I’ve been reading a great book about decision making.
'How Doctors Think' by Dr Jerome Groopman discusses, with case examples, the way in which human clinicians make decisions. And the interesting thing is that they’re not that different to the vets.
When first faced with an emergency the author didn’t know what to do. At university he had been able to spend minutes or hours thinking about one case: What were the clinical signs? What could be the problem? Developing an extra long list of differentials make himself appear knowledgeable in the class. And he was. But when you’re faced with a patient, you need to know what to do now. Not what the 20 top differentials are.
So when faced with an emergency what could you do? Well, it will depend on the type of emergency.
If they can’t breathe check the airway and give oxygen. There’s no point in giving oxygen if their airway is blocked with a ball.
If they’ve collapsed, look at the colour of mucous membranes, get an IV line and give fluids.
If they’re bleeding try to stop it. Determine if it’s arterial or venous. Pressure on arterial won’t work. You need to clamp an artery if it’s bright red blood shooting across the room.
That reminds me of a case from practice. I was presented with a rat which was having problems breathing. Looking in the mouth I could see something moving at the back of the throat. I had not idea what it was, but we had to do something to improve the rat's breathing.
What would you do?
After anaesthetising the patient I was able to get a better look at the back of the mouth with an endoscope. I could see a flap of something moving each time the rat breathed. Gently grabbing it, it easily came away - I pulled out a necrotic lining from the respiratory tract. Breathing immediately improved and I woke up the patient. It did fine.
I don’t remember being taught that at vet school.
Every day you are going to work with cases that didn’t read the text book and you were never taught what to do. You need to be able to take what you do know and apply it to different situations. Sometimes you will think about what you can do and use System 2 thinking, but a lot of the time you will just act on System 1 responses. So you need to build up that data base - cases from seeing practice, cases from vet school, simulations, even cases on TV. Bank as much experience as you can - it will come in useful.
Back to, what to do when faced with a case. After giving oxygen, stopping any bleeding and getting an IV line, you can then get a minimum data base.
· Get a blood sample - check glucose. Get a pcv.
· Get a urine sample – do a dip stick. Remember ketones don’t always show up on dip sticks.
Think about the clinical signs – what is the animal doing – can it breathe, what colour is it, is it in pain? Does anything immediately come to mind?
We are always telling you that System 1 thinking is bad. It leads to short cuts and you can miss something. But when faced with an animal that could die at any minute, patterns and shortcuts have their place. Talk to any older vet and they will have a routine – what do they always do first when faced with an animal?
As a student, start to develop your own plan. In an emergency what could you do first in most situations?
Oh and if you have any spare time, have a read of Dr Groopman's book.