Palmo Anest

Please tell the whole truth, not just the truth...
Few days ago in CCU...

A 70+ years old gentleman, known case of 1st degree heart block with Ischemic Heart Disease admitted from A&E (Department of Accident & Emergency) for MI (heart attack).

On arrival to CCU, patient was found Asystole (heart no longer pumping) secondary to complete heart block, CPR (Cardiopulmonary Resuscitation) and ACLS (Advance Cardiac Life Support) was started promptly and a temporary pacemaker inserted to pace the heart (a device to meke the heart beat in regular rhythm).

Good knows how many minutes the patient has been in asystole before he arrived at CCU. Although ACLS was started and we manage to 'kick-start' the heart again with CPR and pacing, mantaining a good BP, the patient remains unconscious, opening eyes to call but with blank stare and not obeying commands.

He sustain hypoxic brain damage, he is not going to have any quality life after this.

His BP is stable, gases exchange is good on very minimum ventilator setting but still needs intermitten CPAP/SIMV switch. I would like to tracheostomy him.

The problem arrised from here... In my hospital, we dun't have cardiologist. CCU is incharge by medical team and support by Anaesthetic team. Medical team painted a good picture to patients family member on patient's prognosis based on stable heart with pacing, they would refer patient to state hospital with cardiology service for permanent pacemaker.

Cardiologist agree to take over if patient is out of ventilator support.

So the balls is in our hand, the anest team. medical told family that patient's heart is 'stable' and waiting for anest team to extubate patient. They also said patient can survive if cadiologist take over for permanent pacing.

Wow... come on man! Yes, they are telling the truth (that the patient 'can survive' with permanent pacemaker, and can send patient to the hospital with cardiologist once patient is out of ventilator). The Big BUT is, they are not telling the WHOLE TRUTH!

Patient's GCS remains 6/15. He is not going to have any quality life after this. It will be continuous suffer for him and the family if we can discharge him home after this.

I sincerely felt that medical team had unnecessory gave false hope to the family. We should informed the reallity and the whole truth... Let them understand the whole situation and make an informed decision.

2 days after the admission, I was oncall again and was greeted with family who are eager to know when can we send the patient to otherhopital for permanent pacing... And those initial few days, patient can't even tolerate CPAP. I had to nail the hard reallity and broke the bad news to the family, regarding the bad overall prognosis.

Arrh... Just another sad case to share with you guys... venting out my frustration...

posted by LT @ 1:07 AM