EMS in Arizona

John Tobin goes gives an overview of EMS practices and processes in Arizona for SEMS ASM 2014. It is always nice to see and learn how others do it. Long may this co-operative learning thrive.

The slides are here:

Sunday, 13 July 2014

"A" is not for aardvark, its for ARVD.

ARVD has long been a difficult thing to detect. It starts from knowing it exists and adding it to your differential for syncope in young adults. Dr Amal Mattu clears the air over and how...

For more of his videos, go to his UMEM site

Wednesday, 9 July 2014

Tuesday, 1 July 2014

SEMS 2014: Geraldine Leong - Pre-hospital ECGs

Dr Geraldine Leong goes through some important points in ECG reading and tips for the "not-to-miss" pathologies.

The slides are here: