Thursday 11 June 2009

Rise of the Machines

With all the technological advances in Emergency Medicine that have happened over the last few years, especially with regards to ambulances, sometimes it's easy to forget that we're treating the patient and not the machine.
Alex is a 55 year old man. Asthmatic since childhood. Heavy smoker since not long after that. Not a good combination.
His breathing today is the worst it's been for a very long time. He's tried all his normal remedies, including oxygen that he now has at home, but has realised that this time he's going to need an ambulance.
I'm back on the FRU again, and turn up first. The smell of smoke hangs heavily in the air, and there's a light fog to go with it. As I walk through the mist, Alex's friend calls through to say that it's OK, he's put out all the cigarettes, and it's safe for me to enter. I don't need to listen to his chest, I can hear the wheeze from the hallway. He's struggling to put 3 words together, and looks very flushed. "I.... Can't.... Breath...."
I put Alex on a nebuliser, and check his observations. His oxygen levels are a little low, his breathing rapid and noisy, and his pulse escalated. After a few minutes on the nebuliser his breathing eases a little, and the oxygen levels begin to improve. The crew turns up as well.
"I still.... Can't breath...."
"Don't worry", says one of the crew, "the machine says you're doing fine, and the machine's never wrong."
"But I can't..... Breath...."
I can't imagine what it must feel like to struggle for breath, but then to be told that the machine says that everything's ok, must just add to the anxiety. Alex's breathing was getting better. Slowly, but definitely improving. Except that he still didn't feel like it, and that needs to be our main concern.
Show some level of empathy.
Treat the patient. Don't just treat the machine.

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