Think Like the Body Does

     If you pay attention and put forth the effort, throughout your career you will be able to connect with people who have the capability of really impacting your practice. Dr. James Adams was one of those people for me. As I look back, I can recall countless times when he said incredibly smart things. In truth, pretty much everything he said to you about ways to improve your medicine was smart, but sometimes it was way up the smart scale.

     One such incident occurred after my partner and I brought in a patient with some nasty trauma as a result of being in front of a fast-turning metal lathe that decided to disintegrate, taking most of his pelvic girdle out as it did so.

     Our prehospital efforts had been successful: We delivered a viable patient to the ED, rather than a fatality. In turn, the hospital delivered on its end, resulting in a truly outstanding save. Several days post-event, Dr. Adams was doing his own mini-critique and told my partner and me, "You boys did a great job and showed a lot of common sense on that call. No matter what else you do out there, you need to think like the body does." As a young paramedic, most of what I initially heard was the words of praise. As time passed, I finally got the more important message: his recommendation to think like the body does.

     To me, the human body is a blend of the finest work of creation coupled with the ultimate performance machine. The continued developments in computer technology pale by comparison to what your brain does for you second by second, minute by minute and day by day throughout your lifetime. No reboots or new software; your brain just gets it done! And what about your heart? Your heart has a primary pacemaker that usually functions for a lifetime as well, plus another backup pacemaker should that one happen to fail. Oh, and what about those other cells with pacing capabilities, just in case your luck goes south and pacers one and two go belly up? The heart can pump more when you need it and less when you don't, and does it all with no reminders from you.

     All that being said, let's look at some of the benefits of thinking like the body does, along with some of what happens when you don't.

     You encounter a patient with an evolving problem of heart failure who now sleeps on three firm pillows.

     No one had to tell him not to sleep lying down. As fluid accumulates in his lungs, his body lets him know that by increasing the angle of his upper torso, gravity works to his benefit, and the fluid collects in the bases of his lungs. What if you ignore the body's message and attempt to lay him down? He freaks out as fluid washes over his alveoli, and demands to be sat up.

     You find an asthmatic in the midst of her first really serious asthma attack, sitting in the tripod position in her bedroom, looking scared and tired.

     Believe it or not, she didn't get a friendly postcard from her doctor that said, "Oh, by the way, if you have a bad asthma attack, try sitting with your hands on your knees, leaning forward to help ease the work of breathing." How did she know? She didn't; her body did.

     You get dispatched to the mall for a woman down, and as you approach, you observe some helpful folks trying to sit her up after she fainted. At that point, she faints again.

     As an old-dog medic told me early on in my career, "Fainting is God's way of telling you to lie down." Instead of being in a hurry to sit the woman up, you leave her on her back and elevate her legs to further improve blood flow. In the meantime, you try to figure out what prompted her to faint in the first place and solve that problem.

     You get dispatched to a high school football game, where you find a young man with a couple of fractured ribs, courtesy of the outside linebacker who lit him up after he caught a pass out in the flat.

     You notice he's breathing fast and shallow, well in excess of the 12 to 20 your textbook said was normal. He can't breathe deeply because it hurts, so he breathes faster. What happens if you try to assist ventilations and give him slow, deep breaths? The increased chest excursion hurts so bad he cries out, and if he could, he would probably beat you to a pulp with your stethoscope. On the other hand, if you apply high-flow oxygen and increase his saturation, while trying to make him comfortable, he may still be breathing faster and more shallow than normal, but he'll be perfusing well. That's just what his body was trying to help him do after the injury.

Conclusion
     These are only a few examples of many that I hope show the benefits of taking the time to think about why any given patient presents the way they do.

     Often it's just a matter of common sense. The patient who is breathing fast may be trying to provide his body with additional oxygen, or help adjust his pH by removing CO2. Figure out why their body is responding that way, and more often than not you solve the problem. For the patient with sustained tachycardia, the body is moving that blood around quickly to keep it saturated with O2 and meet some metabolic need. Figure out why they have increased oxygen demands, and again you solve the problem.

     It's just a matter of having a good understanding of how the body works and how it responds when things break or run amok. Add that to a little common sense, and just think like the body does, and you are there. Doc Adams would be proud of you!

     Until next month…