Jonathan Shen submitted 2020-10-06

When someone’s heart stops, what do you do? Most people answer CPR. When can you start CPR though? That answer is a bit more nuanced. But with the right training, anybody can learn when to start and how to perform this life saving intervention; it only requires a few simple steps. Armed with the skills, that person can now save a life, whether it be at the grocery store, mall or even at home. That is why there is tremendous value in learning life support.

I first became involved with emergency medical care when I attended a BLS course during EMT school. Once I became a certified EMT, I had many opportunities to participate in pre-hospital cardiac arrests. Those calls tested my BLS skills- the rate and depth of chest compressions, how often to ventilate and when to defibrillate patients. Soon after participating in a few of those calls, I realized the most important skill was not the act of giving breaths, but rather chest compressions. That observation is further corroborated by data as well. Compressions are deceptively difficult when performed correctly, especially when performed on a patient with excess subcutaneous fat and over a soft surface like a bed; there is no shame in having to switch out every 2 minutes. Thus, I always made it a point to maintain good health and strength- that way I can always perform high quality chest compressions to help increase the patient’s odds of survival.

Now as a medical student, I have the privilege to care of critically ill patients. Unfortunately, when someone is that sick, it is hard to predict when decompensation will happen. We can risk stratify based on current condition and associated comorbidities, but we are just making educated guesses. Therefore, it pays dividends to be prepared for the worst.

For every patient I see, I take a thorough history and review the chart to make sure nothing is missed. After parsing the gathered information, I mentally run through various scenarios that can be born from the patient’s current condition. That way, I have considered both good and bad outcomes to mentally prime myself. However, when faced with an unfamiliar situation, I often find myself a bit tense and unnerved. Knowing I could easily freeze up and forget how to critically think, I follow these steps to ground myself; I first take my own pulse and then stop, just for a few moments, to take some deep breaths. That gives me enough time to collect myself and to remind me that in any emergency, it is the patient and not me that is having a crisis. From there on, I just follow my training and once I am in the moment, any leftover jitters melt away.

When disaster invariably strikes in the hospital, the right tools are often nearby; they just need to be used correctly. Because of the increased tools available with ACLS, more things can go poorly as a result. For example, incorrectly administering sodium bicarbonate, delaying transcutaneous pacing, or poorly timed epinephrine doses can all worsen patient outcomes. Very soon I will be dictating patient care as a resident, so I periodically refresh myself on life support algorithms, particularly ACLS. That way when the time comes, I can waste less time on thinking about my next steps, allowing me more time to focus on the patient and the situation at hand.

Aside from the clinical aspect of emergency medical care, less talked about is how to navigate the social side. The act of providing care gets all the spotlight, but how to talk to family is arguably as important. As healthcare workers, we are used to seeing patients coming in unstable. However, the public is not and seeing their loved ones unwell can be extremely frightening and anxiety provoking. How we choose to break bad news and the way we do so drastically affects how they react. From working alongside many physicians, the ones that do it best tend to speak in a clear, calm manner, while being sympathetic to the situation. Even if family members become emotional, they continue to stay composed, while simultaneously recommending best treatment options and educating family on patient prognosis. Oftentimes people forget about the intangibles and their positive effect on improving both patient and family quality of life.

Finally, for those interested in entering the medical field, my advice is to develop a mindset of being a lifelong learner. Know the current guidelines well, especially BLS and ACLS, and always be on the lookout for updates to said guidelines. By having a solid knowledge foundation, you can act faster and be more confident in your decisions. In addition, continue practicing the skills you have learned and continue reviewing important topics pertinent to your health field. I believe with the right attitude and work ethic, you will be able to accomplish amazing things.