Problems for clinical judgement: 3. Thinking clearly in an emergency

THE RESUSCITATION OF A PATIENT IN EXTREMIS is frequently characterized by c haos and disorganization, and is one of the most stressful situations in me dicine. We reviewed selected studies from the fields of anesthesia, emergen cy medicine and critical care that address the process of responding to a c ritically ill patient. Individual clinicians can improve their performance by increased exposure to emergencies during training and by the incorporati on of teamwork, communication and crisis resource management principles int o existing critical care courses. Team performance may be enhanced by asses sing personality factors when selecting personnel for high-stress areas, ex plicit assignment of roles, ensuring a common "culture" in the team and rou tine debriefings. Overreliance on technology and instinct at the expense of systematic responses should be avoided. Better training and teamwork may a llow for clearer thinking in emergencies, so that knowledge can be translat ed into effective action and better patient outcomes.