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The Procedure Paradox

Why high risk procedures in the ED place clinicians in tricky siutations

http://www.stemlynsblog.org/the-great-day-paradox-st-emlyns/

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The Procedure Paradox

  1. 1. How it felt Simon Carley @EMManchester
  2. 2. Standby phone
  3. 3. 14 yo Fall from height GCS 14 No IV access Possible Pneumothorax Abdominal injury
  4. 4. excitement
  5. 5. Intervention Me Children Parents/Carers Distraction Bubbles :-) Bubbles :-) Bubbles :-) Ketamine Awesome Wheeeeee Trippy Pulled Elbow Watch how cool this is Ow, but thanks! Wow! Cannulation I’m good at this NEEDLES!!!!!!! PLEASE get it in 1st time Chest drains Love them Aaaaaaargh!!!! OMG Thoracotomy I am the Resurrection Dead/Nearly dead. No words
  6. 6. Intervention Me Children Parents/Carers Distraction Bubbles :-) Bubbles :-) Bubbles :-) Ketamine Awesome Wheeeeee Trippy Pulled Elbow Watch how cool this is Ow, but thanks! Wow! Cannulation I’m good at this NEEDLES!!!!!!! PLEASE get it in 1st time Chest drains Love them Aaaaaaargh!!!! OMG Thoracotomy I am the Resurrection Dead/Nearly dead. No words
  7. 7. Intervention Me Children Parents/Carers Distraction Bubbles :-) Bubbles :-) Bubbles :-) Ketamine Awesome Wheeeeee Trippy Pulled Elbow Watch how cool this is Ow, but thanks! Wow! Cannulation I’m good at this NEEDLES!!!!!!! PLEASE get it in 1st time Chest drains Love them Aaaaaaargh!!!! OMG Thoracotomy I am the Resurrection Dead/Nearly dead. No words
  8. 8. Intervention Me Children Parents/Carers Distraction Bubbles :-) Bubbles :-) Bubbles :-) Ketamine Awesome Wheeeeee Trippy Pulled Elbow Watch how cool this is Ow, but thanks! Wow! Cannulation I’m good at this NEEDLES!!!!!!! PLEASE get it in 1st time Chest drains Love them Aaaaaaargh!!!! OMG Thoracotomy I am the Resurrection Dead/Nearly dead. No words
  9. 9. 2
  10. 10. 2 Need
  11. 11. 2 Want Need
  12. 12. Are your intentions honourable?
  13. 13. It’s not going well
  14. 14. a
  15. 15. self team environment
  16. 16. self team environment
  17. 17. self team environment
  18. 18. self team environment
  19. 19. The Procedure Paradox
  20. 20. Final thoughts

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