To Resuscitate or Not: The EP's Dilemma

​BY ROSHAN MATTHEW, MD A 40-year-old man arrived in an unresponsive state, his carotid pulse not palpable. His initial rhythm was asystole, prompting us to start CPR.Prehospital care is virtually nonexistent in our part of India, so no resuscitative measures were performed before arrival, and we were told that the patient had been unresponsive for 20 minutes.Five minutes into our resuscitation, we attempted to intubate the patient, but laryngoscopy revealed a mass protruding through the glottis. We decided to do a surgical cricothyrotomy, my first attempt on an actual patient after practicing on manikins about 100 times. Within five minutes of establishing the airway, the patient had return of spontaneous circulation.The patient's relatives reported that he had been diagnosed with a growth in his larynx two months earlier and had not had any treatment for it. As a last hope, they brought him to our institute, and he became unresponsive on the way. My shift was ending, and the next team took over his care.I asked about the patient's status on my next shift, and learned that the family had decided to take him home after ENT and neurology said his prognosis was poor. The treating team was not willing to admit the patient because of his grim chances, and said more “deserving” patients should be admitted instead.The joy of my successful cricothyrotomy vanished in a moment. I may have achieved a personal milestone, but was I helpless. Questions flashed in my mind: Di...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research