10 years ago today, a friend lost his life in what could only be described as tragic circumstances.
Experiencing loss ourselves is markedly different to the compassion we feel for the loved ones of our patients, when we meet them on what is inevitably one of the worst days of their lives.
The practical side and distractions of ‘making arrangements’ only lasts for a short time – the weeks, months and years ahead present the real challenge after experiencing profound loss.
In this presentation from SMACC Chicago, Rob Rogers talks about what he did (and what he wishes he did) to cope;
I think one of his points which I best relate to is that everything else can wait – you need to take time to process the change a tragedy brings, and regain your perspective after feeling overwhelmed.
The other thing I’d like you to consider is the nexus that presents when you experience tremendous pressure at work – it can easily overwhelm and isolate some of the people it touches, and although I’ve linked to this amazing talk by Tim Leeuwenburg before, perhaps you might like to take another look;
The take away from this is that we are great at giving others advice with dealing with grief, loss and stress – it’d be fantastic if we took some of our own advice – please don’t be too proud to ask for help if you are feeling burnt out.
I was listening to one of the excellent SMACC Chicago panel discussions on the management of traumatic brain injury recently, and it occurred to me that the pathophysiology of patients presenting in cardiac arrest secondary to head-strike might be under appreciated pre-hospital.
After checking-in with a few colleagues to see if they were familiar with the concept of Brain Impact Apnoea, I thought you might find this quick summary from Life In The Fast Lane useful;
Here’s the ‘It’s a Knockout’ panel discussion from SMACC Chicago;
TLDR; It seems that the mechanism of a head-strike, leading to respiratory arrest, which then progresses to cardiac arrest might be poorly understood in the pre-hospital setting. Attending a scene where a patient is in arrest post head-strike might be averted by simple airway management.
On more than one occasion I’ve been heard to say “just because you can, doesn’t mean you should” – consider the scenario of an unconscious (and anonymous) patient who has a mobile phone that you could unlock with a press of their thumbprint.
Here’s a noteworthy post from St. Emlyn’s blog by Simon Carley that discusses the legalities of doing so (with a UK slant);
I think the law of necessity would probably be the relevant principle to rely on in Australia –
perhaps Michael Eburn from the Australian Emergency Law blog would provide some commentary ? provides his view in the comments section below.
(and please encourage your patients to use the ‘Emergency ID’ feature of most modern mobile phones)
TLDR; Every situation is different – consider your patient’s expectation of confidentiality and the need to access this information pre-hospital if you’re going to do it.
In case you missed the latest round of histrionics from the popular media, there have now been a couple of cases of Zika virus reported in Australia.
Here are the peer-reviewed facts about Zika from Lauren Pike at ALiEM that should answer any nagging questions you might have;
TLDR; Zika is transmitted by Aedes mosquitoes (so it’s unlikely that you would get bitten anywhere South of Far North Queensland in Australia) and the first human case was 62 years ago !
So your patient’s ECG is pretty much ‘normal’, but there’s something not quite right about the look of those T-waves ?
You may well be onto the first, subtle signs that your patient is at the start of their infarct, before S-T segment elevation becomes obvious.
You’ll be doing them a favour by checking out this great post by Justin Bright at EM Docs that steps you through 4 causes of abnormal T-waves;
I’ve attended to more than one paediatric fall where parents or guardians have an expectation that their charge will be taken “for a scan” upon arrival at hospital (as seen on TV*).
The same parents or guardians are subsequently reassured if you are able to explain that this might not happen, unless there is a very very good reason to do so, given that emergency physicians try to avoid exposing kids to radiation unnecessarily.
But how much radiation are we talking, and what are the risks ?
Here’s a great post from Robert Cloutier at Academic Life in Emergency Medicine (ALiEM) which steps you through the radiation numbers and projected risks;
I think it’s good to know that a single CT can the the equivalent of hundreds of plain film X-ray images.
For some more detail on dosing in the adult population, you’ll find a handy summary table here;
*Television has a lot to answer for..
If you’ve been having a robust discussion about spinal immobilisation of patients with ‘mechanism’ recently, you’ll find this summary from EM Docs very useful for addressing the arguments which keep coming up;
(I’m yet to encounter a conscious patient with altered sensation or deficits who hasn’t self-protected their spine)