|Addia Ababa, Africa|
Anyway, I got the invite while I was in Ethiopia-- Addis Ababa to be exact working, at a
That said, it's still (emergency) medicine in the developing world, which means things go sloooooowly. Coming out of a fast-paced urban tertiary ED, it gave me pause to reflect on something that is central to the MD aware mindset: very, very few things in the ED or in medicine in general are so time-critical that seconds count.
What I have seen here is head injured patients with GCS 4 who don't get intubated for 45 minutes and keep breathing; comatose patients who wait an hour for a head CT; hypotensive patients who don't get fluids for 20 minutes and don't die; babies with cap refill ~8 seconds who wait 40 minutes for a fluid and bolus, and so forth. They are things that in the
So since I'm over here moving at the speed of Addis I decided to come up with a list of SECONDS-MATTER EMERGENCIES: things in medicine that cannot under any circumstances wait even 30 seconds. I did not include things that must happen cognitively very fast (i.e. cric) but only those that must be in-progress or done in a matter or a few seconds.
- Control of arterial hemorrhage
- Decompression of tension pneumothorax
That’s about it, I think.
This gets at the main thrust behind the “don’t just do something- stand there” philosophy — don't spin your wheels unnecessarily. Seconds-matter emergencies are great opportunities to really help people; it just saddens me when people (routinely) focus on the wrong things — running around like the patient’s going to die in the next 10 seconds unless we push labetalol on the asymptomatic patient at 180/100; or pushing lasix on the APE patient instead of the NIV mask.