JG: Do you remember what it felt like to suddenly have that new resource or technology?
CC: Sure—I remember CAT scans. We had no way of taking care of people with intracerebral bleeds. We didn’t know whether they had an intracerebral bleed or stroke or a tumor. In regard to patients with abdominal pain, we had no definitive way to diagnose a ruptured abdominal aortic aneurysm. I remember most of the time, if it was the right scenario and you could feel a pulsatile mass, it was probably an aneurysm. But we had no way of proving that. And then they went to the operating room, and we hoped we were right. Now, you can do a CAT scan or an ultrasound in a few seconds and make a diagnosis.
Explore This IssueACEP Now: Vol 39 – No 03 – March 2020
Ultrasound has been even more influential in the emergency department. I’m only sad that I wasn’t very facile at using the ultrasound. I envy some of the younger emergency physicians coming out of residency who are very good with ultrasound because that made a big difference. You can make a lot more diagnoses right at the bedside. That’s even a bigger change, although certainly CAT scans and MRIs, especially in the field of trauma, that was a big change to the good.
One of the most important things is ability to manage airways. We didn’t know how to manage an airway back in the late 1960s and early 1970s, but that gradually got better. We went away to those courses and learned how to do intubation with the correct and proper way of induction. And then the other thing that has been very important is the procedural sedation that we do in the emergency department. We’re really very competent now, and what a change. Before, we had to call anesthesia down, and if they were tied up, they weren’t available, or if it was the middle of the night, especially in a rural hospital, there was nobody there.
And, of course, the use of computerized records, too. I’m a big fan of computerized records. I know a lot of people don’t like them. They do slow you down, but the EMR is very helpful. It’s given us so much information that we didn’t have before. I remember we used to have to go through pages and pages of old charts to figure out something, where it’s so much easier now.