REMSTARBC.ca Rural Emergency Medicine Simulation Training and Resource - British Columbia
What your 'Emergency Room Mindset' should be, Not this!
I subscribe to the notion that ER work is a "95, 4 and 1%" proposition.
By this is meant 95% of what you see in
a rural ER is exactly what you would see in your office.
4% are very ill patients that need immediate attention and possibly admission.
The last1% are the critical patients that need resuscitation.
This web site pertains to that last 4 - 5 % of patients that need your 'attention' and
that will give you sweats and tachycardia unless you have a plan and some training.
There are '3 Knowledge Pillars' which I believe emergency work rests on.
Many might argue for others and that is acknowledged.
However I actually think the 3 main pillars are:
1. "Own the Emergency Department". This is something that is often overlooked in ER teaching.
If you know every aspect of every piece of equipment, your anxiety level will drop exponentially.
2. Knowing your Emergency Drugs. This is your 'menu' that you can offer critically ill patients.
You MUST know how they work, what hemodynamic effects they will cause
and the problems/complications of the drugs. The dosages aren't that crucial to know
and if fact you should likely look them up unless you are POSITIVE of the dose.
3. Airway, airway, airway. The common end point of treatment for most critical patients is
being able to protect and maintain the airway.
Airway and in particular, intubation, is the thing that seems to cause the most anxiety.
One of the worst things you can do is to 'wait' and see if the patient improves or
wait until the medivac crew arrives to intubate.
The longer you wait, the more critical and difficult the intubation can become.
Of all the procedures you learn, this one is the most important.
Hopefully all of these topics (and more) will be covered during your residency.
Finally there are 4 'personal components' I believe doctors need to learn when dealing with critically ill patients in the ER.
Some of these can be easily taught, others are more difficult.
The first is to have a PLAN.
When the critically ill patient comes in, you may not have any idea what is wrong with them initially, but you need a plan. Without one you are both hooped! That is why they teach 'ABCD'.
The second thing you need is SITUATIONAL AWARENESS.
This can be difficult to learn but is you are the team member you need to know what everyone else is doing. In a rural setting, where you may be managing airways, setting up vents etc, this can be challenging.
The third thing is GOOD COMMUNICATION. This includes talking 'out loud' so other team members know what you are thinking and can understand your 'plan'. It also involves communication skills, examples being 'closed loop' and 'asking to be told' communication.
Finally you need to be CALM.
This includes both during a resuscitation and after.
If during a resuscitation you are anxious and scattered, your team will be also.
Afterwards you need a place both internally and sometimes physically, to do a 'decompress' and relax for a moment. Formal debriefing can be part of this, but there is always that need for time of self reflection.
Below are some videos of general interest to working in an ER. Some entertaining, some educational.