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Stopping the vasopressor rollercoaster:  Mr. Toad’s Wild Ride and the rule of 5.

I was given a vial of epi, a bag of D5w to mix it in and instructions to titrate as needed. I sent patients on a blood pressure roller coaster ride. Over the course of a few hours there would easily be 100mmhg swings in their systolic blood pressure.

Action is comfort. Action fixes things, and you are a fixer. You were trained to be a fixer, to be a man or woman of action. Sometimes decisive action is exactly what the situation calls for. Other times it is not and that is when things get hard. Sitting on your hands and giving the drugs time to do their thing is much harder than pushing buttons and spinning dials. Inaction is uncomfortable, it produces feelings of anxiety. No part of your training was ever about inaction, about waiting and thinking about the long game. You are a hammer and the world is your nail. You play the short game and get results. Most of this is not your fault. It is equal parts human nature and how we train in EMS. How many scenarios did you have in school where the correct answer was to do nothing or to wait and see? How many of the questions on the NREMT test have “do nothing” as the best answer?