Monday, January 24, 2011

Resuscitating dilemma

Resuscitation is an art. It is highly stressful and definitely not for the faint hearted. I chose anaesthesia because i saw anaesthetists dealing with such ordeals in a composed manner unlike my discipline's registrars then. It is a combination of skills but most importantly a fast logical mind by the team leader to solve can be straight forward or it can be mind boggling, but need to think and ACT fast. Otherwise, CHAOS would be the order of the day.

AHA revised its guidelines last October. the emphasis for good CPR, push hard push fast becomes the main ingredient for a successful return of spontaneous circulation. Patient struggling between life and death is not a good sight. Most would not be keen to be responsible for that and i guess this gives us ( Critical Care) the edge to take the challenge.

Being a clinical specialist in Anaesthesia & Critical Care is not easy. Most of the decisions to continue, to stop, to act would be upon us. All Anaesthesiologist graduates are expected to master this skill and time and time again it will be tested.

I had 2 patients yesterday; both young patients collapsed and CPR commenced. One i stopped as it was about to start because there was absolute poor prognosis based on her current injuries. My MO initially refused to do that but being a young MO and seeing a young patient, i can understand why. I told her sometimes we as doctors must think as a whole especially the Critical carers; we are of a different breed. We dont compartmentalized our care and we always look things from a far and the bigger picture. Doctors tend to resuscitate more for to their benefit rather than the patient's. The guilt of being there and not doing anything will glare and becomes a nightmareto some. However, we are carers that will try to save lives with good quality and not to prolong death and suffering. The distinction must be clear and to do this, knowledge and experience would be the key.

The 2nd patient collapsed and needed intensive CPR. He was shocked twice and given appropriate drug intervention and we got him back. ROSC would not be complete without a proper cooling and cerebral protection management. What was the cause? I am not sure myself but i have settled the acute problem. Now we pray that there was minimal insult to his brain during his collapse and we will see how.

It is never easy when decisions are in your hands. Just need to tawakkal and make sure that you do your job the the best of your ability.

No comments: