Our first taste of emergency patient management: four students ready to handle whatever the surgical ward has to throw at us. We take a call; a 58 year old woman, increasingly short of breath two hours post elective laparoscopic cholecystectomy who has just been started on postoperative antibiotics—can we please review? Of course we can. We calmly discuss differentials, drawing on almost 20 years of medical school experience between us, and plan each person’s role on our walk to the ward. We grab the observations chart from the nurse and greet our patient who seems quite well—just a little out of puff, as though something is stuck in her throat. Then suddenly, she gets worse. Her tongue swells as she gasps for air. This catches us off guard. We check her notes to discover with horror that she has been prescribed intravenous piperacillin and tazobactam (Tazocin) but has a penicillin allergy. Then all hell breaks loose.
Someone scrambles for the anaphylaxis protocol. Another two begin frantically assessing “ABCDE,” as we’ve been taught to. Someone else runs for the box of airway adjuncts. Despite the protocol, we all get muddled and miss steps. We spend quite a lot of time on “A,” but it’s a while before we choose and successfully administer an adjunct. The calculation of drug doses that is normally so easy in prescribing examinations seems to take hours. Drawing up doses from complicated little ampules presents a further nightmare. No one is quite sure when or whom to call for help, but time’s passing and we aren’t getting to grips with things. One of us scampers off to summon the medical registrar, or surgical registrar—anyone to come bail us out.
In our panic, nobody remembers to disconnect the culprit antibiotic infusion for five minutes, counteracting our heroic efforts. We soldier on, trying and failing to get into our stride, when the door opens, in walks the registrar and we breathe a sigh of relief. It’s over.
Luckily, this is a simulation training day, and our patient remains unharmed. But our experience prompts me to ask—why were we all so unprepared to deal with a relatively simple emergency? We’ve read about it in detail many times, and with some of us less than 12 months away from hitting the wards it should be a situation that we know inside out. Our debacle was recorded, and afterwards we return to a group of our peers to watch the highlights. We squirm over our incompetence and errors, and discuss what we’d do differently. Others comment on what was done well and what wasn’t. We learn, and then we wonder why it has taken until the end of medical school to do something this useful. I think many medical schools are guilty of favouring detailed knowledge over practical skills. Although I agree that a level of knowledge is necessary, come foundation year one, I think I’d value a few more sessions with our simulation patient over a working knowledge of mass cell surface markers.Anna Kate Barton, fifth year medical student
1University of Edinburgh
Correspondence to: A.K.Barton@sms.ed.ac.uk
Competing interests: None declared.
Patient consent not required (patient anonymised, dead, or hypothetical).
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f7378