Clinician Perceptions of the Impact of a Shock Team Approach in the Management of Cardiogenic Shock: A Qualitative Study.

INTRODUCTION: Designated cross-specialty shock teams have been proposed as a mechanism to manage the complexity of decision-making and facilitate collaborative, patient-centred care-planning in cardiogenic shock. Observational data support the notion that shock protocols and teams may improve survival, but there is an absence of data interrogating how clinicians engage with and value the shock team paradigm. This study sought to explore clinician perceptions of the value of the shock call system on decision making and the management of CGS. MATERIALS & METHODS: A descriptive qualitative approach was used. A focus group, semi-structured interview was conducted with twelve cross-specialty members of a shock team at a single tertiary cardiac centre in the UK. The focus group was audio-recorded, transcribed, and thematically analysed to capture and describe the clinicians' experience and perceptions of shock team discussions. RESULTS: Eight cardiac intensivists, two heart failure cardiologists, one cardiothoracic surgeon and one interventional cardiologist participated in the focus group. Four key themes were identified from the discussions: supportive decision making; team communication; governance and learning; and future directions. CONCLUSION: This study supports the notion that cross-specialty, real-time patient discussion may provide added value beyond protocolised decision making and account for the complexities of managing patients in a field where definitive, high-quality evidence to guide practice is currently limited.

Training for medical support of mountain operations.

Man is not designed to live or to fight at altitude, and mountains have successfully resisted armies' attempts to conquer them for centuries. High-altitude mountainous terrain imposes great strains on individuals, units, and the health services designed to protect them. Medical personnel are challenged to minimize the damaging effects of the harsh environment, to maximize survival rates, and to preserve combat effectiveness by optimizing physiological and behavioral adaptation. Such challenges are best met with targeted medical training. This article reviews basic altitude physiology, relevant military history, the scope of altitude illnesses, prevention and treatment strategies, and existing mountain medicine training programs.