For my entire Emergency training, every time I intubated or sedated someone, or dealt with any resus patient from the head of the bed, I had to constantly look over my shoulder to look at a monitor that was attached to the wall behind me, whilst trying not to lose focus on the patient laying in front of me. The worst part of this setup was during intubation, when you actually want to know what the sats and sometimes the BP are doing, and you couldn’t tell, unless you waited for the ominous dropping tone of falling sats from the monitor behind you, or someone in the room called them out. Once the tube was in and you wanted to see the end-tidal waveform, you had to look over your shoulder, away from the tube and bagging circuit, to see the trace. For years I practiced like this, with my “control panel” placed behind me, out of sight, and accepted this as “the norm”.
Recently it dawned on me that it would actually be quite easy to place a monitor adjacent to the patient, facing me, so that if I needed to know what was happening with the vital signs during intubation, I could just glance up, and a few degrees to the side, and glean that information, with the patient remaining in my field of view.
Lo and behold, when I arrived at my regular place of (locum) work a few weeks ago, I was thrilled to see someone had already thought of this, and monitors had been installed on the wall facing back towards the head of the bed. “Brilliant!” I thought, I can’t wait to use them…
You can see the line of sight from the head of the bed to the monitor, it’s a glance sideways,
and the numbers are actually displayed large enough to easily read.
So what happened when my first resus came through the door? I reflexively looked over my shoulder at the monitor behind me, repeatedly. It wasn’t until I was leaving the room that it occurred to me that the monitor in front would have been much easier to use, and I hadn’t even registered that it was there. This demonstrates the power of ingrained habit, and that something new, no matter how good an idea it seems at face value, takes practice and concentration to master.
I think the setup above is good, with one wall mounted monitor for everyone else in
the room to watch, and another one facing the head of the bed for the airway doctor to use.
It made me wonder, would aircraft manufacturers build a plane with the radar, altimeter, compass and airspeed indicator behind the pilot’s seat, so that every time they wanted some critical flight information they had to look over their shoulder? Of course not! Would car manufacturers place the speedometer up above your head behind the drivers seat? No way. So why do we do it? Of course it’s easier to bolt a monitor to a wall and wire it up there, but many ED’s have their monitors on mobile stands, yet still place them behind the bed or out of convenient sight.
In resus, the monitor is our Control Panel, our vital mission information. Often the first sign we get of a change in patient status is from the monitor, so why place it somewhere you can’t see it, especially during critical procedures like intubation.
What do you do to keep abreast of vital mission information during intubation/resus? Does your resus room have a monitor visible to people at the head of the bed? Is there a better place to put the monitor? Have you broken the “look over your shoulder” habit, and if so, how did you do it? Leave a comment and let us know what you think.
A song about resus room monitors:
“…when times are bad for you, and you need someone to help you, look over your shoulder, I’ll be standing right there…”
“…when people pass you by, and they look at you out of the corner of their eye, when you feel very small, like you’re not there at all, look over your shoulder, I’ll be standing behind you…”