Indexing Title: NALUDINOs Medical Anecdotal Report [04-6]

MAR Title: The right decision

Date of Medical Observation:  August, 2004

Narration:

 It was a weekend, another sleepless night. Quite a number of patients were coming to the Surgery Emergency Room. The usual motley crue of patients. Routine? It was beginning to look like it.. At around 6 pm, a patient was wheeled in, apparently a stab victim. The patient was hypotensive and in respiratory distress. Closer examination revealed multiple stab wounds to the chest with decreased breath sounds. I immediately informed my seniors and decided to insert a chest tube. The immediately relative expressed his objection and said that we might just complicate his condition. I explained the procedure to him and told him that if he insists otherwise, he must sign the medical record. Through all this, I was still preparing to insert the chest tube, with consent or not. He ultimately allowed us to proceed with the procedure.

Upon insertion of the chest tube, fresh blood was evacuated. The patient later on showed improvement. Together with other measures we instituted the patient eventually recovered and was discharged.

Looking back, the decision to insert the chest tube was the crucial point. If the relative prevented us from doing the procedure he would have certainly signed the death warrant of the patient. He trusted us to make the right decisions and I am glad we did.

Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements)

Do not panic. Panic makes us irrational and as a result, make the wrong decisions. In the emergency room it is essential that we the residents show composure all of the time. Our clerks and interns depend on us to make the right, informed decisions. We must therefore be equipped to think on our feet, be rational when everything seems chaotic. We must put order into things. We can only do this if we have the right knowledge and skills. It is therefore encumbent upon us, to continually learn new things and reinforce the knowledge we already have.