don't know what to do。。。。

I had this OHCA(out of hospital cardiac arrest) patient few days ago during my shift. The patient is a case of Diabetes mellitus. He had collapsed suddenly while chatting. The EMT had found him with no sign of life on arrival and he was sent over to us for further management.

It was a peaceful afternoon and I had enjoying a rest after the busy morning. The intubation process was smooth and with the aid of automated CPR machine, it was less tiresome then before. There were this narrow QRS waves mixed intermittently in the CPR wave. I had a hunch that there would be an ROSC(return of spontaneous circulation). I got a carotid pulse 15mins later; as usual, I waited for a good 5 mins before I sent him for imaging. Just about time for the epinephrine effect to wear off and if the patient is unstable, he would go into arrest again. He made it and he was sent for CT and CXR. Although there is a rare chance the brain scan would give a positive findings but the attending staff would like to see it when they saw the patient and I had to complied with the protocol….

The CXR had shown acute pulmonary edema and the probable explanation was acute myocardial infarction with congestive heart failure.

I admitted the patient to ICU and hoping he could make it. Later that night, our night shift staff called me what should he write in the dead certificate and I told him to leave it to the attending cardiologist. Thank god, it would be another staff who sent the patient away. In the past, I would be the same one who resus the patient in ED and the same staff who would pronounce the patient in the ICU. Some of the family would be grateful, some would throw their anger at us complaining that why didn’t referral to a tertiary center is made earlier.

I had read a story about a sophomer of civil engineering in the famous NTU. He had collapsed during a ball game and later sent to the NTU’ hospital. He had later become vegetative and his father a Professor in another University had brought up a suit against the university for not sending his son to another tertiary center which was 150m from the field. He had requested a large sum but his plead was rejected by the court of law. The father had later posted a loot of articles with similar content over many BBS on the net and evoke a so called “XXXXXpa phenomenon” resulting his posting being blocked from many forums over the net.

I could imaging the feeling of such families. During the resus period, the family would beg and plead the medical staff to save their love one; unaware or omitting the fact that the patient might be handicapped mentally or physically for the rest of their life. When the worst (not death of coz…. That would be a relief) case scenario become reality, some families would start to find evidence trying to divert their disappointment and rage toward others and in some of the case, the medical staff is their target…

Unlike other colleague who would do the 30mins routine, I would certified earlier if the pre-hospital session is too long( 30min and above).

There was this TV celebrity in his early forties who had died after a late night drinking spree, according to the news, the ED staff had resuscitated 1+ hours before he was certified, in the past it would be a strenuous process for the medical staff but with the aid of automated CPR machine, it is acceptable. But still I consider prolonged CPR(exclude the extreme such as severe hypothermia) as a waste of medical resources – take millions buck to care for a vegetative cae….