Strategies to manage complex Resuscitation by Chris Hicks

Resuscitation is complicated, but the solutions don't have to be. Chris Hicks brings you four psychological strategies that will help you manage complex resuscitations. It is a fascinating time to be a resuscitationist with ROBOA, ECMO and EPR. Chris explains that as we learn more about critical illness, we learn more about the complexities of resuscitation. Therefore, we need ways to manage and constrain complexity and to simplify and organise problems that will see us through. Chris’s lessons are founded on a case. A 22-year-old female is brought into the Emergency Department. She was an unrestrained driver in a motor vehicle accident. She is agitated, has multiple facial smash injuries, burns to her torso and neck, a right sided flail segment, and a mechanically unstable pelvis. Also, when you ultrasound her abdomen, you realise she is well into the third trimester of a pregnancy. Chris discusses four strategies to cope in a complex situation. The first is grounded in habits. Habits have a lot to do with whether or not we succeed at a given enterprise. They can help break down complex problems into simpler parts. Once a habit has been practiced and rehearsed, it becomes harder to not execute the habit than it is to execute it. Next Chris advises to foster emergent organisation in the team. This is self-organisation in teams whereby individual simplicity can create organised complexity. During periods of high task loads it makes sense to create smaller teams to create divisional lines. This allows semi-autonomous teams to function independently towards a specific goal. Thereafter, try to factor down complex problems. Take a problem as you see it and lead it in a direction you’d like to see it. By simplifying a problem into a few sentences, you assert that you understand it, and you can then begin to manage it. Finally, Chris talks about limiting variability. This is in order to constrain chaos. Eliminate variables and thereby eliminate unnecessary steps. This can sometimes mean cutting down team size – Chris conjects most teams are too big! Join Chris as he takes you through four strategies to manage complexity in a complex resuscitation. Lean on habit. Foster emergence. Factor down the problem and limit the variables.

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