What to do in the Post-Resuscitation
Inspired by my friend Mike Mallin, today I discuss the post-resuscitation. This squarely fits into the Mind of the Resuscitationist (MotR) series.
Parasympathetic Backlash
Follows the adrenaline dump. You are basically performing at a much lower level than normal.
The moment of greatest vulnerability is the instant immediately after victory.
~ Napoleon Bonaparte
We briefly touched on this concept in the On Combat bookclub.
…It doesn’t take a rocket scientist to guess that a soldier must pay a heavy physiological price for an enervating process this intense. The price that the body pays is an equally powerful backlash when the neglected demands of the parasympathetic system become ascendant. This parasympathetic backlash occurs as soon as the danger and the excitement are over, and it takes the form of an incredibly powerful weariness and sleepiness on the part of the soldier.
~ Grossman, On Combat
What to Do?
- Scene Check/360 degree sweep/Stabilization steps
- Eat
- Drink
- Change Clothes
- Nap?
Debrief
- Organized Debrief
- Need your input here
- Guilt Release
Process and Avoid Post-Traumatic Negatives
Go on the Couch
Visualization
Use the highest fidelity simulator, your brain, to replay, re-act, and improve
Meditation
Will discuss on an upcoming podcast
Gaming Processing and Recreation
Play Tetris or Mindcraft
- DOI: 10.1371/journal.pone.0004153
- Doi: 10.1177/0956797615583071
- Jane McGonigal's Ted Talk & her interview on Tim Ferriss' podcast. Read her book: SuperBetter.
What if you actually screwed up?
Jason Brooks-Come Help me…
Post-Traumatic Growth
Resilience may lead people to go down the path of Post Traumatic Growth rather than PTSD
Additional New Information
More on EMCrit
- EMCrit 339 – Decisions, Decisions, Decisions with Andrew Petrosoniak(Opens in a new browser tab)
- EMCrit 350 – Mind of the Resuscitationist – Emergency Teams with Dan Dworkis
Additional Resources
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Professor
Nassau University Medical Center
No conflicts of interest (coi).
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AWESOME pod cast Scott. I agree that the talking though the mistake with a friend is a good way to release and try to get some clarity on what happened and why. In the USA though, we do have to be careful as you point out. The destruction of transparency is solely due to the increasing potential of litigation. I have a fear that the residents and fellows are entering into a very difficult world. I recall training and how un supervised I was and how when I made mistakes we got scolded the next day on rounds. Those days… Read more »
Wow…..!!!!! I’m a 2nd year EM Registrar in Cape Town, South Africe. I listened to this podcast last night driving home after a weekend of day shifts, awaiting a Christmas weekend of nights coming up. Totally exhausted, with mind and soul shattered, I was mentally belittling myself for not being able to clear out the Orange Box (of 8 unseen) after dealing with a 2-yr-old drowning and an unstable praecordial stab, before the night shift came on at 8pm. This is the problem with Emergency medicine as a specialty, especially in South Africa! Not only are we seen as glorified… Read more »
Lynne–thanks for this amazing comment! Totally agree!
Greetings Thanks for this podcast Dr. Weingart. You continue to make a significant contribution to our industry. You described the act of changing one’s scrubs to transition after traumatic events. In addition may I offer the idea of going to the nearest sink and washing ones hands and face. In my career as an ED nurse I frequently have metaphorically gone to “the spa” and washed away the physical and emotional residue of events. This simple act has supported me well like a clutch to help me change gears between event. Best of all, nobody has ever said to me,… Read more »
oh, absolutely
Great podcast- a recent observation that goes nicely with what you talked about- I had a really sick patient recently who crashed after intubation despite fluid loading and pressors (drip started before tube and push dose afterwards). Airway went in quickly but the post-intubation time was very dicey and required a lot of action to keep the patient alive. Afterwards I felt that adrenaline dump to the extreme. Despite me not being the least bit tired and well rested from the night before, I could have fallen asleep at my desk in the middle of the ED. My observation is… Read more »
Absolutely agree! Though what I have come to in my mind is that the sicker the pt, the more I own them. All decisions become mine, all procedures are done by the residents only if I can tell my conscience that there will be no better outcome than if I did it myself. So I really don’t feel a loss of that instant control.
Scott, Such a phenomenal topic and post. I share your exact feelings regarding working with residents & taking care of super sick patients- “the sicker the pt, the more I own them”. Well said. The tough balance in these patients is between letting the residents fly, yet providing the best care possible for the actively dying patient. I particularly relate to your description of getting that sense of how sick the patient is, and what that actually means in terms of how quickly definitive action needs to be taken. The phenomena of “social loafing” & “diffusion of responsibility” often take… Read more »
absolutely, buddy
Thanks as always for the fantastic discussion. We all deal with stress and with failure in different ways. One outlet I’ve found to be extremely helpful is to take the most difficult cases and transform them into simulations. There is immense benefit in the process: 1) You review what actually took place. This gives you an opportunity to reflect on what happened and think about where errors occurred and what could have been done better. 2) You read about the topic and get to learn more about the pathophysiology, management, controversies, ongoing research, etc. 3) You get to share the… Read more »
Great podcast Scott! I listened to this after Mike’s talk. Congratulations to both of you for being so completely honest about how one can feel during stressful situations. I practice in Eastern Europe , a place where a doctor is expected to perform with calm and no emotions. Also admitting that you were stressed in a given situation, or that you made the wrong clinical decision is not something you can afford to talk about. It is seen as a sign of weakness. Now I realise, that this assumption is false. My take on how to manage after this situations:… Read more »
Lavina, thank you for these wonderful comments.
CHOCOLATE AND COFFEE! Seriously, I fully agree about the stress and needing a break. As a rural hospitalist though, there is no one else to hand off the pt to, unless I transfer them. So finding out how to get that few minutes for fresh coffee, chocolate, change scrub/t shirt, is worth a million bucks so you can see the next pt or recheck the one on the vent.
It’s such a pleasure learning from you. Your blog post is always catchy and easy to read.