Driving Pleasure
I’m not a car nut by any stretch of the imagination. I see driving as a means of getting from point A to point B. Of course I can appreciate a good car, but by and large it’s from a distance.
However, having spent the last 2 weeks or so pottering about in town, never driving above 35mph, I did enjoy heading home today. A nice open country road, no one else around. I might have contravened a few speed laws, but never in an unsafe way. Nothing excessive, I didn’t quite get to 80mph. But it was such a lovely afternoon, a bit of sun, a bit of cloud, nice and dry on the roads, it was difficult not to. There’s a good mix of long straights and sweeping curves.
It was fun.
iPhone love
A friend asked me the other day what I would do if they broke my iPhone. Not deliberately, but by accident. At the time I told them I would just buy a new one. After all, I am planning on upgrading from my current 2G original model to whatever Apple releases next summer. I could make do with an old phone for a few months, right?
Well; no, I couldn’t. The truth is actually slightly different. The way I envisage it, I would strangle the person with the iPhone sync cable; rather poetic really. Many phones ship with pathetically fragile sync/charge cables that would be no good for strangling people. Not so with an Apple product, you can get a nice strong grip on it. No way that thing was snapping mid-strangle, even if you got a fiesty one.
I would then hold a funeral. For the phone, clearly not for the person; they will burn in a level of hell specifically designed by Steve Jobs for people who break his beautiful products.
So, little tip for all you non-Appleists out there. Don’t pick it up if you aren’t willing to accept the repercussions of breaking it.
Loves
I was told today that I have three loves:
- Apple products (on which I am typing this)
- The outdoors (where I spend far less time that I should like)
- My girlfriend (whom I spent the evening with)
The person who told me this forgot to mention my other true love: medicine.
Everyone seems to be going a bit crazy about their future medical speciality right now, but I’m not one of them. Odd, seeing as how I spend so much of my time living in the future, but right now it doesn’t really concern me. I spent enough time thinking about it before I got in to medicine, now I’m just happy to be here. Some people simply knew they wanted to be doctors, I knew what specialism I wanted to do before I even got here. I talk about anaesthetics and critical care, and yes I might well do the critical care dual accreditation, but really, all I want is emergency medicine. Pre-hospital care would be an added bonus, but really that’s even further away.
But back to my love of medicine as a course. I think in many ways it’s true to say I do love it. I can’t see myself being happy with anything else. I derive a great deal of satisfaction from learning about it. I devout a great deal to time to it with no regret. I sacrifice many things for it, similarly with no regret. I plan on spending the rest of my life with it. Sure that is love; if not this, then what?
In many ways, medicine is the truest love of all. If I was told I had to give up three of the above four, if I had to choose which I could continue to have, it would unquestionably be medicine. Is that right? I don’t know. How many people would give up their girlfriend for their university course? Again, I do not know, but I suspect it would be more than one might imagine. In reality of course, such a clear cut choice would never happen. It is a balancing act. Apple products do not really demand much, but the other three have certainly battled for my time. Perhaps I do not always make the right choices, but we all make mistakes.
“Medicine comes first,” always.
Recorded Interview
As part of their dogged determination to teach us communication skills, the university set us up twice over the length of our course with a simulated patient and a video camera. The idea is that by looking back at how you did the consultation you can see what needs improvement, and by doing it twice you get to reflect on how much better you’ve become, or that’s the theory anyway.
Well, I had my first session today. I hadn’t really been putting in much work for the communication skills course up to this point. You know, fill in the answers to the questions in the 10 minutes before the tutorial, that sort of thing. I find that if you just try and remember that your patient is a human being and treat them as such, things usually go quite well. I decided that since this session was going to be held up as a typical example of my ability to communicate, I might put a bit of effort in. So I spent the morning revising from the workbook we were given, and from the Oxford Handbook of Clinical Examinations and Practical Skills. I got right into it, with some active learning. Some people draw pictures, some people write rhymes and mnemonics. Me? I put on some music (my ‘Revision’ playlist) sing along, prance about the room, talk to myself and scrawl all over the whiteboard on my wall. This sort of learning only works for some types of material, I used it extensively for anatomy last year, but obviously not for the sort of work I was talking about in my last post. It works because I enjoy it.
Anyway, I spent a good couple of hours on that and felt confidant that I could cope with most of what was likely to be throw at me. In our handbooks it said that all the presenting complaints would be either respiratory, cardiac or GI in nature. So obviously I focused on key questions for those systems. And yet, my ‘patient’ presented me with something else entirely. Red, itchy eyes. You can actually see the moment she says this when you look at the video, even on mute, not by looking at her, but my looking at me. There is a moment, nothing more than a fleeting glimpse, of pure and unadulterated shock. Obviously I get it together very quickly since my first few questions are basically the same no matter what you say is wrong, but inside I’m frantically searching for an algorithm for the eyes. I come up with nothing. Since the point is communication skills and to eliciting a diagnosis, it doesn’t really matter. You can go in there with a generic routine for any symptom and do just fine, and obviously that’s what I fell back on. I just think it looks a bit slicker if you can pull some specific questions, apparently out of thin air, dealing particularly with the complaint presented to you. I went back and looked in the textbooks about eyes. Certainly at our current level there are no symptoms or signs associated with disorders of the eyes, only specific things that can be seen in the eyes that are symptoms of other pathology. “Red, itchy eyes” is not a clinical sign we have been taught to recognise for anything, other than the obvious things like allergies, which I don’t think this girl had.
And that’s another thing, she was a girl. As in, she was younger than me. I was expecting someone old, almost every other simulated patient we’ve ever had has been into their 50s at least. To say I was surprised when this girl in a school uniform walked in to the room would be an understatement. And she asked me to refer to her by her surname, not her first name. It was odd saying “Miss itchy-eyes” to someone younger than me. However, once I overcame all the surprises that beset me, I don’t think I did too badly. Did I extract a perfect history? No, of course not, there is no such thing, but I think for the most part I communicated effectively and did my best to put the patient at ease, even if I did forget that they were just another human from time to time.
Problems
I have a problem.
Well, I have many problems, but let’s just focus on one for now. My problem is I can’t study, specifically I can’t study at home. There are places where I really like studying. The Matthew Hay building, much as I might complaint about it’s ‘official’ name of “The Suttie Centre for Teaching and Learning in Healthcare” (yeah, don’t even get me started); about how there are no hand driers in the male toilets on the 1st floor [Ed: Fixed, although there are now no mirrors??]; and about how they’ve left an entire internal wall as bare concrete, not even a coat of paint; I actually really like the place. In fact, I’m really tempted to take my video camera in one day I’m staying late and just walk around with it. It looks amazing at night, it’s peaceful and open, well lit and beautifully architectured. I find the whole place very conducive to study. I have my favourite spot, it’s in the back corner of the first floor (hence the problem with the absent hand driers), with my back to the dark window, looking out across the inside of the building: the sculpture, the art, the shadows cast by the up- and down-lighting. I don’t mind studying in the computer room either. It is on the ground floor with two walls floor to ceiling glass, again looking out onto the dark night and the hospital grounds lit up around you. It reminds me why I’m here; I think of all the patients settling down to sleep on wards, the duty anaesthetist doing a solitary ward round on ITU, the StR in A&E preparing for the long night shift. It’s also a great help that the desks have plenty of space, you can shove the keyboard out the way and really spread out. I don’t really like working in the café area, I associate it too much with socializing, but at a push…
The whole thing just makes me feel at ease and relaxed. I can sit down for a solid 2 hours when it’s quiet and just write. I know many of you are probably thinking, “pft! 2 hours? so what?” Well for me, that’s a pretty decent study session. I used to have trouble lasting more than 45 minutes with my head in the books, and that was assuming I got past the first, fidgety, five minutes. So getting in a couple of hours, then being able to go back again after a quick twitter/blog reading/coffee break is actually quite monumental for me.
The problem arises if I have to go off and do something else then go home. Today it was because I agreed to help Becky pick up a bookcase from Argos and take it to her flat; having a car does have it’s disadvantages, not that I mind really. It seemed stupid to go straight back to the hospital having just left, so I told myself I’d go home and force myself to study. Would you like to guess what happened? Bugger all studying, that’s for sure. Okay, in 4 hours I wrote up one lecture. It wasn’t even like I was paraphrasing the information, I was just copying from the notes I made in the lecture to a more structured form. I did everything I could to avoid iworking. I faffed. I watched the last 30 minutes of a movie I started watching yesterday. I caught up on blog reading. I though about reading a book, but didn’t quite. I even got to the point that I just couldn’t figure out what else I could do to avoid studying, so I just threw myself on to my bed, pulled the covers over my head and lay there for a few minutes. I realize this probably isn’t ‘normal’ behaviour, but when I get into these kind of desperate moods I’m not really good for much else. Anyway, we can discuss whether I actually have a mental illness another time. There is, I think, a reason I find it so hard to work at home. It boils down to the fact it isn’t really ‘home’.
It’s like when I was studying for my Highers back at school. I told Dad many times that I couldn’t come over for the weekend as I usually did because I needed to study. He always suggested I just bring my books and work at his house. He doesn’t really understand the system. First off, I need to set up a place to study, I can’t just plonk down anywhere and pull out the books. I need a location that’s just right, with everything I need within easy reach, and just enough distractions to amuse me when I tire of work, but not too many, otherwise I never go back to work. The other problem is I need to be in a place where I feel comfortable and relaxed, hence why I made such a big deal about these things when talking about Matthew Hay. These are certainly not emotions I feel when I’m at Dad’s house. Mum understands that when I disappear behind that door, nothing short of a nuclear winter is sufficient excuse to disturb me. I need to get into the zone, and it’s very ease for me to fall out of the zone. I just couldn’t achieve that zen-esque state at Dad’s house, and I can’t achieve it at my flat now. I’m just not comfy enough. I’m always slightly on edge, that I might be called upon or spoken to. It’s not ’stressful’ in the conventional sense of the word living here, but nor is it a place I can really chill out in either. I know this is a problem, and if I though I could do something about it I would, but I don’t think I can. Perhaps with time it might feel more like a home to me, but not any time soon. The cats, particularly, stress me out completely out of proportion to their size. I’m an animal lover, I adore them all, but I have never come across a pair of animals I have more wanted to kick than these cats. Rest assured I never would, kicking an animal is an absolutely abhorrent act to me, I would honestly rather kick my best friend in the face than kick an animal. This does not seem to preclude me from fantasising about causing these cats considerable discomfort. It is very strange, I cannot explain it, I have never met an animal I actively dislike before. There have been those that I am ambivalent towards, those who weren’t exactly my favourite, but never a true dislike. I have a friend from school who really dislikes dogs. All dogs for some reason, he’s very much a cat person, and I just never got it before. Now I do. Everything they do annoys me.
I know that by this point some of you are probably thinking, “wow dude, just chill out. Don’t worry about it!” Has there ever been a less helpful response?? If I could just “chill out”, don’t you think I would? I am normally a difficult person to offend and a difficult person to rile. When I flip, I usually loose it big time. It’s not a pretty sight and afterwards I’m always sorry that I did, but in that moment seeing the look on the person’s face as I shout them down in front of a room full of people is worth any price. I have been more irritable of late and I’m sorry for that, it’s no one’s fault and as usual the people who deserve it least have to put up with my abruptness the most; just tell me to buck up and get a coffee. Even better, bring me a coffee and I promise to be nice to you for at least 12 hours! This whole thing is probably because I’m making an effort to care more about studying, and because situation and my psyche conspire against me to make that difficult, I start getting flustered about that which I would normally not care about. I realize this is a far from ideal situation, and as I’ve been saying these past few days, I’m either going to work myself in to the ground or just adapt to this new level of intensity. Then I might stop jumping down people’s throats and going quiet and moody because of stupid little things. Hey, I might even start being a half decent boyfriend again, but let’s not get our hopes up, eh? Several years of past experience would suggest it’s highly unlikely that’s going to happen on it’s own, I usually need to be shouted at.
Busybusybusy
I’m very busy now and for the next couple of weeks. As such, blogging will be absent.
Apologies.
Found:
One state of Nirvana.
Characterised by:
- Extreme motivation to work
- Reduced need for sleep
- Good vibes
- Lots of energy
- Everything going right
Found within last week. Owner can call to reclaim item.
Good Lectures
I know I quite often complain about when we get rubbish lectures or the university send us to pointless lessons, case and point in Inter-Professional education. Rarely, it seems, do I praise good practices. Well that’s about to change. In this last block, Principles of Disease, we’ve had two amazing lectures.
The first is a pathologist, he gave us lectures on the inflammatory response. I have mentioned him before, he’s the one who I had the big rant with last year about the state of post graduate medical training.
In the course of these recent lectures he has:
- Danced and sung a song
- Lay down on the floor, face down, and commented “it’s really not that interesting, you know”
- Told us “25% of what I teach you is probably crap”
I really like him, not everyone does though. I believe some people disapprove of his swearing, which is always proportional and never offensive.
The second amazing lecturer I will tell you about later.
Wards – Week 1
Now that I’m in second year I spend two hours on wards one morning a week. We’ve only been back three weeks now, although it feels like much longer, so I’ve had a couple of sessions there so far. And to date, they’ve been quite enjoyable. As I’ve said before, I’m on the respiratory wards, which is actually split in to a male ward and a female ward. So, what have I been up to?
Week 1
Most of us arrived 10 minutes early since it was our first day and we were really keen. Other people in our year kept walking past up and down the stairs looking lost. As it got to a couple of minutes to 11 we decided the girl who hadn’t turned up yet wasn’t going to, so we just ventured in. The junior doctors’ room looked like I hopeful place to wait, so we went in and blocked the place up very effectively. Doesn’t matter where you stand, you’re in the way. It’s best to just kind of move in a loop, blocking the light box, the notes trolley, the door and the computers in turn.
Our consultant was remarkably close to being on time, far closer than my regent has ever been, brilliant as he is. He took us through to the staff room, which was much smaller, people had to sit on the coffee table, but at least it was empty. We were given a couple of forms the likes of which junior doctors would use to clerk in patients. He started with the example of chest pain, what would you ask specifically about the pain. Going round the room, I was second last to have to provide an answer. Everyone had already said all the things I’d thought of, so I decided to give an answer I knew was sort of right, but not exactly what he was looking for, rather than just stare blankly at the floor. They hate it when you just stare blankly at the floor.
We went through all the things on the form: history of presenting complaint; past medical history; social history; drugs and allergies. The very basic, very important stuff that should become second nature. Then we went through a pre-formatted clerking sheet that detailed every question we should ask for each body system, which obviously took some time. All this took us to about 11:45, at which time he declared we were ready to be let loose on patients.
Our consultant, whose name I’m ashamed to say I’ve forgotten, took us out on to the male ward and over to a patient. He had been pre-warned of our appearance and was in “good humour,” as our clinical skills videos relentlessly bleat at us. The consultant took a full history from the patient as though he was just a lowly junior and clerking the patient for the first time. We thanked the patient profusely and were shepherded off to a different fellow. We were introduced and Robert, who obviously looked the most competent, was asked to take a history. I was certainly slightly taken aback for a second, and I’m pretty sure Robert was too! I was expecting to meet patients, yes. I was expecting to be asked to talk to them, but I was not expecting to be just thrown in at the deep end. I guess it’s probably the best way.
Robert did a fine job extracting a history from the patient, who was very compliant but did tend to drift off into unrelated subjects. It was helpful that the patient presented us with a diagnosis before Robert had even started asking questions. Most of the other members of the group got a chance to take different bits of history from a couple of different patients before we were hustled off again to our final patient. We were introduced to John, a 68-year-old man, before the consultant turned to me and said “why don’t you get a history of presenting complaint and medical history.” Right, easy done.
I stepped forward and shook hands, introducing myself as a 2nd year medical student and by first name only. He looked reasonably healthy, with the exception of a slightly distended abdomen. I established a history of the presenting complaint, which incidentally had absolutely nothing to do with his respiratory system, odd seeing as how I was on a resp. ward. No problems there, he’d had this present condition for about five year, so although exact dates were sketchy the important events had obviously been recounted so many times to so many different people that they were easily reeled off again for my benefit. I asked about any other medical history; “none,” he said.
“No surgery or stays in hospital before this started?”
“No,” a simple answer, and easy for me to deal with: move on.
“Any family history of diabetes, heart attacks or asthma?”
“None.” They seemed considered answers, it wasn’t that he was just replying “no” to everything I said. I don’t know what made me ask, it wasn’t something we had discussed before we came out to the ward, but it seemed appropriate.
“So, how did they discover you had these polyps?”
“Oh well, it was when I went to my GP after my fits started, back when I lived in London with my daughter. He did some blood tests and they found them then, like I say it was about 5 year ago now.”
Bingo. Fits? He hadn’t mentioned these fits before. Seemed like a significant medical history to me, even if he did only mention it in passing, buried in a load more fluff then I’ve illustrated here. I figure, go for the direct approach.
“So, these fits you mentioned…?”
“Oh yes. I tripped you see. Bashed my head on a rock.” At this point the patient looks up at me, as though expecting another question.
“Yes?” I prompt.
“Well I ended up in hospital for a few days. A week I think it was, I had bleeding, in my brain. That’s when my fits started.”
I was replaced by a different student at this point, who asked very quickly and quite quietly about social history. The patient stopped for what I can only describe as a dramatic pause, before enquiring quite slowly and clearly what she had just said. He was quite the character. She managed to extract a history of smoking, and eventually, some significant whiskey drinking that the patient was clearly ashamed to admit.
We gathered in the hallway afterwards and our consultant explained the full history. Turns out he fell over, hit his head and ended up with a subdural haematoma that the surgeons decided not to operate on. It resolved by itself but left him with an epilepsy type brain injury that resulted in fits that were currently being controlled by medication. Our consultant praised us all, then me individually for picking up on the fitting comment then pressing for more information. Ok, I admit it, hearing him single me out like that made me pretty happy. It also gave me the opportunity to ask why the hell the patient was on a respiratory ward with ascites and polyps?
Pulmonary hypertension, secondary to liver cirrhosis, as a result of all that whisky drinking in the past. Ah.
Overall my first experience of wards was a good one. I actually enjoyed being throw in to the thick of it, and once I got over the initial “oh my god I’m speaking to a real patient I mustn’t mess up” and got into the flow I really enjoyed it. I may not have much actual knowledge of disease processes or presentation, but even slotting in the little bits and pieces of theory that I do have to the real person in front of me is a great feeling. It has already made 2nd year far better than anything we did in 1st year, and I think it is a good sign for the future.
As this is the first time I’ve spoken about patients directly, I feel duty bound to make something perfectly clear. I’m sure you all know what it is, and many of you have probably been wondering where it is. I refer to the disclaimer. There always is one on medical blogs. Somewhere, tucked away at the bottom or displayed prominently in the sidebar, depending on the balls of the writer, you will find it. Well here’s mine:
Obviously the patient I met on wards that day was not John, a 68-year-old male from London with ascites, benign polyps, a drinking history and pulmonary hypertension. Those details have been changed to protect his confidentiality. I do actually like being a medical school, and as such I’ve no plans to be thrown out by a fitness to practice committee. What is true though is the gist of the story. The key points and the message behind it are not fabricated, but they have been woven in to a slightly different tapestry to ensure everyone is protected.
Resuscitation Training
I have tried to make this post as understandable as possible for people of a non-medical background. If you are a medic, or even a first aider (no disrespect to you), you’re probably going to find some of my explanations a little basic.
At uni, we have just been given two lectures on Basic Life Support (BLS). This is the sequence of actions (or ‘algorithm’) that you follow if you find someone who is unconscious, unresponsive or not breathing, and includes things like mouth-to-mouth ventilation and cardiopulmonary resuscitation (CPR). These lectures are part of an ongoing series throughout our five years as medical students that teach us how to respond if we encounter these very time critical emergencies. Several studies have shown that mortality, that is, number of people who die that could otherwise have been saved, increases by 7-10% for every minute that the application of a defibrillator (which passes an electrical current through the heart) is delayed. Of course, if no one is there to give assistance, or is unwilling to help for whatever reason, then mortality from cardiac arrest is 100% (unsurprisingly). It is therefore vital that as many people as possible are taught what to do in an emergency such as this.
Any first aid course should teach you two distinct types of things: How to deal with the everyday cuts, burns and sprains you will encounter reasonably often through life; and how to deal with the cardiac arrest events that many people will never witness in their lifetime. In my opinion, a first aid course that doesn’t teach good, effective CPR and BLS is less than worthless. Being able to put on a bandage doesn’t save a life; BLS does. That isn’t to say that other first aid skills aren’t important, I very much believe they are, but I know who I would rather have around if the proverbial shit hit the fan.
To return to the instruction we get at university, in first year we were given a small group tutorial followed by a practical session on BLS. It was the most basic of life saving skills; how to deliver effective CPR and rescue breaths. Now, in second year, we will get another small group practical and the lectures I mentioned above. These lectures refreshed our knowledge of adult BLS and introduced us to paediatric/neonate BLS and the choking adult or child.
When I trained as a first aider, I was taught not to look for a pulse, but instead to look for signs of life, such are movement, coughing or colour in the extremities. This was borne out of research that suggested it takes too long for lay rescuers to find a pulse, if there is one present1. I was under the impression that this was in line with the new guidelines issued by the European Resuscitation Council, the not for profit organisation that commissions and evaluates best evidence for this sort of thing. As it turns out the newest guidelines suggest that even looking for signs of life is little better, and first aid courses should simply teach to begin CPR if breathing is absent in an adult. As medical students however, we are taught that we should be looking for a pulse in BLS situations. There have been mutterings on twitter that we shouldn’t be taught to look for a pulse, as it wastes time. This is where we encounter our first conflict with first aid training.
As a medical student who is also a qualified first aider, I have to make a distinction between the two related but distinct bodies of knowledge I’m being given. First aid training is a one off event for most people. They go for a day or a weekend and learn a lot of things that they are rarely going to have to recall. Three months later they’ve probably forgotten more of it. The goal of first aid training is therefore to give people simple, basic information that is easy to retain. As a student doctor, I’m being taught BLS as preparation for the fact I will go on to learn intermediate life support (ILS) in a few years. This means there is a slight shift in the emphasis of what we are being told, despite the fact it’s all still BLS right now.
There was another study done just a few years after the paper on carotid pulse detection in lay persons that assessed the ability of health care professionals to detect a pulse in a healthy adult male2. This study showed that even the ability of doctors and nurses to detect a pulse is inadequate. Obviously you cannot simply say to doctors in training, “we don’t trust you to find a pulse, so look for something else instead.” We have to be able to quickly and accurately determine the presence or absence of a heart beat, without a heart monitor (which often isn’t that useful in an arrest situation anyway). This is why, even from this early stage, we are being taught how to look for a pulse and being assessed on our ability to find one. Indeed, it might waste time now, when we’re practising on dummies and each other, but that is quite the point, we can waste time now because nobody is about to die. We waste time practising it the ‘hard’ way so that when the time comes, we have the skills to make that determination.
The second discrepancy arises in paediatric basic life support. We were taught that in resuscitation of a child, the best ratio of compressions to rescue breaths is 15:2. This was the ratio of adult BLS in the old guidelines, but changed to 30:2 with the new recommendations several years ago. A couple of people have been complaining that what the university teaches is wrong, and that the British Red Cross, St. Andrew’s Ambulance Association and St John Ambulance all teach a 30:2 ratio regardless of the age of the patient. I found it very unlikely that what we were being taught was genuinely wrong, just different. In all honestly, I would treat information given to me by the university preferentially to information delivered by a first aid charity, although I humbly suggest neither is wrong. I went and read the guidelines and discovered that I would be correct in that humble suggestion. I reproduce the paragraph below directly from the ERC 2005 paediatric resuscitation guidelines.
The ILCOR [International Liaison Committee on Resuscitation] treatment recommendation was that the compression:ventilation ratio should be based on whether one or more than one rescuers were present. ILCOR recommends that lay rescuers, who usually learn only single rescuer techniques, should be taught to use a ratio of 30 compressions to 2 ventilations, which is the same as the adult guidelines and enables anyone trained in BLS techniques to resuscitate children with minimal additional information. Two or more rescuers with a duty to respond [i.e. health care professionals] should learn a different ratio (15:2), as this has been validated by animal and manikin studies. This latter group… should receive enhanced training targeted specifically at the resuscitation of children. … There is certainly no justification for having two separate ratios for children aged greater or less than 8 years, so a single ratio of 15:2 for multiple rescuers with a duty to respond is a logical simplification.
It would certainly negate any benefit of simplicity if lay rescuers were taught a different ratio for use if there were two of them, but those with a duty to respond can use the 30:2 ratio if they are alone, particularly if they are not achieving an adequate number of compressions because of difficulty in the transition between ventilation and compression.© The European Resuscitation Council, 2005
The emphasis is my own, as I believe it highlights the two key points I’m trying to make. That what the university teaches us is correct, and that there is a discrepancy between what they tell us and what we are taught by first aid groups because of the differing goals of these two organisations. Crucially, as doctors we will usually be responding in a health care setting where there will be more than just ourselves avalible to help, hence “two or more rescuers”, hence 15:2.
In summary, being a medical student and a first aider can be confusing. You’re being taught different things and will be assessed differently depending on who’s watching you. However, in principle the idea is the same, keep someone alive until definitive help arrives. The details are unimportant, effective CPR and quality rescue breaths are.
References:
1. Jan Bahr, Heiner Klingler, Wolfram Panzer, Heiko Rode, Dietrich Kettler. Skills of lay people in checking the carotid pulse. Resuscitation 1997;35:23—6.
2. F.Javier Ochoa, E Ramalle-Gómara, J.M Carpintero, A Garcıa, I Saralegui. Competence of health professionals to check the carotid pulse. Resuscitation 1998;37:173—175
The full resuscitation guideline can be found here.
Finally, Kal over at Trauma Queen wrote not only about why we resuscitate babies differently, but also about his fear of being sent on a neonate job in: Paediatric screaming terror.
