​​A recipe for ​curbing chao​s:​ 5 Tips to stay cool in the Emergency Department​

I will never forget the day when I learned the meaning of stress in the Emergency Department (ED). There was a massive multi-vehicle road traffic accident and many patients were brought in, pulling away most of the ED doctors and nurses on call, leaving the rest of the ED at my disposal. I was focusing on a procedure to save a man with a life-threateningly low blood pressure, when a nurse approached me with an electro-cardiogram of a new patient. Even at a distance, I could see he was suffering from a massive heart attack. And if anything worse couldn’t have happened, there was an overhead page for another trauma patient.​​

I felt my blood pressure rise and I said to myself, “I can’t do this anymore!”

What makes ED physicians not only stay calm, but function at the height of their game in face of an emergency? Some people may be a natural at this. But for those who are not, including myself, I have learned that we can rise to the challenge, eventually surprising ourselves. In order to be effective, you must learn above all to keep your head. The lessons that I share below apply to any challenge, whether it’s a real emergency or merely the stuff of daily living. Try to stay in control with the following five tips that I frequently use, and trust me, they work quite well.​​​

1Start breathing the right way. When the body is in fight or flight mode, it starts to hyperventilate. Hyperventilation drops your carbon dioxide levels and makes you feel even worse. Do not only take slow, deep breaths as we are often told to do, in fact focus on longer, slower exhalations. Practice regularly and turn this into a habit.

2. Check your own pulse. I was once told in residency, “When you get to a crashing patient, the first pulse to check is your own.” That is because when we face panic, we go into fight-or-flight mode forgetting our ability of critical and executive thinking. Therefore, do not jump into a situation if you are feeling as chaotic as your surroundings.

3. Stop panicking. When you are in the position of a team leader, whether running a code or as a teacher during medical rounds, everyone looks to you. If you will lose control, they will follow suit. Yes, you may be terrified on the inside, but if you can appear calm externally, your entire team will feel more capable.

4. Focus on what needs to be done first and do it. The complexity of dealing with a crisis can paralyze decision making. Following the example of how we prioritize the “A-B-Cs” in emergency medicine, identify the priorities in respect to your patient and address them first. Do not be tempted to get misguided in trying to figure out each and everything from the start.

5. Always communicate clearly with the team. Do not forget that your team can be a great source of insight. When I am taking care of a particularly challenging case, I will often stop and ask my team for any suggestions. Sometimes, a different point of view can make all the difference.

Try the above and see for yourself the changes that result. And always remember that you have the upper hand in ED-based crises as long as you approach them methodically.  

DISCLAIMER: Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences. 

About the Author: Dr. Muhammad Akbar Baig, is an FCPS-certified Emergency Physician currently pursuing specialization in the field of medical toxicology in the US. He has been a hacker in several AKU Hackathons. He has also mentored startups that are led by students or professionals.  ​ 

Editorial Note: This is from a 'phase II' continuation of Narrative Medicine at AKU - what started as a Workshop-based initiative on January 20th, 2016. The editorial work was performed by the Writers' Guild, an interest group at AKU, with the purpose to promote love of reflective reading and writing, within and outside of  AKU.