Precision Emergency Medicine & Outcomes by Anand Swaminathan

Anand Swaminathan brings precision emergency medicine and outcomes in critical care into the light.

He will convince you to start calling diseases for what they are and as a result start offering the proper treatments and care. All disease exists on a spectrum. You can't treat one end of the spectrum the same way you treat the other end.

This talk is inspired by a case of Anand's. An older man presented to the ED with acute onset shortness of breath and crackles. He was treated with Lasix. More and more Lasix – even though he wasn't improving.

Anand knew this presentation was more than just an exacerbation of heart failure. This was acute pulmonary oedema and this man needed a different treatment. Disease is on a spectrum with 'urgent' on one end and 'critical' on the other.

The umbrella term that identifies the disease needs to be spread out so that it can be placed on this spectrum by you and others around you. Calling a presentation an exacerbation of CHF when it is in fact acute pulmonary oedema is wrong and leads to harm for the patient. We have the medications and treatments for both end of the spectrum. However, they aren't always used.

Too often disease gets miscategorised on the wrong, milder end of the spectrum. Why? First, more patients exist at this end, and we therefore default back to this presentation of the illness. Secondly, there is an inverse relationship between the severity of disease and the research guiding treatment. Therefore, the temptation is to use this research to guide management all along the spectrum. Finally, time and resources are precious. The sicker a patient is, the more of these commodities they use up so err towards an approach for milder disease.

To counteract these points Anand wants you to understand the diseases better. How? First, educate yourself and those around you to assess and treat disease properly. Call the disease the right thing and ensure proper allocation of proper and adequate treatment and resources. Secondly, spend more time at the bedside – especially early in your training. This is how you rapidly identify sick patient, and rapidly determine what needs to be done. After this talk Anand hopes you are inspired and can walk into work tomorrow and make a change. Empower each other to act by calling things what they are!

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