Managing Medical Emergencies:

A Peek Inside the Sausage Factory

This was a typical cheerleader circa 1893. The subject
of today’s tale looked nothing like this.

They say you should never tour a sausage factory. The tacit implication is that if you knew what went into making sausage, you’d have eaten your last. As with most professions, medicine is like that to a degree as well. Before I went to medical school, I assumed that doctors generally knew what they were doing. Reality is not infrequently something else altogether.

It’s really the fault of the movies. In the classic Western film, if Tex gets gut shot, but you can get him to the local sawbones in a timely fashion, he’ll be fine. Forget that the standard of care for this era was tobacco smoke enemas and the liberal application of leeches. In that weird artificial world, doctors can fix almost anything with nothing more than hot water and a stethoscope.

Modern movies are little better. Big-screen heroes bounce back from some of the most egregious trauma with few, if any, residual stigmata. In the local cineplex, anything but a clean shot through the heart or brain will rarely even slow you down. It’s like action heroes are all Terminators. Reality is, lamentably, not quite like that.

Cheerleaders start pretty young these days.

You Never Forget Your First…

My first sort-of medical emergency occurred when I was a college student. At the time, I had the coolest job in the history of jobs. I was a counselor at a cheerleading camp. At least, that’s how I’d describe it on a CV.

In reality, I was more of a chattel slave. Several thousand high school cheerleaders from all over the South converged on the University of Mississippi for some intense instruction from the Ole Miss cheer squad. I was tasked to keep the Gatorade topped off and address problems as they arose. My job title was actually Gopher, meaning to “Go For” stuff.

It was Africa hot, and these hundreds of perfectly turned-out young ladies were bouncing and screaming underneath a blistering sun. I sat off to the side in a university van, standing by to do stuff as it needed doing. Then, one of the perky young lasses fell out.

That wasn’t all that unusual. It was hot, after all, and they all seemed a bit anorexic. However, when I got to this young lady’s side, she proceeded to vomit up great gouts of bright red blood.

I know a little bit about human anatomy and pathophysiology nowadays. I didn’t know anything about that stuff back then. However, I was insightful enough to appreciate that a 110-pound girl shouldn’t be yakking up a quart of bright red blood. Channeling my inner superhero, I hefted the limp lass up and carried her bodily to the van before violating all manner of traffic laws in my mad trek to the local emergency room.

Everything Starts With A Good History And Physical

The ER guy was as impressed with the story as I had been. By now, the girl was hovering in and out of consciousness. I’m sure, in retrospect, that she was both tachycardic and pale. That bought her a ticket to the front of the line.

They let me stay with her, which was weird in retrospect. I couldn’t have been mistaken for her dad. If I was what passed for an authority figure, she was pretty much doomed. However, the ER doc jostled the young woman awake long enough to field some questions.

Nothing seemed illuminating until they asked when she had eaten last. I can only assume there was a CT scan in her future, and this was, therefore, pertinent. She duly reported that she had skipped breakfast but had rather downed a Big Gulp Cherry Slurpee from 7/11 before reporting to the practice field.

At this revelation, everybody palpably relaxed. The girl spunked up with a liter of IV fluids and resumed her foolishness the following day. No harm, no foul.

Every good diagnosis begins with a thorough history and physical.
Sometimes you should start by asking if the patient has visited a minimart recently.

A Fixed Point

By now, I have actually managed my share of real medical emergencies. I have subsequently come to appreciate that, while technical knowledge is important, a generally implacable demeanor is all the more so.

When life is going sideways, people need a fixed point. Military leadership works the same way. When lost or terrified, the human animal just wants to be told what to do. Whether you are an Army officer, a highway patrolman, or a physician, that’s an integral part of the job description.

Sometimes things really are as dire as they appear. As a cop, soldier, health care professional, or simple unlucky civilian, we need to be ready for that. However, to paraphrase Kipling, “If you can keep your head when all about you are losing theirs and blaming it on you … you’ll be a Man, my son. Oftentimes it really is that simple.”

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