Medical Interventions That Take Less Than 8 Minutes and 46 Seconds
Authors: Martin Kaminski
Journal: Annals of Internal Medicine (2020)

On Being a DoctorJanuary 2021Medical Interventions That Take Less Than 8 Minutes and 46 SecondsFREEMartin Kaminski, MDMartin Kaminski, MDCambridge Health Alliance and Harvard Medical School, Cambridge and Boston, Massachusetts (M.K.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4575 Audio Reading - "Medical Interventions That Take Less Than 8 Minutes and 46 Seconds" Audio. Virginia L. Hood, MD, a physician from the University of Vermont, reads "Medical Interventions That Take Less Than 8 Minutes and 46 Seconds" by Martin Kaminski, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 8 minutes and 46 seconds, you can go up to a person who has just collapsed; feel for a pulse in their neck for 10 seconds; and, in those same 10 seconds, observe no signs of breathing. You can then start chest compressions. You can shout for help. You can continue chest compressions to the tune of "Stayin' Alive" by the Bee Gees while pausing when someone else provides two rescue breaths every 30 seconds. You can continue while someone brings a defibrillator. You can attach the pads of the defibrillator; then, after 2 minutes of compressions, you can pause and recheck for a pulse. For 10 seconds, you can see whether the person has a shockable rhythm. You can see that they are in ventricular fibrillation, and someone can deliver 200 joules of electricity through the defibrillator. You can resume CPR for another 2 minutes, check for a pulse again, find the same rhythm, shock again, and get back onto the chest. Someone can put an intravenous line into the shin bone using a medical drill and give 1 mg of epinephrine to restart the heart. Another person can put in a breathing tube to help prevent the compressions from causing the contents of the stomach to be vomited up into the mouth and back into the lungs. After 2 minutes, you can check again for 10 seconds and then shock again. All in all, you can perform at least three, maybe even four, 2-minute cycles of good-quality CPR.Or you can take your knee off someone's neck.In 8 minutes and 46 seconds, you can enter the room where a person is sitting. You can apologize for the delay and ask them how their children are doing. You can tell them that you asked them into the clinic today to talk about the results of their CT scan. You can give a warning shot: "The results of the CT scan show something very serious," you can say. You can ask them if they want anyone else there in the room before you proceed. The person says they would like to get their wife from the waiting room. You can wait for a few minutes, and, when they come back and settle themselves, you can tell them that it's cancer. You can wait for a few seconds. When they compose themselves after crying, you can tell them about their options.Or you can take your knee off someone's neck.In 8 minutes and 46 seconds, you can be in the emergency department, already waiting at the door to greet a patient on a stretcher with the ambulance crew. You are ready because the crew called a code stroke on the way to the hospital. You can quickly examine the patient while someone else puts in an intravenous line. You can find out from the patient's daughter that the patient's symptoms started suddenly 70 minutes ago. You can see that the right side of the patient's face is paralyzed. You can assess that their right arm is weak. You can stat run them through a CT scanner and see on the computer screen that they had a stroke: a blockage of the left middle cerebral artery. You can consider giving a clot-busting drug.Or you can take your knee off someone's neck.In 8 minutes and 46 seconds, you can give aspirin or nitroglycerin tablets, get blood tests, and do an EKG on someone who may be having a heart attack.Or you can take your knee off someone's neck.In 8 minutes and 46 seconds, you can treat an asthma attack with aerosolized inhalers, steroids, and intravenous magnesium.Or you can take your knee off someone's neck.In 8 minutes and 46 seconds, you can determine that someone's rash, swelling, and breathing problems are due to an anaphylactic reaction to peanuts that were in the person's pad thai. You can give 0.5 mL of epinephrine diluted in a 1:1000 solution, steroids, and Benadryl.Or you can take your knee off someone's neck.In 8 minutes and 46 seconds, you can see that your patients' health is not an isolated variable that can be thought of solely in the abstract. Instead, you can realize that health is inexorably tied to the structure of our society and its injustices, which are all too often overlooked and overrationalized despite recurring over and over and over.You can tell society to take its knees off all those necks. Comments0 CommentsSign In to Submit A Comment Ross Abrams, MD FACPHadassah, Ein Kerem, Jerusalem, Israel28 July 2020 The power of words and thoughts Or in the time it takes to read this article, much less than 8 minutes and 46 seconds, you can connect with the words of a powerful author, viscerally feel how wise and correct those words are, and appreciate his sensitivity and insight. Thank you. Disclosures: The author has nothing to disclose Author, Article, and Disclosure InformationAffiliations: Cambridge Health Alliance and Harvard Medical School, Cambridge and Boston, Massachusetts (M.K.)Corresponding Author: Martin Kaminski, MD, Department of Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139; e-mail, [email protected]com.This article was published at Annals.org on 28 July 2020. PreviousarticleNextarticle Advertisement Audio Reading - "Medical Interventions That Take Less Than 8 Minutes and 46 Seconds" Audio. Virginia L. Hood, MD, a physician from the University of Vermont, reads "Medical Interventions That Take Less Than 8 Minutes and 46 Seconds" by Martin Kaminski, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics January 2021Volume 174, Issue 1Page: 119KeywordsBreathingCardiopulmonary resuscitationComputed axial tomographyEpinephrineHeart rateKneesShockSteroidsStrokeThorax ePublished: 28 July 2020 Issue Published: January 2021 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...