Resuscitation Rounds 

Emergency medicine is fast paced and requires rapid transition between tasks. This is why most of us fell in love with the speciality. Even on the busiest shifts there are moments to sit down and discuss emergency topics methodically. But what about bedside teaching?  Taking this one step further, are there education opportunities during active resuscitations? We offer some pearls on how to incorporate bedside education during the controlled chaos of resuscitations.

 

 

Two Minute Teaching

Active resuscitations can seem like controlled chaos at times.  Nurses, medics, residents, and attendings all have roles during these high stake scenarios. However, this does not mean education needs to stop. Many academic institutions have the luxury of multiple physicians in the resuscitation bay at once.  Here are some tips on how to utilize resources and maximize educational opportunities in the moment:

 

  • Teaching Resident: If you have more than enough help assign a resident to lead teaching to medical students who may be observing. Charge the teaching resident with assisting the interns in procedural mastery during the resuscitation.
  • Scribe: A lot of resuscitation bays have convenient monitors to document timing of interventions and medications given. Regardless if you have this tool, assign a non-essential team member to scribe on a dry board or glass window in the bay. This engages the ‘bystander’ team member, promotes mental visualization, and allows for quick differentials to be written down. Most importantly, this provides a framework for debriefing after case resolution.
  • Two Minutes: Between every pulse and rhythm check is two minutes. No need to PIMP on Henderson Hasselbach equations here. Rather, use this time to reinforce basics such as “quality CPR”, indications for defibrillation or challenge the team leader to anticipate interventions if the rhythm were to change on next CPR pause, or depending on what is seen on saved ultrasound clips during the check.

 

Bedside Teaching

Most of us are familiar with bedside teaching during the deliberate, and at times monotonous, internal medicine rounds from residency and medical school. However, there is immense value in discussion of patient presentation and care at the bedside. Most people are visual learners. If you can approach a topic and provide the learner with a patient to reinforce learning points you have a much higher chance of leaving a lasting teaching point:

 

  • Ultrasound: This a fantastic bedside educational tool to utilize at the bedside. Whether it is suspected or known pathology use ultrasound to illustrate disease states in the moment.  Heart failure, pulmonary edema, cholecystitis, and FAST exams are a few examples of quick bedside teaching pearls that can be demonstrated easily.
  • Physical Exam Findings: Nowhere in medical education does it say you are tethered to the patients with your name next to them on the board. Take a proactive approach in sharing interesting physical exam findings for others. In my experience, very few patients will deny other providers the opportunity to learn. If your patient has a unique physical exam findings share that with your team! Peritoneal abdomen, heptojuglar reflex, murmur, crepitus, neurologic deficit are just a few of the possible exam findings you can share with others.
  • Labs and Imaging: Similar to above. If there is an interesting imaging finding or EKG change, engage others so they too can learn.
  • Patient Discussions: too often patient findings (physical exam, labs, imaging results, etc.) are discussed between resident and attendings and then the resident is told to “go tell them the plan”. Although this “drop the kids in the deep end of the pool and see if they can swim” approach can work in some areas of medicine, discussing patient results and plans may not be the place to implement it. Having residents see how attendings discuss results, treatment options, give reasons to return is a vital opportunity for teaching residents the actual practice of medicine.

 

 

Take Home Points

Even busy ED shifts are filled with hidden teaching opportunities. The most impressionable teaching pearls are those that can be taught in the moment with real patient examples. Don’t be afraid to use the most chaotic moments of a resuscitation to impart knowledge to new medical learners. Remember, even in ACLS there are two golden minutes to make an impact in someone’s education.

  • Use your personnel resources: charge a team member to lead in education or scribing during the resuscitation.
  • Use technological resources: bedside ultrasound can be a great tool for in the moment education.
  • Share the wealth: find new learners in the department to share interesting exam findings with

Keep Learning! Emergency medicine is the best job in the world. We help people in their worst moments. We have a duty to our patient’s to keep improving no matter what level or experienced provider you are

 

Andy Little DO, Gregory Tanquary DO