Welcome to First10EM, a FOAMed project where I plan to contemplate the necessary actions of the first 10 minutes in the resuscitation room for patients that I might encounter in the future. This is a site about resuscitation. It is about what to do when the sickest patients are wheeled through your door and it is about how to prepare yourself before you ever see those patients.
“First 10” refers to the first ten minutes in the resuscitation room, when immediate action is necessary and information is generally lacking. In most of medicine, I am a strong believer in doing less; in the mantra “don’t just do something, stand there”. The first ten minutes in the resuscitation bay are an exception. They are a time for action rather than contemplation. You must know what you are going to do, how you are going to do it, and why it is being done well before the patient arrives.
My goal is to create a collection of the scenarios that need to be managed instantly. Things that we need to know cold, because we will never have time to look them up.
For me, this is also a site about simulation. Not the kind that occurs with a group around a high tech mannequin, but the kind that you can do anywhere and everywhere. The kind that occurs within what I have heard Cliff Reid (@cliffreid) refer to as “the most high fidelity simulator in the universe”: the human brain.
The idea is to visualize the case – to truly simulate it in your brain – to the extent that you can actually picture your own resus room. So that if your third option for managing a difficult airway requires a scalpel and a bougie, you can picture exactly which drawer those will be in, and you can see your hand moving the knife across the neck, so that those actions are automatic if and when they are ever required.
I know that to some extent most of us already do this simulation, driven by the mild anxiety and slightly elevated levels of endogenous adrenaline that go along with being an emergency doctor. However, aside from promoting this ‘cerebral simulation’ I hope this site will also act as a reminder of rare emergencies that aren’t as frequently discussed and therefore probably aren’t frequently simulated. I have visualized myself performing a cricothyrotomy and a perimortem c-section thousands of times. I was driven to create this site when I realized that there were other scenarios I just wasn’t preparing for. I had never truly visualized the steps I would take when faced with a TET spell or a breech delivery when working, as I sometimes do, far away from the closest obstetrician.
What this project is supposed to represent is my current best approach, based on the resources available at my community hospital and my best read of the literature. The goal is to think the cases through, not to be sure I am correct. I hope to uncover shortcomings in my current knowledge and slowly refine my approach to resuscitation. If through discussion on this site, people can point out my flaws and improve my practice, all the better.
Here are a few of the most popular First10EM approaches:
- Neonatal resuscitation
- Approach to the unconscious patient
- Torsades des Pointes
- The bleeding tracheostomy
- Management of severe asthma
I have also always been interested in evidence based medicine, and over time I have been posting more critical appraisals and in depth evidence reviews on First10EM. A few of the most read evidence reviews include:
- Thrombolytics for stroke
- IV antibiotics for cellulitis
- Don’t prescribe tramadol
- Would you choose adenosine?
- Peripheral vasopressors
I hope you find the content of this website helpful. I am always grateful for any feedback you might have. And of course, don’t forget to subscribe to First10EM, so you never miss a post: