Wednesday, November 29, 2017

Should you call an ambulance or drive a gunshot victim to the hospital?

Let’s start off with a theoretical problem: 

You come out of a restaurant just as a man you do not know gets shot right in front of you. The gunman runs off and the gunshot victim and you lock eyes.
The victim is bleeding from the center of his body, you find yourself taking your shirt off, putting it to the man’s abdomen, and applying pressure. You can’t believe what is happening, as you yell, “Call a doctor! Call a doctor!”
Your thoughts are racing. “What if he bleeds out before the ambulance arrives?”
You think to yourself, “My car is right there, should I drive him to the hospital? It’s not far, but I’m not an ambulance driver. I have no idea what to do! I have no emergency medical training.” 

Should you transport a gunshot victim, or should you wait on emergency medical services?
Before you read on, take a minute to play the thought game. You desperately want to save this person’s life, what should you do? Wait for help, or get your patient to the ER?

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A study in JAMA Surgery found…
Do whatever gets the patient to the Emergency Room the fastest. For most injuries, the prehospital support of an ambulance was often best. But when it came to gunshot or knife wounds, the evidence showed that time was the most important factor. The faster the victim got to the hospital the better. 
The senior researcher, Elliott Haut, at Johns Hopkins University School of Medicine says:
Typically, protocols for prehospital interventions are established at a regional or statewide level, which allows first responders to determine what, if any, medical procedures should be performed prior to and during transport to the hospital, Haut says. But research studies have rarely, if ever, evaluated or compared all of the effects of system-driven pre-hospitalization policies, leaving ideal prehospital care strategies undefined, he adds.

Friday, November 24, 2017

I’m too bored to do this for another second!

I am often asked by patients, “How can I get myself to do stuff I don’t want to do?”
To this, I give the simple answer, “Switch up the stuff you’re doing, so that you aren’t totally bored.”
I am not a big believer in willpower. At best, people can only bully their way through a task for so long. Willpower may work for short bursts, mainly when you are newly motivated, but it doesn’t work in the long run.
In the real world, we often have to do stuff that needs to be done, but we get no direct reward for doing it. We like the idea of getting the boring project done, but we really don’t want to do it.
The project could be laundry, exercise, or a big report—we want it done, but we really don’t want to do it.
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Break it up into small chunks
The old question is: How do you eat an elephant? The answer: One bite at a time.
For example, if I am working on a large writing project I take regular breaks, usually every hour and fifteen minutes. Then, for the next 15 minutes, I do something else that needs to be done, such as move laundry from the washer or clean the bathroom. Yep, it’s true. I don’t want to do the laundry or clean the bathroom, but I do want it done.
After 15 minutes, I go back to my writing project. (I have a load in the dryer as we speak.)
By changing activities, I have found that I can get more done and stay motivated to complete tasks.

Research from the University of Toronto backs up my actions
University of Toronto (U of T) News reports, “…according to new University of Toronto research, there may be no noticeable dip in our motivation and ability to do something as long as we switch up tasks throughout the day.”

Dan Randles, is a postdoctoral fellow in the lab of Michael Inzlicht, a professor of psychology at U of T Scarborough. He says, “While people get tired doing one specific task over a period of time, we found no evidence that they had less motivation or ability to complete tasks throughout the day.”