I have been there when 2 emergency medicine residents, one EM attending is walking about a patient with a heart rate of 30s, but mentating well. No hypotension. No delayed cap refills of fingertips. No Vitiligo Reticularis. But the patient looks so well.
The patient already has a transcutaneous pads on the chest connected to the external pacemaker. Just in case. The machine isn't turned on yet. The patient isn't in pain yet. You know when its turned on.
The Cardiologist smells the blood in the WATER.
The word TVP is in the air.
If he hesitates that procedure gets done.
The procedure gets mentioned so many times, he may convince himself it will be needed.
Peer pressure by badgering. By mentioning so many times.
We offer to place a TVP.again Transvenous pacemaker in case he goes downhill. If he in the future, in one hr or 3 days gets unstable. That Cardiologist hesitates and he knows we love procedures. We who are of the RESUS CLAN do not walk away from procedures.
If that cardiologist hadn't show up. Someone would have had that TVP accidently, I meant purposely placed.
Another patient needs a chest tube. How do I know? the CT cervical spine found a Pneumothorax by accident. He had fallen and some how despite no sob/cp/tachycardia or hypoxia, has a pneumothorax.
No chest wall trauma noted externally.
The patient is very stoic and slow to respond from likely early dementia.
I found the pneumothorax. Then proved it with a lung ct scan. no rib fractures found but the ptx was proven not to be a bleb but moderate sized pneumothorax.
Do I wait for another service to perform this chest tube. Do I call a surgeon from another department? Heck no. The surgeon finds out about this pneumothorax and offers place the chest tube later.
I give that look. The What Evs look. I don't hesitate. I wont hesitate.
THE CRAZY EYES AND DROOLING OF A RESUSCITATIONIST.
THE LOOK OF A PERSON IN LOVE WITH A PERSON OR THE PROCEDURE THEY KNOW THEY HAVE MASTERED OR WANT TO MASTER.
DO NO HARM.
BUT DONT HIDE BEHIND MADE UP RULES OR PROTOCOLS IN THE REASONS WHY YOU DIDNT DO THE POTENTIALLY LIFE SAVING PROCEDURE.
I DIDNT BECOME AN EM DOCTOR TO BE TOLD WHAT I CAN OR CANNOT DO IN THE HOME THAT IS CALLED THE ED.
REMEMBER THIS. YOU ARE REMEMBERED BY THE ACTIONS DONE.
NOT THE WHAT IFS.
YOU ARE REMEMBERED BY THE LEGACY THAT THE STIRRED IN THE HEARTS OF THOSE WHO KNOW YOU.
WHEN YOUR NAME IS MENTIONED, THE PULSE THAT RAISES. THE SMILES COME OUT.
LET DEATH COME. LET US FIGHT THE GOOD FIGHT.