In medical school the family medicine folks are in charge of teaching you how to get a nice, detailed history from the patient. They mention things like not interrupting, letting the patient tell their own story, asking open-ended questions, and so on.
The ER, although a very different setting from a family medicine office, actually likes lots of details in the history. If you don’t ask when the last meal was, who the primary care doctor is, when they were last seen, how much they used to smoke, you can be sure the attending will want to know about it, and have some reason why it’s important.
But there are special circumstances:
Elderly male, well-known lung problems, brought in by squad, short of breath. He’s not a healthy color, clearly struggling to breathe (you can see all the accessory muscles). The resident is dutifully attempting to get a history: when the problem started, what makes it worse, when was he last hospitalized. The attending walks in, takes one look at the patient, one look at the monitor (tachypnea, sats in the low 80s), and says: “There’s only one important question here: ask him if he wants everything done.” The man says yes. “Then call respiratory, because this isn’t going to last much longer.”
December 24, 2007 at 11:39 am
Another thought, was elderly male on oxygen at home, has he been on BIPAP before, does he take breathing treatments at home? Respiratory would like this type of history.
I’m proud of you Dr. Alice! I love to see you fly.
Merry Christmas,
Debate Coach
December 24, 2007 at 1:03 pm
Merry Christmas, Coach!
Nice to see you here. Since becoming a doctor, I appreciate the respiratory therapists even more. You call when there’s a problem, and they show up and clear airways, provide oxygen, make sense of the tangled loops of nonconnecting equipment that you and the nurses have been getting lost in. 
December 24, 2007 at 1:33 pm
i don’t even know what a respiratory therapist is. where i come from the fastest emergency tube of a patient would be done by a surgeon. (although everyone including interns can tube)
December 24, 2007 at 5:47 pm
Bongi – We really are from different worlds.
Respiratory therapists over here do breathing treatments for COPD and asthma patients, and take care of ventilators and CPAP machines. They don’t do intubations, but you call for them when you want to do one, so they can bring the ventilator cart and set it up.
January 3, 2008 at 12:35 am
At my hospital the RT’s can do intubations unless a resident beats them to the patient. Not in the NICU, but we don’t generally let the residents intubate there, either. Maybe the occasional elective intubation in the daytime, but if our NNP’s can’t get it done, we’re calling anesthesia.
Those docs are amazing. We had a kid our neonatologist couldn’t get tubed, so we called anesthesia for backup. He put the tube in first try then told us he’d never seen a baby that small.