lay people love asking this flippantly. we sometimes stop people from dying. it is relatively rare, however, to catch someone actively dying in real-time and stop that from happening single handedly.
for one, it's never a one-handed activity.
rarely, too, is it ever one thing that's gone wrong with one simple fix. how many times have I given a bolus of propofol or prescribed magnesium to buy some time?
the one time I can say I perhaps saved someone's life was when I saw someone going into anaphylaxis fulminantly and gave them adrenaline.
Core EM – American. topical discussions, a la the RCEM induction series.
Emergency Medicine Cases – case based discussions mostly. Very American. Mix of EM presentations and human factors. (This was the one with the “how do I convince ortho to take this intra-articular fracture”)
RCEMLearning, Resus Room – UK-based. I still stand by these but I think you already know them
Paediatric Emergency Playbook – hasn't updated or a while but good for systematic rundowns on a specific topic
Two Paeds in a Pod – more PEM. UK-based.
Tasty Morsels of Critical Care – despite the name I think there are topics relevant to your critically unwell ED patients
REBEL EM – regularly has studies, now the podcast feed includes articles. American.
you learn a sort of patter in paediatrics – simple to understand, non-threatening ways to explain the sometimes uncomfortable things you have to do. I came across some remarkably unfriendly things the other day.
is your [accompanying adult] normal? (why would you ask this.)
[while looking in a child's ear] we're just going to look for spiders!
regional teaching today. being for novices, it meant that “airway day” was all about the basics of induction of anaesthesia and extubtation.
they got a consultant to talk about front of neck access, a very rare event overall in most anaesthetists' careers, which my colleagues found super interesting, and I found devoid of self-reflection
in contrast the talks about ventilation and preoxygenation which people usually zone out at – I found really interesting. proper applied physiology, that. and extubation – the boring bits that people tend to overlook because it's not as flashy as intubation, but is equally a high-risk event.
I had no department induction because “I'm not new to the department”
tasked to do pre-op assessments, told I could do some e-learning, having had zero feedback I hope the day anaesthetists enjoyed my shitty assessments with loads of detail (apart from where teeth are, what's up with that)
wanting to be involved with cases, but not even knowing there were cases overnight until I stumbled across them... please. I will cannulate and art line whoever. Anyone.
and emergency medicine, ie my parent specialty, constantly being slated
I get it, my regs have to scope me out, as do I, but I was expecting more. to find things difficult because there were lots of new skills to learn and the intensity of the work, not the constant defense of my specialty and my place on the team and asking permission to do simple things
(my supervisor and I talked about belonging, early on this year. ED recognises (kinda) me as one of its own – that I'll be coming back to them eventually. the tendency on ICU and theatres is: anaesthetics trainees are a known quantity – the favourite children – and most of the seniors know exactly what they need from training. most of the seniors don't know what signoffs ED trainees need, don't think much of EM as a specialty anyway, and keep saying “you're not going to use it anyway”, as if that precluded actually training a trainee)
There's something rather satisfying about being one of the many sets of hands to stabilise someone really unwell on ICU.
“Did you save any lives this week?” my parents often ask. Well, not directly. It's unlikely any one thing I do directly saves someone's life definitively. The seniors might, by spotting a pattern in a critically unwell patient and acting promptly. The nurses might, by actually giving the treatments and – well, good nursing care goes a long, long way.
Did I save any lives this week? Not directly. Not dramatically. But I did put in the lines to allow for lifesaving renal replacement and vasopressors, I guess. I did keep things safe as much as I could (prescribing, handovers, making sure there were good senior plans for important things). And if that sounds like working on a regular medical ward, then yes, it is! The stakes tend to be a little higher (if you don't fix the problem, that's it – you can't escalate to anyone else. (Transfers don't count)
It's changeover week, and I leave having learned so much, done quite a lot, and received overwhelming kindness from unexpected corners.
I am weirdly verbose (at least online), despite not actually being that verbal. (I sometimes involuntarily speak really quietly at the end of a night when I'm shattered)
I think I'm wanting a debrief, or at least some sort of decompression for the rather eventful night.
we joke about british-isms minimising disaster but, genuinely:
* patient heading for a crash intubation: “in trouble”
* horrendously unstable patient who's been mismanaged for their entire hospital stay: “in a heap”
Being on ICU with a bunch of IMTs has... its advantages: they enjoy making sense of someone's incredibly complex history, calling tertiary centres and looking at old clinic letters, and some are not particularly interested in doing lines
we are complementary
(I know how to dig into someone's records if needed – of course! but it's not my favourite place to be)
Read everything. Solid advice for young writers and artists, to gain as much variety in exposure to art, history – everything.
This is here because... this applies to medicine too. Emergency medicine, I think, values as broad an experience as you can get. The more you get exposed to, the more you see and hear, the better you recognise patterns
Apart from time, what I've found helpful is:
reading and listening to people talking about medicine
talking to specialties about our referrals – not just “yes” or “no”, but what they would do, how they interpret investigations and so on
The “old school” doctors often lament the cynicism and disillusionment of current junior doctors. It is fairly uncontroversial that doctors from a couple of generations ago were expected to have a broad skillset and knowledge base, even within specialty, often having had much more gruelling hours and levels of cover that would be considered safe nowadays. Again this doesn't seem to apply as much to emergency medicine, but specialty doctors nowadays are expected to have a narrow range of skills. Perhaps on a system scale this is more economical. But I think, as individual doctors, we only lose out when we limit our
If only I could actually remember all these things.