I am having a hard time making the leap to running resuscitations. I have the knowledge but am having a hard time shouting orders to a room full of people. I think it is largely from a lack of confidence (imposter syndrome). Does anyone have advice for overcoming this?
Thanks
To answer this, I need to know if you are a medical student? Resident? What year?
Without knowing that, I'll give a partial answer, assuming you're a medical student like your bio says. It's almost entirely about the voice. If you walk into a chaotic room where someone is coding, push your way to the head of the bed and loudly, confidently and forcefully booming orders across the room, you'll notice that almost immediately everything changes in the room. It's almost like a disorganized beehive that's waiting for it's Leader and once it senses the Leader's presence, it calms down, becomes organized, finds purpose and works efficiently. But until it's sensed that an Alpha has stepped up and assumed that role, no one knows what to do.
Who's the Leader, who's the Alpha?
Like everywhere else in life, it's who says they are, who steps up to the plate, who steps through the fear and puts him/herself in the hot-seat.
It almost doesn't matter if what you're doing or saying is right, just that you're projecting Alpha vibes. Prior to being in EM, I was not an Alpha by nature. This was something I had to learn.
Try it sometime. Step right up to the head of the bed and f---ing take charge. Just do it. You'll be amazed. It works. The more you do it, the easier it becomes. And the beauty of it is, if you do this and you're in a code on some random floor running it forcefully, you'll see senior people roll in that easily could step in and run it. But they don't. Because they see you Alpha dogging the whole situation. But that's the cool think. If you totally start f---ing, they'll step in, and whatever...you learn from it and will do ten times better next time.
But, back to the start. If you are a medial student, you probably don't have to worry about running codes, entirely. You should try if you're the first MD there. And you just might end up running one, if more senior people show up and you're killing it. But as a medical student, you probably don't need to worry about this just yet.
But let me help you here: 99% of this is having the confidence. 1% is knowing the protocols. That an important 1%. You need to know it cold. But the hard 99% if just mustering up the confidence to take a stab at it.
I'm sure you know the "ABCs" and the ACLS stuff. But they make it messier that is needs to be. I look at codes (medical ones) as basically "airway" and "everything else."
You must must must get the airway stuff down cold. Nurses with know enough ACLS to start suggesting, electricity, meds and drawing them up, before you even order them. But they won't know airway at all. It takes time. The most important thing to learn is the basics. Start with learning how to put a nasal or oral airway in a patient and bag with it in. If you can confidently learn how to do this you just bought yourself ETERNAL seeming amounts of time in every code. Panic melts into calm oxygenation. Then you slow your own breathing down because your patients sat is no longer 55%, it's 99% and you haven't even started yet. Then you can plan your definitive airway.
Intubating: Like any procedure, it's volume, volume, volume. Intubate in the OR, on dummies, on babies, on adults, in the ED, in the ICU, SICU, traumas. Intubate every chance you get. Only volume allows you to cross from that "I feel like I'm lost" feeling to the "Damnit, it just clicked. I get it!" feeling.
Confidence
Airway
Then the meds and ACLS/ATLS stuff flows easily.
I remember the days when I was thinking, "Holy s**t. I don't know how I'm ever going to be able to do this." And then one day I was an expert in it, proficient and confident.
It'll happen for you too. You're in training. It'll take a while to get it right. But you can't ever do that until you dive in. Some take the leap (with supervision). Tell your next resident on your next rotation, "I'm running the next code. Back me up." Before you do this, walk through it in your head. Visualize walking into a chaotic room. Where do you walk to? What do you say? What's your first action? Also, watch codes run by pro's and mimic the best of the best.
And dive in. It's easier than you think.
