Midnight Silence of the hospital was breached by irritating continuously blowing horn. "Hurry up...stretcher..stretcher....", shouted three persons in chorus.
There was a middle aged man lying lifeless in the backseat of a car with his trousers wet with urine, mouth wide open, flaccid neck oscillating with movement of car. On clinical examination there were no signs of life, also there were no signs of death too. He was candidate to be declared brought dead at most of the hospitals.
"He seems to have expired.....".
"No..no..doctor do something....save my father, he was alright in the night, had chest pain and collapsed just 15 minutes ago...", his son interrupted.
"We will try our best but chances are almost nil", I primed them.
In the mean time cardiac monitors showed ventricular fibrillation, first DC shock was given on the stretcher, chest compression was started, and in the meantime help arrived in casualty from critical care, cardiology and anesthesiology teams.
After 8 minutes of CPR, for the first time pulse returned but it did not sustain for more than 2-3 minutes. Thereafter pulse kept on playing hide and seek game for next 2 hours. Also cardiac rhythm kept on varying from VF to VT to sinus in between.
At one point of time electrical, chemical cardio-versions, ionotropes seemed to be failing. Everyone decided to stop the resuscitation. I don't know from where I got the guts to oppose 8-10 years senior doctors from different departments. In between I was reminded of various international protocols regarding the time period of giving CPR by them. Finally after around 2 hours, sinus rhythm and pule sustained, also BP improved and then patient was shifted in ICU.
"you have just postponed the death declaration. It will be wastage of one ICU bed for no outcome, You are handing me over a dead body.", said the intensivist while taking hand over of the patient.
Interestingly patient improved neurologically over next 10-12 hours. Next day angiography was done and revealed blocked coronary artery (LAD). Angioplasty was done. After 48 hours, patient improved sufficiently enough to be put off the ventilator. Further after two days he was discharged from hospital in conscious, oriented condition and left hospital walking.
Life and death are the mysteries, we will never understand. Man made protocols can never holistically cover natural events. Unfortunately most of the hospitals in order to avoid mortality, medico-legal issues do not try to resuscitate and declare brought dead or refer the patient to other center. Also due to specialization and super specializations, many practicing doctors do not know about resuscitation protocols. One thing taught in our medical schools is to focus on common things and ignore rare things. Since successful resuscitation of unwitnessed cardiac arrest is rare, it is rarely focused upon. However, it is always matter of bringing life from the jaws of death. Therefore never give up...let the patient die rather than be declared dead.
There was a middle aged man lying lifeless in the backseat of a car with his trousers wet with urine, mouth wide open, flaccid neck oscillating with movement of car. On clinical examination there were no signs of life, also there were no signs of death too. He was candidate to be declared brought dead at most of the hospitals.
"He seems to have expired.....".
"No..no..doctor do something....save my father, he was alright in the night, had chest pain and collapsed just 15 minutes ago...", his son interrupted.
"We will try our best but chances are almost nil", I primed them.
In the mean time cardiac monitors showed ventricular fibrillation, first DC shock was given on the stretcher, chest compression was started, and in the meantime help arrived in casualty from critical care, cardiology and anesthesiology teams.
After 8 minutes of CPR, for the first time pulse returned but it did not sustain for more than 2-3 minutes. Thereafter pulse kept on playing hide and seek game for next 2 hours. Also cardiac rhythm kept on varying from VF to VT to sinus in between.
At one point of time electrical, chemical cardio-versions, ionotropes seemed to be failing. Everyone decided to stop the resuscitation. I don't know from where I got the guts to oppose 8-10 years senior doctors from different departments. In between I was reminded of various international protocols regarding the time period of giving CPR by them. Finally after around 2 hours, sinus rhythm and pule sustained, also BP improved and then patient was shifted in ICU.
"you have just postponed the death declaration. It will be wastage of one ICU bed for no outcome, You are handing me over a dead body.", said the intensivist while taking hand over of the patient.
Interestingly patient improved neurologically over next 10-12 hours. Next day angiography was done and revealed blocked coronary artery (LAD). Angioplasty was done. After 48 hours, patient improved sufficiently enough to be put off the ventilator. Further after two days he was discharged from hospital in conscious, oriented condition and left hospital walking.
Life and death are the mysteries, we will never understand. Man made protocols can never holistically cover natural events. Unfortunately most of the hospitals in order to avoid mortality, medico-legal issues do not try to resuscitate and declare brought dead or refer the patient to other center. Also due to specialization and super specializations, many practicing doctors do not know about resuscitation protocols. One thing taught in our medical schools is to focus on common things and ignore rare things. Since successful resuscitation of unwitnessed cardiac arrest is rare, it is rarely focused upon. However, it is always matter of bringing life from the jaws of death. Therefore never give up...let the patient die rather than be declared dead.
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