The Arrow of Time

I have of late been reflecting on times past in EM, on how some things persist but others become part of the “good old days” that men of my age start to drone on about if given half a chance. I thought I’d try and create two shortlists, the first one composed of facets of daily 1980’s Casualty life that are now never (or rarely) encountered, and the second my Nostradamoid predictions of innovations to come in the 2020’s ED.  The former was pretty easy, the latter not so much… I do wonder too which routine aspects of practice now will be extinct in 2025?

The 1980’s    

I think we agree the past is over   

George Bush
  • Epiglottitis   just the odd unimmunised and adult ones now
  • Perforated Peptic Ulcer with board-like rigidity
  • AAA rupture
  • Flail chest from steering wheels in MVA
  • Intracardiac adrenaline for cardiac arrest
  • IV Aminophylline for asthma
  • Orogastric lavage for OD (? therapeutic, ?punitive)
  • Ipecac syrup for childhood poisoning
  • Diagnostic Peritoneal Lavage
  • Venous cutdown for difficult IV access
  • ICC insertion with trocars
  • CVC insertion without Ultrasound
  • IVP for diagnosis of renal calculi
  • Death certification for out of hospital deaths

The 2020’s 

Trying to predict the future is like trying to drive down a country road at night with no lights while looking out the back window.

Peter Drucker
  • An immediate sensitive + specific bedside test for chest pain
    (so no chest pain units, serial measurements or provocative testing)
  • Wireless ECGs with expanded number of leads
  • Wireless monitoring, no spaghetti to disentangle
  • Accessible and synchronised individual patient medical information
  • Paperless workplace – no written notes
  • Novel non-invasive analgesia modalities – topical/electronic…
  • Self guided lines – will sense/scan patient anatomy and guide themselves to specific designated point eg intrathecal/intra-arterial
  • Rationing of expensive medical therapy and interventions

I’d love to see some comments on my lists, and your suggested additions, particularly  for the next decade. I’ll post the best ones, and maybe bury them in an e-time capsule for unearthing in 2025 or so…

emergency physician keen on medical education and cycling

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