Again a situation where performing basics of cardio pulmonary resuscitation has saved a life. It re emphasizes the need for every individual to be thorough in basic life support technique and for all medical professionals to be thorough with advanced cardiac life support techniques. When 23 year old Shivani got admitted to hospital for a minor orthopedic procedure, little did she know that it is going to be a near death experience.
This young dentist was admitted to KRIMS for anterior crucial ligament repair of her left leg and underwent procedure smoothly. Post operatively she was mobilised within 6 hours. Following mobilization she collapsed on the floor and medical emergency team was called in. Chief of ICU Dr Swapna Khanzode attended her promptly. She was cold, breathing was laborious and there was no BP. The moment she was taken on bed, she had a cardiac arrest. Dr Swapna and her team began chest compressions rigorously and she was promptly put on ventilator. About one hour of CPR and her heart rate was restored. Meanwhile her heart scan showed Massive Pulmonary Embolism ( huge clot in the right side of the heart). Immediately she was given medications for the clot to get dissolved. However her condition remained critical requiring high dose medicines to support her body.
In spite of right kind of treatment, Massive Pulmonary Embolism has a reported death rate of more than 15%, Dr Swapna informed. Timely help from Dr Abhay Thakre, cardiologist was invaluable. However this was just the beginning. The risk of injury to other organs especially brain was still high in spite of timely resuscitation because clot in the right side of the heart stops the forward blood flow from the heart and hence reduced blood flow to organs like brain, kidneys etc is inevitable. After 48hrs, heart started showing recovery, but kidneys got affected, hence dialysis was started. Fortunately MRI brain did not show any major changes due to low oxygen supply and after 72 hours, she started responding.
Dr Swapna said this was the most positive consequence. In medical fraternity, there is a popular saying..”Time Is Brain”. But in Shivani’s case, we feared inspite of the fact that CPR was started immediately because of the time taken for her revival. 60 mins is a time enough for brain to get damaged. But fortunately we managed to save it.
One more interesting turn in this case was a rare entity that was diagnosed, called as Paroxysmal Sympathetic Hyperstimulation syndrome. Dr Swapna said, It is an uncommon entity to be seen after cardiac arrest and very few cases of post cardiac arrest autonomic instability are reported. This condition is commonly seen after traumatic brain injury. It’s problem is delay in its recognition as signs and symptoms overlap with many other critical conditions seen in ICU. She said, it was a learning curve for us in ICU too. This condition presents with high heart rate, unusually rapid breathing, profuse sweating and pupils become dilated and there is no reaction to light. This can be like a nightmare for the intensivists as it mimics severe brain injury ( eg: bleeding in the brain or raised pressure inside the brain).However these signs are temporary. After thorough evaluation and discussion with Dr Vasant Dangra, Neurologist , diagnosis of paroxysmal sympathetic hyperstimulation was done and accordingly treatment was ensued. She responded to the treatment well and such episodes eventually ceased. This is one important syndrome to be kept in mind by all ICU doctors, especially after reviving a patient from near death situation.
Shivani was recovered completely without any neurological deficit, fully resolved blood clot in lungs and normal heart and totally recovered kidneys. Efforts of doctors from KRIMS Hospital, Nagpur, mainly the ICU team led by Dr Swapna Khanzode along with support of Dr Abhay Thakre and Dr Vasant Dangra paid off well. What’s more! Shivani walked back home smiling. Shivani and her family were all praises for the ICU team.