Hi there, my name is, Josh Glazer. I'm one of the chief residents of emergency medicine at the University of Michigan. And I was asked to tell you a story about autonomy. So this happened last year to me when I was a, I think early to mid-level second year resident. We were in the resuscitation bay. My attending and I just getting starting with a sedation on a patient. And just to kind of give you a mental picture, our resuscitation bays are large spaces but they're curtained off. So you, there's some interface between them. Anyways we had just gotten started with this sedation and one of the nurses ran over and said, we've got a stroke coming in, sounds pretty sick. And so we just put this patient that we're working with under a large amount of sedation so we can't walk away. So I turned to my attending and I said, I've got this. And I could see some nervousness in her shake nodding her head back to me but she said okay. So ran next door and this patient comes in and he is pretty sick looking. He story from paramedics is that he fell down at home and was poorly responsive and that's about how he looks right now. He has complete hemineglect and paralysis on the left, and he's got this, kind of silly altered mental status that after you see enough, just kind of screams, I have a big head bleed. So sure enough this guy is on Cumindin assess him and establish that his airway is going to be stable for the next few minutes at least. So we get our access, we get our initial vitals, and we get this guy over to the CT scanner. All the while that we're doing this, I'm verbalizing everything that's going on. My exam, my orders to the nurses. This is helpful not just for the team, but I was pretty cognizant of the fact that my attending is about 15 feet away behind a curtain. Probably very interested in what's going on. So we get the guy over to the CT scanner. On the way over there, I stop and and, and spoke with her in person and kind of reiterated what she had probably already heard when she was in agreement with the plan. Got the patient back to the resuscitation bay after indeed the cat scan did show a large right side parietal bleed. And at this point his mental status was deteriorating. So we had to intubate this gentleman. Got all of our medications ready, we're ordering other things to bring his blood pressure down and to reverse his anti-coagulation. My attending came over just as we're kind of getting ready to push the induction medications and said, just real simply, you said this guy fell at home. I said yeah. She said why don't you put a C-collar on him. Great. Got the C-collar on him. I really appreciated the way that she did that. Because it was a good suggestion, it was unobtrusive, and it really allowed me to keep my momentum with the resuscitation, and the team itself. Put the collar on, got this guy intubated, got his blood pressure down, reversed his anticoagulation. Got him to the ICU. He ended up doing great. And again, it was just a real nice resuscitation that I felt complete ownership but at the same time, I know that my attending was also kind of in the loop the whole way along.
