Osteopathy in the Emergency Department

  I wanted to share an experience with you that happened to me over the weekend, which needed a different kind of manipulation.  I say that tongue in cheek, since I feel osteopathy is a mindset and not just a physical medicine modality. In plain English, I do more than just pop joints.

  I work in the Emergency Department in a couple of places and love it.  I like helping people.  There are many that come in with minor stuff, but they need help too.  This last Saturday I helped many such people.  However, I also had a patient who came in, who needed my help. 

  The ambulance brought in a lady, who was about 32 to 33 weeks pregnant, and in labor.  She had been having contractions all day and when she decided to go get checked out, her water broke.  It was her second baby and since babies are supposed to stay inside mom until 40 weeks, it was early.  The ambulance brought her to me, since I was the nearest physician.  The next closest Emergency Department, and the next nearest Neonatal Intensive Care Unit was 30 minutes away.  

  Usually, we can do a quick assessment and send the patient on her way to the experts.  However, this patient was too far along.  That, and with baby being so small, I was concerned that she would deliver in the ambulance if I sent her away.  Oh, and mom also told me that the baby was backwards on the last ultrasound.  

  I did my check and baby was indeed backwards and going to be out really soon.  Unfortunately, we don't normally deliver babies at my hospital and my surgeon would not make it in time to do a C-section.  We gathered what troops we had and got ready.  Trust me, I was on the phone with the high-risk OB doctor down the road and he stayed glued to my ear during this time.

  Now, it is said that the universe provides for everything.  I give credit to God, since I know him better than the universe.  Either way, earlier that day, on my trip up to work, I asked myself what to review (since I have a 2 hour drive).  I reviewed codes and then, based on a random thought, glanced through breach deliveries since I hadn't reviewed that in a while.  Boy, am I glad I did.

  Babies that age are small, yes, but the head is as big as the body and tends to get stuck.  I got everything out up to the head and it indeed got stuck.  I was getting desperate as eternities passed and I couldn't get baby out.  I used every trick I knew of, including several that one of my attending physicians mentioned way back in residency.  This physician had delivered a breach baby and the next day gave an excellent lecture on it to us.  I had that in my head the entire time.

  We got baby out after about 16 eternities and two gallons of sweat.  The baby girl was not moving, not breathing, was more black than pink, but did have a heart beat.  I immediately switched to resuscitation mode and hoped the mom would be ok.  The nurses did a great job in assisting the mom and myself.  I also had an internal medicine doctor there, who quickly learned what I wanted to do and did it without complaint.  We also had two EMTs from the ambulance, who were my extra hands.  As a team, we worked on the baby.  She lost her heartbeat after two minutes, so I started CPR.  Babies need oxygen, so I intubated her and we got her heartbeat back.  Yay!!  We all wanted to cheer.

  I did the resuscitation in the room with mom and dad watching.  I wanted them to see everything we did for their baby because to me, uncertainty and lack of information is the worse situation to be in.  We worked on the baby for 49 minutes before the team from the NICU transport team arrived.  I was glad to get up off my knees and to pass the baby on to them.  

  Then, I sat down with mom, dad, and grandparents and explained everything I did.  A cynic might say I did it to lessen the chance of me being sued.  Although that thought was always present, I did it because I would want someone to do it to me if I were in that situation.  As I explained everything, they sure seemed receptive.  

  I sent them both off to the hospital and wonder how they are doing.  I don't think I can just call up and check on them.  

  How did osteopathy play into this?  I used body mechanics and function to get that baby out.  I used physiology and knowledge to save two lives.  I was a physician, receptive to learning and responsive to inspiration.  There are only two Emergency Medicine trained physicians at that little hospital, and she came on the day when I was there.  

  My colleagues all congratulated me on the save, but I felt more humbled to be part of a bigger picture and accept the congratulations humbly.  It was a neat save.  I never did a CV4 or myofascial release, but I acted like I feel a doctor should, which is osteopathic, too.

  Thanks for sharing in my story.  My thanks goes to God for the knowledge, my team for support and the baby for fighting on!  

Electronic Medical Records - the switch

  Electronic Medical Records (EMR) are supposed to make the physician more productive.  I did my Emergency Medicine residency on one.  But then, that is misleading because each institute that I rotated at had a different system.  Not only that, but the adult Emergency Department at one place used a different EMR than the pediatric Emergency Department at the same place, right across the hall. 
  There are quite a few EMR companies out there, with big names and bigger price tags.  I would like to just touch on a few of the problems and how it plays into my work as a physician.
  First, the learning curve is rather big.  Trying to teach an old doc a new trick is difficult.  Teaching that old doc to use a computer on top of that is also difficult.  At my current work place, we are being trained on an EMR system that will be replaced in less than ten months.  So, all the old docs get to learn TWO systems in less than 10 months.  Welcome to efficiency. 
  Speaking of efficiency, everyone knows that we will need extra time to get used to it and productivity drops by at least 50%.  Yay, we lose 50% of our money and increase the risk for billing errors for 2-6 weeks. 
  Another problem lies in the audience for the EMR.  Most of the hospitals choose an EMR based on billing, not ease of use or 'doctor friendliness.'  So, the ones who bring in the money for the group or hospital get a crummy EMR forced on them by the administration, which does not bring in any money at all.   Hopefully, you can see the potential for conflict and ill feelings.
 
  All in all, EMR is here to stay.  Or to be erased by a virus.  Or a power outage.  Or user error.  And what about those old antique charts that we are trying to get rid of?  We have them filed away, just in case.