New doctor ever freeze?

[quickfeet]

Very weird question but I wanted to ask - have you ever seen or heard of a new doctor panic in the middle of some severe trauma situation? I.e. some one arresting upon arrival or particularly brutal trauma? Thinking mostly about residents here, but really anyone will do

---

Members don't see this ad.

 

[Doctor Bob]

Oh yea... I've seen attendings freeze-up.

The good ones don't stay frozen very long. Training kicks in at varying speeds, but eventually if you've made it through an EM residency you've got the skills to deal with these unexpected situations.

 

[Hair Police]

Of course you will see some shocking things. But once you start the ABCs and get them on the "ED safety net" (monitor, IV, O2) you've had enough time to know where to go next.

 

[Birdstrike]

Very weird question but I wanted to ask - have you ever seen or heard of a new doctor panic in the middle of some severe trauma situation? I.e. some one arresting upon arrival or particularly brutal trauma? Thinking mostly about residents here, but really anyone will do

I can't say that I've ever seen it, or noticed it happen, but I'm sure many have felt on the edge of this without necessarily letting it show. Usually when you feel panic taunting, you just go back to the ABCs,

Thinking to self, "Holy ----, this is bad, this patient may not make it but, let's do what we can do....lets get an airway (A), let's get some oxygen in this patient's lungs (B)" and so on. Like HairPolice said, by the time you get done with the ABCs, usually you're in a place where either there's nothing more to be done (patient dead) or your treatment is working, the patient is more stable and you're starting to relax a little bit, which makes things easier.

I suppose everyone at some point early on asks themselves if this could happen to them. You just do what you were trained to do. There's only so much you can do. So you just do it. Some patients will do well. Some will not.

In a high stress situations, you have a choice:

1-Fight, or

2-Flight.

What's the worst that can happen if you stay and "fight"? You might pass out? You might make a mistake?

Yes, and yes.

But that's about it. Most people prone towards panic stricken freeze-ups have weeded themselves out long before reaching the Big Leagues and have chosen some other specialty, or profession entirely. I suppose it's much like making the choice to enter pilot school. Don't do so until you're ready to commit to fighting until your nose is an inch from the ground. But it's a very valid question to ask yourself, and I think one all young EM hopefuls need to ask themselves. Will I panic? Will I freeze up?

The answer is:




.







.






.



.







.





.







.







.





.



You must choose: 1-Fight or, 2-Flight.

 

[link2swim06]

Very weird question but I wanted to ask - have you ever seen or heard of a new doctor panic in the middle of some severe trauma situation? I.e. some one arresting upon arrival or particularly brutal trauma? Thinking mostly about residents here, but really anyone will do

Trauma and cardiac arrests are actually one of the most cookbook things out there. Also depending on your institution they can be pretty routine (in one trauma month I did primary survey on >250 trauma activations). As people above have said, A, then B, then C, then D. It's very clear what you are suppose to do and when. ACLS and ATLS makes them nearly idiot proof and pretty simple. If you can follow those algorithms you are doing at least 90+% of what you are suppose to be doing.

The only area I have seen people really freeze up is when they screw up a procedure/or decision and they are panicked because it's their mistake/call that is bring the ship down. For example...sedation goes poorly and a healthy peds patient nearly arrests from a unexpected reaction to the drugs (granted no ones fault). In these situations people just have to go back to basics even though your mind is probably racing a mile a minute.

 

[Vandalia]

Never in a trauma situation.

I have seen people freeze for a moment when something completely unexpected happens: e.g., you are talking with a patient in for a sprained ankle and they all of a sudden collapse.

The other time is when they bring in what I like to call the "mechanical engineering" cases. You know, like the toilet the firefighters bring in because a kid managed to get a leg and an arm stuck in it. This freeze is mostly due to the first thought of "how the heck did they manage to do that!?" closely followed by "how am I going to get them out of it?!?"

 

[engineeredout]

Sometimes in a situation you just need time to think. You walk in, the patient is doing something that isn't exactly clear cut, you've never seen the patient before, don't know their history, and what you need is a few seconds to process what is going on. Now when you're the doc in charge in the room and you have 25 people standing in there doing absolutely nothing but staring at you, it is going to seem to them like "hey he's freezing up, he doesn't know what he is doing". When it's a code, it's easy, because you can just get the ACLS protocol started, give people tasks to do "You start compressions, you bag the patient, you get the dopper, you get me a coffee" etc... In a well oiled machine like an ER or an ICU these things are automatic, but if you are going to something on the floors or if you're with inexperienced staff it may not be.

Same thing goes for just about every other critical situation (IE Rapid responses). I learned from my 5th year senior on my first rotation of residency that whenever I walk into a room where there is something like a code, rapid response, critical situation, or any other WTF situation, ask for four things:

1. CURRENT vital signs - be sure to ask for them right now, because you wouldn't believe how you walk into a crashing patient, ask for vitals, and someone reads you off the last recorded vital signs from eight hours ago.
2. Oxygen - Does the patient have oxygen on? Do they need it? Very little to lose throwing someone on a NC when nobody knows what is going on. Is the patient on a NRB and looks like ****? Do you need to call respiratory so they can bring a CPAP over? If so, start that right off the bat. Worst thing that happens is they don't use it but at least you have it at bedside should you decide you want it.
3. IV access - What IV access does this patient have? Can we get IV access? Can we get more IV access? Yes that 22 in the thumb is nice but any chance of getting anything bigger more proximally? Oh the patient has a PICC? good to know
4. Accucheck glucose - Many a problem can be caused by hypoglycemia, so just being able to eliminate this off your list and put it out of your mind is helpful. If you do find something, it's an easy fix.

So by asking for those four things, not only are you setting in motion the collection of additional information and stabilizing measures, but you are also giving people something to do. They have specific tasks and they will get them done, and you can take a moment, examine the patient, look at the last set of lab values and PMHx. By asking for those things you will instill confidence in the staff in yourself because you will give the aura of calm, authority, and seem like you know what to do (even if deep inside you don't).

 

[Chip N Sawbones]

The other time is when they bring in what I like to call the "mechanical engineering" cases. You know, like the toilet the firefighters bring in because a kid managed to get a leg and an arm stuck in it. This freeze is mostly due to the first thought of "how the heck did they manage to do that!?" closely followed by "how am I going to get them out of it?!?"

What was the solution for this one? Did traction and lube work, or did you have to reach for a hammer to shatter the toilet?

 

[EctopicFetus]

I only froze once.. a patient called me the "N" word, I was stunned. I was speechless which is a rarity cause I feel like im pretty quick on my feet.

As a resident I dont think I ever "froze" but I remember the first code I ran alone and my attending having to remind me to push more epi. I lost track of time. Now I have run a bunch and there is an internal clock for meds etc.

 

[Makati2008]

I only froze once.. a patient called me the "N" word, I was stunned. I was speechless which is a rarity cause I feel like im pretty quick on my feet.

As a resident I dont think I ever "froze" but I remember the first code I ran alone and my attending having to remind me to push more epi. I lost track of time. Now I have run a bunch and there is an internal clock for meds etc.

Well I'm in that club I've been called that 3x this year already ( and I am an intern ). I don't freeze I get angry and take a quick walk around the ED and continue with my fake happy face lol.

 

[EctopicFetus]

Well I'm in that club I've been called that 3x this year already ( and I am an intern ). I don't freeze I get angry and take a quick walk around the ED and continue with my fake happy face lol.

Truly it made me mad. But more than anything I was just shocked and stunned. Ive been at this for 3 years as a resident and almost 6 as an attending. It really takes a lot to get any sort of response out of me. I worked nights for years and dealt with a slew of drunks. I consider that my fellowship.

Nonetheless, I was totally lost for words and had no idea how to respond. Looking back at it, its easy for me to laugh about it. I have heard some funny stuff in the ED. My favorite, I was in a room with a drunk patient and one of our techs, the patient was a mid 50s skinny intoxicated lady seen around 3-4 am.

My tech asks her to put on her gown and is trying to help her get dressed, the tech tells the lady her name is Bertha and wants to help her get dressed. The patient without even flinching says "Oh, my vibrator is named Big Bertha". The tech and I just burst out laughing. It was pretty classic.