I am currently working on a presentation that I will be giving next week, called “Death in the ED”.

During my research for this talk, I was trying to find information, guidelines, on when Emergency Physicians can and should stop resuscitative measures on a patient.  The issue is very complex, and there does not seem to be a clear cut answer.  In my practice, I have relied on multiple clinical predictors and factors such as whether the patient’s heart is beating on my bedside ultrasound, or what the blood gas shows during CPR, or historical factors such as how long CPR was done for and whether the patient ever had a shockable rhythm (i.e. a rhythm that responds to electrical intervention).  My colleagues and I have made decisions to terminate CPR based on these findings, and I don’t regret doing so because in each case I very deeply considered all the information I had in my hands at that moment in time and made the decision based on the facts I had.

But today, I watched a Youtube video that will completely change my practice from here on in, and that made me question so many decisions I have made.  This video was by a colleague speaking at a conference a couple of years ago, in which he very convincingly detailed all the other things we should consider during a resuscitation, including new methods and tools we have at hand now that might make a difference.

At the end of his talk, he was in tears.  The audience was in tears.  I was in tears.

It’s hard sometimes, in the work that we do as emergency physicians, to separate ourselves from the algorithms and textbook learning we have memorized, and think outside the box.  It’s easy to follow what we’ve been taught, easy to say we tried everything we were supposed to try, and stop at that.  It’s easy to say, I don’t think this patient will survive.  But can we do that?  Should we do that?  At what point should we truly stop resuscitating our patients?

I don’t know.  I still don’t know.  But this 30 minute talk I watched today stirred something in me and will change my practice going forward.  This is why it is so important to keep learning as a doctor; never stop, never quit reading and watching videos, listening to podcasts.

We have never learned enough, we will never know it all.

And most of all, we will never ever be able to predict with certainty, who might live and who might die.  We can only try to steer things in one direction or another, using all tools and knowledge we have.

3 thoughts on “Soul Searching

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