Making the Right Call With No Good Options

What do you do when there are no good options, but you have to make a move?

(Inspired by Jocko Underground)

“Sometimes you are in a bad position and any call you make puts you in a worse position..” → What do you do?

1.) Avoid it. Avoid getting into that position in the first place.

- applied to our world, would you rather wait until the patient is in profound uncompensated shock and have to resuscitate them, or prevent them from going into shock altogether.

- be aggressive and forward thinking and building/maintaining good situational awareness.

- Perceive, comprehend, and project = recipe for making a good call.

2.) If it does happen: step back, detach, and understand the situation that you are in.

- acknowledge it. Speak it out loud. Dr. Dworkis talks about this in his book, the Emergency Mind in the chapter on “Suboptimal.”

- be cool and don’t panic. Calm is contagious and so is negativity. Keep your cool and be the anchor for the team.

- reframe it. Again, see Dr. Dworkis’ book mentioned above.

3.) Do something unexpected.

- If you only think about the two bad options, you only have two options. If you can humor your imagination and generate an unexpected third option, you may end up with a win. (see Pete Blaber’s The Mission, The Men, and Me).

- Open your mind to other options. Don’t let anything dictate your options. You can only be painted into a corner if you aren’t willing to get pain on your shoes. (see Lateral Thinking).

4.) Don’t give up.

- there is a way to win. You have to believe that. You have to act like it.

- you can take an impossible situation and make it some of your best work.

- sometimes you have to take a loss in order to win. Take the loss and learn so that you can move forward, apply what you learned, and win.

Concept Applied: ARDS → avoid having to deal with this if at all possible with lung protective ventilation strategies. If you do have to move one of these patients, acknowledge the difficulty and start trying to understand your situation. Is there recruitable lung? Are they oxygenating at all? Is there overdistention due to too high of PEEP? Etc. Do something unexpected, APRV, inverse ratio ventilation, perhaps even go back and start completely over with basic lung protective vent strategies and MAYBE watch things get better. Most importantly, keep working, don’t give up. Humor your imagination. You won’t find an evidence based solution when you’re operating beyond the edge of the evidence…