Sunday, June 5, 2011

Prepared for Chaos

As a young Boy Scout, I always loved reading through the handbook and learning how to MacGyver objects on hand into something useful. It was continuous testing of the Boy Scout motto "be prepared." In emergency medicine the challenge is similar; always being prepared for the worst case scenario. [Pictured: Make-shift hospital outside St. John's Regional Medical Center in Joplin, MO. Image provided by Mercy Health]

Ready at a Moment's Notice

In recent headlines, tornadoes have shown their gruesome force by leveling towns and causing mass chaos. The incident in Joplin, Missouri was no different and Dr. Kevin Kikta shared his experience of the night the tornado destroyed his hospital in 45 Seconds. This is a prime example of being ready for the moment when everything is wrong. He managed the care of patients with the limited tools on hand as he moved from one to the next. He didn't need functional rooms, a full set of staff, or the best equipment. He knew what needed to be done and found a way to make it happen. He was prepared.

I suppose this is the "what if" game so many emergency medical professionals play when they have time to think. "What would I do if...?" we think to ourselves and play out a scenario that one would never expect to happen. After playing the game enough times, you start to realize how your response to a particular situation changes to maximize your performance. Should the situation play out, you might just be one step ahead rather than caught up in the element of surprise. Whether the Boy Scout manual was premature training or the "what if" game preparatory, I hope that in those unsuspecting situations I will be prepared to act accordingly.

Question of the Week
Shortly after having a subclavian venous catheter inserted, a patient is noted to be acutely short of breath with rapid and heavy breathing. He is not yet in respiratory distress. A chest x-ray reveals a pneumothorax. Management should consist of

A. removal of the central line.
B. insertion of a new central line on the other side.
C. insertion of an angiocath in the third intercostal space on the side of the central line.
D. insertion of a chest tube on the side of the central line.
E. insertion of a chest tube on the side opposite the central line.


Answer & Explanation

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