Hi everyone! I'm a 2nd year resident doctor in an inner city hospital.
For those of you who follow me, this is not my official introduction (this will likely come around January 2nd or 3rd). This is a blog to document some of the experiences I encounter as a training doctor, and some of the things that I learn in the process. After all, being a physician means that I'll be learning some fascinating topics for the rest of my career, and seeing how I can use those to help patients.
Let's get started with today's experience:
CPR
CPR, an abbreviation for cardiopulmonary resuscitation, is a technique used to restore a person's circulation and/or breathing when it is lost (due to any of a large number of reasons). For those with proper training, ACLS (advanced cardiac life support) is a set of protocols used to perform step-by-step resuscitation based on a person's condition as it evolves, and frequently involves intubation, shocks to the heart, and infusions of various medications to stabilize the patient.
My experience today involved a successful resuscitation of a person who had pulseless cardiac arrest (the heart stops and there is no pulse because the heart cannot pump blood through the body) with acute hypoxic respiratory failure (there is no breathing because the blood, which normally carries oxygen, cannot bring oxygen from the lungs, so the lungs cease to work) due to a cause which is unknown at this time. THe return of a pulse during the ACLS protocol is known as ROSC (return of spontaneous circulation).
Compressions
I had noticed that my compressions, 3 out of 4 times this month alone, resulted in successful ROSC, including on today's patient. How can compressions do this? Well, a compression is manually pumping the heart so that it can start moving blood on its own. The hope is that once there is some movement of blood and activation of the heart muscle, as well as movement of medications through the bloodstream, the heart will be reactivated. High-quality compressions can instigate this to happen.
How were my compressions so successful? Aside from following the standard guidelines provided by the American heart Association, I used a special technique; namely, I used my legs to provide the force of movement. Instead of bending my torso for every compression, I kept it straight and allowed my calves to do the muscle work. This permitted me to retain energy in the upper body in case my calves started feeling weaker. Thus, I was able to perform deeper, stronger compressions for a longer period of time until the patient achieved ROSC. It's quite likely that ribs were broken in the process (those who have performed compressions will recognize that snapping sound), but that is very frequently the price of a successful effort.
Compressions can be quite an exhausting activity. It helps to have good cardiovascular health in order to perform them for a prolonged period of time (which, in all honesty, I don't recommend doing unless you're very fit). I practice at home, and have been running for a year and a half, so my current fitness level has permitted me to specifically train my compressions to be more physically effective.
What happened to the patient?
Well, the patient was indeed intubated and started on medication infusions to maintain her blood pressure. She was sent over the medical intensive care unit (MICU) so that she could be closely monitored and continue receiving the medication infusion. If she survives, the MICU team will try to figure out what exactly caused her to go into cardiac arrest today, and they will try to bring her back to how she was before: breathing without a tube and blood pressure maintained at a normal level without a continuous infusion of supporting medications.
After ROSC is achieved, the prognosis tends to be quite poor. Many patients end up in cardiac and.or respiratory arrest again. There are uncommon cases of people returning back to their original state. They are usually on the younger side, and their cardiac or respiratory arrests tend to be caused by external factors which are more easily reversed (for instance, drug overdose).
I hope you've enjoyed this little snippet of an experience I had as a resident in an inner city hospital. I'll have many more stories and learning experiences coming in the future, so stay tuned.
Sources:
Being able to revive a patient is something that causes joy, I know that it is not easy, and that when the CPR maneuver is assumed it is because the patient's condition is very unstable, they are minutes of intense physical activity where every second counts.
Excellent work that you have done.
Thank you kindly for your appreciation! ☺️
The joy honestly depends on the patient. On the general medical floors or in the MICU, a revival is often proceeded by a sense of impending doom, because we know how sick the patient is and that the chances of further survival with an acceptable quality of life is severely diminished. The rewarding moments occur when we see the patient recover close to how they were before, which is unfortunately quite rare (for multiple reasons: by the time recovery occurs, the care teams switch; permanent damage from crashing the first time). The few times these recoveries happen, and we're around long enough to witness them, they are indeed very joyful.
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