Category Archives: Story of a Picture

Story#14 Hulk Hogan’s ear wave & Compassion

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READING TIME 5 MINUTES

BACKGROUND

If you have watched Hulk Hogan wrestling, you would know he has been a hero to many. Among his many sensational moves was a signature “ear wave”. Take a look

Before the Hogan decides to take on the the poor referee, he performs his ear waves where he walks to all 4 corners and “LISTENS” to the crowd. He makes them feel important. He is indicating it to them that “I am a world champion but I am “LISTENING” to you”.

THE STORY

A 29 year old female presents with abdominal pain and increased work of breathing. She suffers from type 1 diabetic. Her blood ketones are 6.1 and blood gas shows

pH 7.15 HCO3 15 Glucose 29 mmol Base excess -12 Lactate 1.6

The conversation between the “Doctor & Patient” was as follows

Hi..My name is  “dr fast & the furious”. How can I help?

Well Dr I have diabetes and

Do you take insulin?

Yes I am on insulin but yesterday I was feeling poorly. I had this terrible belly pain & felt like..

Did you had any vomiting…

No but I was…

any diarrhea…

No…

burning urine…

No..

Chest pain..

No…

Allergies…

No…but Doctor I was saying that I felt nauseous yesterday and didn’t wanted to…

Have you been taking your  insulin regularly..

Yes…

Okie I am just going to review your blood results and will come back to you..

Doctor reviews the results and makes the correct diagnosis of Diabetic Ketoacidosis, writes the correct management  and refers the patient to medics. He then carries on seeing other patients and doesn’t get time to get back to this patient. She goes to the ward, gets better gradually and is discharged 3 days later. After few  of weeks later, ED department receives a complaint letter that says…..

 

I would like to express my concerns regarding the contrast in  care I received between emergency department and the medical ward. As soon as I reached ward, doctor explained to me what was my condition, listened to me and treated me. I started feeling better after few hours. I felt the doctor in ED acted more like a traffic warden who just directed me to medical ward .I felt I was not listened to. How could the doctor have diagnosed me when we wasn’t even listening. I understand the busy and noisy nature of A&E but strongly feels that ED doctor should have spent minute or two to listen to what I had to say.

MORAL

ED compassion is as important for patients as giving good clinical care. Though there are many scientific papers and theories behind ED compassion, true delight of compassionate care comes from an introspection. Here is what I have found by listening…

5 lessons learnt

Be an ED hero

Have a listening ear

Let your patient know

You have time to hear

So next time when you are treating your patient,                         ask yourself have you listened?


 

Story 11 Situational Awareness: From Bean to Spiderman in 2 minutes

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READING TIME:6 MINUTES

“Situational Awareness” or shall I say lack of…

So this is what happens when I lose “Situational Awareness”

& this is why “Situational Awareness” is essential.

This is a kind of junction I used to cross during my college days. All I had to do to keep my  “Situational Awareness” was to look 1-left, 2-right, 3-straight, 4-back mirror, 5-both side mirrors, 6-repeat all steps every 5 seconds. I wondered if this could be applied in Emergency Department to gain Situational Awareness!

So here is the story of one fine Resus shift

SLIDE 1

Situational Awareness has 3 components

SLIDE 3

A commonly used tool in US air force pilots to gain situational awareness at speeds of MACH 2  is OODA loop. Though we don’t break sound barrier, but sometimes the speed with which new patients arrives to Resus is not far behind.

SLIDE 4

So I applied this to my situation. Here is an example

SLIDE 5

and there I was…From BEAN to SPIDER-MAN in 2 minutes

 

SLIDE 6

Inspirations

Airmanship (Book)

Situational Awareness(Wikipedia)

Human Factors and Quality in Resuscitation(Resus Council)

 

Story 7 FEEDBACK: MAKE OR BREAK

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Slide1

FEEDBACK s2

Okie so this clearly didn’t go well. The Reg needs a feedback on how to deal with juniors. But How, When and What needs to be given as a feedback is an art.

FEEDBACK s1

FEEDBACK s2

FEEDBACK s4

Many models are available for Feedback but try to keep it simple, flexible and logical.The Pendleton model states

FEEDBACK s5

 FEEDBACK s3

Inspired by:

Giving feedback in clinical settings

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a1961 (Published 10 November 2008) Cite this as: BMJ 2008;337:a1961

 

STORY 6 RESUSCITATION, DISTRACTION & STERILE COCKPIT RULE

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Slide1

slide 2

Slide3Slide4slide5 (2)Slide7Slide6

Inspirations

Aviation Knowledge

Flight Safety

Critical phase distractions in anaesthesia and the sterile cockpit concept

Book: Clinical Research for the doctors of nursing practice

Comparing patient safety to airplane, formula 1 safety

FOAM EM Simon Laing

Scott Weingart on S.Hitters at RCEM SCIENTIFIC CONFERENCE 28TH Sept

Anaesthesia Trauma and Critical Care(ATACC)

 

Story-3 Killing with Confidence :Unskilled and unaware of it

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Slide1

 

 

 

 

 

 

 

 

 

 Slide2Slide3Slide4SOAP 2 Drunning Kruger 3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inspired by

http://www.talyarkoni.org/blog/2010/07/07/what-the-dunning-kruger-effect-is-and-isnt/ 

http://www.ncbi.nlm.nih.gov/pubmed/11831409 

http://www.doceo.co.uk/tools/knowing.htm 

https://swaltersky.files.wordpress.com/2012/01/slide1.jpg