Tuesday, April 5

ISO – “Total Protocol Recall”

Wednesday my medic class will take our second to last “module exam”. Originally this exam was to cover abdominal, endocrine, behavioral, environmental and OB/GYN emergencies. Now it will include all of the above plus 55 questions on cardiology. Why? Because Wednesday we had TWO quizzes – one on OB/GYN and one a REPEAT cardiology quiz from over a month ago. People did fairly well on the OB/GYN quiz, but only 5 of us passed the cardiology quiz. Our instructor was not pleased that people had purged their memory banks of previously acquired information and decided that putting 55 cardiology questions on the next test would encourage us to keep that material fresher. Indeed.

We are also at the point in the course where a fair amount of emphasis is being placed on “practical skills stations” (where you demonstrate a skill or skill set). What is weird about these stations is that you don’t just “do”, you “say”. It is the “saying” part that is strange, as you need to remember to verbalize things you would NOT verbalize in the field. For example it would be good to glance at the crotch of a patient who lost consciousness to see if (s)he lost bladder control. I assume it would be BAD to be talking to a patient and say (“I am now going to visually inspect your crotch to see if you wet yourself”), though you are expected to say this in a practical skills station. It really is a separate beast.

The hardest skill station for me has been “static cardiology”. In “dynamic cardiology” you have a patient whose condition changes based on treatment. For some reason this is easier for me than static, where you read an EKG and describe, from top to bottom, our protocol for treating that patient. For example, the tester might slide a strip of asystole to you, and you are expected to say “That’s asystole: Begin CPR, confirm asystole in two leads, obtain IV and ETT access, consider transcutaneous pacing if arrest witnessed, administer 1 mg of epinephrine via IV and repeat every 3-5 minutes, administer 1 mg of atropine via IV and repeat every 3-5 minutes to a maximum of 0.04 mg/kg, consider sodium bicarbonate at 1 meq/kg, confirm asystole in two leads and call medical control for permission to terminate”. Whew.

Anyway, to do this you need, in the words of my instructor, “total protocol recall”. It is slow in coming for many in my class, and I just got it in the last couple of days. For me, the trick was to combing trying to memorize the protocols with what the goal of each intervention is. When I just tried to memorize things, I’d get on the “wrong track” sometimes and recall the treatments for another rhythm. Now, by thinking about what the drugs actually DO, I avoid this problem. I am dangerously close to having “total protocol recall”. What is still a long way away is being able to look at my patient and knowing, without skipping a beat, what’s wrong and what to do about it (this is still a very analytic process for me).