Learn CPR - Save a Life - Be a Hero

 

A young 44 year old female was brought to our Accident & Emergency 8 days back, in a drowsy state with no recordable blood pressure. She had been having pain in abdomen since 2 days prior to arrival, and was diagnosed to have a ureteric calculus causing hydroureter and hydronephrosis (a kidney stone stuck in the tube / ureter connecting the kidneys to the urinary bladder, causing swelling in the tube and in the kidney).

Looking at her poor neurological status, her family was counselled regarding the need for immediately putting her on a ventilator, to which they reluctantly agreed to after a gruelling 20 minutes.

By the time patient was brought to us, she had already been drowsy in the government hospital for more than 4.5 hours, and was in full blown sepsis with pulmonary edema (fluid collection in her lungs) and early ARDS (Acute Respiratory Distress Syndrome). Within few minutes of securing her airway (after intubating her - putting her on a ventilator) and starting all resuscitative measures (with intravenous fluids and drugs to support pumping of her heart), her heart slowed down and suddenly stopped beating.

Immediate lifesaving CPR (cardiopulmonary resuscitation) was started, lifesaving drugs given, and we were able to revive her heart within few minutes.

There are always chances of brain getting permanently damaged if it doesn’t get blood supply for 3 - 5 minutes, in her case it was too early to predict if there was any.

Her husband and sister were distraught as they saw her getting wheeled out to the ICU with all the tubes in her body, IV lines, monitor, ventilator, drug infusion pumps, etc. Only thing they could do now was pray and hope.

Over the next few days, the husband would spend a lot of time in our Emergency waiting area, waiting to just talk to me regarding his wife – I knew that the clinical updates were given by our team of doctors upstairs in the ICU, but he wanted to share his grief too. I would also daily visit the ICU to check on her.

5 days after she was brought to us in that state, she was well on her path to recovery.

3 days back, she was off the ventilator, was given food orally the next day, and today she will most likely be moved to the wards.

This news itself gives such a sense of satisfaction and calm, feelings which can be felt only the heart, and I just thought that stories like this need to be told.

There can be no better reward for we doctors, nurses, and the entire team involved in patient care to see our patients doing well, and come out on top. It always is a great feeling to see the smile on the faces of patients & their relatives as they are being wheeled out from the ICU to the ward, and from the hospital to their homes.

What makes such patient recovery stories special for me is that for a country like India, the survival to discharge percentage for patients suffering an In-Hospital cardiac arrest (heart stopping) will ‘practically’ be less than 15 – 20 %, and I’m glad she will be one of them.

It really has been satisfying to train thousands of healthcare providers and lay persons over the last decade in CPR, as part of ‘Be a Life Saver’ campaign, an initiative I wish to continue in my healthcare journey with the sole objective being – TO SAVE LIVES.

A Hypocrite With No Conscience.

Dear Aamir,

I would not like to begin this by highlighting your professional achievements (like your media dogs do) – but will come straight to the point.

I was really surprised to see you featuring on the advertisements of PharmEasy, and it suddenly hit me that you have signed up as its brand ambassador !! How shameless can you really get?

Episode after episode, season after season, you ridiculed, defamed and constantly showed in bad light on your social reforming STUNT show ‘ Satyamev Jayate’, the hardworking healthcare workers, even claiming they received kickbacks from the same pharmaceutical companies and diagnostic centres that you now chose to endorse.

Where is the intellectual actor who advocated social responsibilities and moral obligations hiding now, when doctors are making a mockery of your double standards on social media? Don't you want to come clean or share any words of wisdom or encouragement with your half baked knowledge and selective outrage, like you did in your show?

Even during the pandemic, where had you disappeared, my friend? Enjoyed in your cosy farm house, going about with your daily life, waiting to get back to your vanity van, to be back on the big screen - while the medical fraternity around the world struggled to deal with the deadly virus. I was sad that we didn’t get to see you clapping or beating your utensils at your balcony to appreciate the healthcare workers (not that it really mattered to me).

The same healthcare workers you ridiculed on your show were the real heroes, serving the nation – Doctors, Nurses, housekeeping staff, etc along with the police and the essential service providers, who were out there – working – trying to save people’s lives – risking their own lives, working tirelessly, mostly without PPEs, without caring for their own families – the wounded healers.

Forget the appreciation that doctors and nurses deserved in times of crisis when they were the front line warriors in the pandemic, in the past too you have never ever spoken when the doctors were assaulted, nursing homes or hospitals vandalized, when Indian doctors have done breakthrough surgeries or research, when doctors have protested against the government for their rights, etc. Only your acting is an art, medical science is not?

Why? Because it will not generate TRPs, or it will not make you rich (I heard you used to charge 3 crores for 1 episode and 2 lakhs per 10 second ads of the series). Had you even thought about donating a small amount out of it when the country needed it the most? Akshay Kumar had donated Rs. 25 crore to the cause; at least Rs. 20-25 lakhs from you would not have brought down your monthly rashan budget.

Let me show you the mirror, the real "Satyamev Jayate", from the perspective of every Doctor, Nurse, and a healthcare worker who felt offended by your comments over the years – you are nothing but an insensitive coward, a low life, self centered guy who likes to be called Mr. Perfectionist (you have never asked media or your friends to not address you as that). In your eyes, your work and profession as an actor is unparalleled, heavenly, pure and honest hard work – the rest can go f*** themselves. You are nothing but Aamir the actor, nothing more than that. A hero with no conscience. Your hypocrisy stands exposed. Shame!!

Doctors across the country are having the last laugh now, and the joke is on you !!

I really hope this article reaches you soon and #GharBaitheBaithe'YOU'TakeItEasy

- From An honest, hard working, ethical, committed Emergency physician: for whom every single life matters, every single day.

Pulmonary Embolism: Beware of a possible clot risk when binge- watching television

A young 20 year old patient was rushed to the Accident & Emergency Department of Global Hospital, Parel, Mumbai last week with complaints of sudden onset chest pain, profuse sweating, hypotension (low BP), Hypoxia (low Oxygen concentration).

Doctors were quick to make a bed side clinical diagnosis of a massive Pulmonary Embolism, a life threatening Emergency where a patient could have suddenly gone into cardiac arrest and died.

With clockwork precision, he was gives the definitive treatment in the Emergency itself, within 38 minutes of arrival, and by the time the medication infusion was over in 2 hours, he had stabilized completely - Chest pain gone, BP picked up, Oxygen levels up and he was much more comfortable.

Cause of this life threatening Emergency - Binge watching television.

Yes, it’s true! Binge-watching television, more than 4 hours a day, not only causes brain rot — it can also lead to blood clot, raising the risk of life-threatening blood clots in the legs or lungs by almost 35%.

Watching back to back episodes of your favorite web series online or too much screen time during work from home may have become be a fab these days, but binge watching of TV, which involves prolonged sitting in cramped positions for long periods of time, has been linked with an increased risk of developing a venous thromboembolism (VTE). This is a condition where a blood clot forms in a vein. It includes deep vein thrombosis (DVT) and pulmonary embolism, which is when a clot travels to the lungs – which can be serious or even fatal.

DVT’s tend to form in the leg and are more likely to occur when you spend long time sitting down. When you’re sitting, the normal circulation of blood through the legs and feet is impaired
and slows down, so it is more likely to pool and start to clot. When you move your legs, the action of your calf muscles helps to squeeze the blood back up towards your heart. Some people do not know they have a DVT until the clot moves from their leg or arm and travels to their lungs.

Even individuals who regularly engage in physical activity should not ignore the potential harms of prolonged sedentary behavior such as TV viewing. Exercise can reduce the risk of death in relation to time spent sitting, but exercise doesn’t seem to reduce this risk as much in people who watch a lot of television. The increased risk could also be due to unhealthy eating habits often associated with watching TV (an unhealthy diet can also increase your risk of blood clots).

Hence it becomes extremely important that whether you’re watching TV or working at your computer, it’s a good idea to frequently get up and take breaks from sitting still. One should try to move around every time there’s an ad break, at least stand and stretch every 30 minutes, or be involved in other physical activities whilst watching to ensure you are staying active.

What are the symptoms of DVT?

A DVT usually forms in one leg or one arm. Not everyone with a DVT will have symptoms, but symptoms can include:

1. Sudden or slowly developed swelling of the leg or arm
2. warmness or pain in the swollen limb
3. Pain or tenderness in the leg on standing or walking.
4. Redness or discoloration of the skin
5. Veins near the skin’s surface are prominently seen

What are the symptoms of pulmonary embolism?

1. Sudden shortness of breath or fast breathing
2. Sharp chest pain that often comes with coughing or movement
3. Pain in the back
4. Cough - with or without bloody sputum/phlegm
5. Sweating more than normal
6. Fast heartbeat
7. Feeling dizzy or fainting

O Re Sathi - The Friendship Song

O Re sathi,

Kahan kho gye woh din
Aao phir jeelen,
Woh pal jo beete tum bin
Koi Shikwa nahi, wahi dhadkanein, umeed
Koi Shikwa nahi, wahi dhadkanein, umeed

Bhule kya, gale lag k,
Jo Bachpan k pal the guzare
Aisi yaari thi, k socha tha,
Beech honge na koi fasle
Shikayat nahi, gila bhi nahi, tumse
Shikayat nahi, gila bhi nahi, tumse

Dosti ka, aisa rishta tha,
Tarane nadani bhare the,
Na bandhan tha, Na fikren thi,
Roothe ko manate the
Koi Shikwa nahi, wahi dhadkanein, umeed
Koi Shikwa nahi, wahi dhadkanein, umeed

Yaad hai kya, tumne maine,
Na bichadne k wade kiye the,
Sath honge, sukh dukh mein,
Juda na kabhi honge
Shikayat nahi, gila bhi nahi, tumse
Shikayat nahi, gila bhi nahi, tumse

O Re sathi,
Kahan kho gye woh din
Aao phir jeelen,
Woh pal jo beete tum bin
Koi Shikwa nahi, wahi dhadkanein, umeed
Koi Shikwa nahi, wahi dhadkanein, umeed

Road to Success - Always Under Construction

A young 20 year old male patient was brought to our emergency with complaints of sudden onset chest pain, profuse sweating, hypotension (low BP), Hypoxia (low Oxygen concentration). ECG was suggestive of Sinus Tachycardia (a fast heart rate).

Based on his clinical evaluation, a quick bed side clinical diagnosis of a massive Pulmonary Embolism was made. Though I have only seen only 4 such cases in the last more than a decade of my practice in Emergency, I was 99 % sure that I would not be wrong, and did not write any other provisional / differential diagnosis on his emergency notes.

Knowing that Pulmonary Embolism is a life threatening Emergency where a patient can suddenly go into cardiac arrest and die, we needed to make quick clinical decisions and interventions.

The family was counselled regarding the seriousness and fatality of the illness, if not treated in time. His father and mother both started crying inconsolably; the patient was counselled regarding the possible diagnosis and he too started crying looking at his parents, with that feeling of impending doom of whether he will survive or not.

A quick CT Pulmonary Angiography was done, which confirmed the diagnosis of a Pulmonary Embolism. With our Emergency team which worked with clockwork precision, we were able to give him the definitive treatment in the Emergency itself, within 38 minutes of arrival, and by the time the medication infusion was over in 2 hours, he had stabilised completely - Chest pain gone, BP picked up, Oxygen levels up and he was much more comfortable.

His father stood by the bedside throughout the life-saving medication infusion. At the end of it, with tears in his eyes, the patient said, “Thank you doctor…” which made me emotional.

Hearing this, the father told him, “Ha doctor dev manus aahe, kahitar honar nahi tumhala (This doctor is God present in the form of a human, nothing will happen to you)…” and I was left speechless.

A reason why I wanted to write & document about this case was because it was one of the most well managed cases of my career, and highly satisfying considering the lifesaving interventions done in a timely manner.

The Head of the radiology department and the cardiologist (under whom the patient was admitted) were all praise for the quick diagnosis and treatment in the emergency, moments which make you feel good to be a part of a Team where we celebrate each other’s success. Also, it reminded me that I still get the same adrenaline rush and kick by saving someone’s life in emergency, like I used to since 2006 when I was a 2nd year medical student and first exposed to the EMS at Sion Hospital.

Over the last few weeks, we’ve had some really interesting and exciting cases wheeled in to our Emergency Department, and as a Head / Team leader, I really feel proud of the phenomenal work that my team is able to accomplish, and we’re growing together.

Plastic Surgeons cheerful as state government makes mask optional.

Mumbai - The Maharashtra government’s decision to withdraw all restrictions related to the Covid-19 pandemic and making facemasks optional has brought happiness and cheer among the plastic surgeons in the city.

It is a well-known fact that plastic surgeons are like Photoshop and Auto-Tuner of the healthcare industry, to correct God’s mistakes. For the last two years, plastic surgeons were the worst hit among all the medical specialisations, battling drought like dry OPDs. Due to the mask, no facial features are seen, and there were hardly any patients seeking enhancement of their facial structures, bosoms and other ‘stare inducing’ features.

In an exclusive interview with the Quackdoses, Dr. Kutting Chahiye, a famous Mumbai based surgeon said, “Plastic surgeons were hit hard twice in recent years. 1st was when the government banned ‘plastic’ in the country and we had to then start calling ourselves reconstructive or cosmetic surgeon. 2nd was due to COVID when people stopped coming for planned nose, chin or lip jobs, skin surface and other beauty enhancing procedures. With such wide reader base of the Quackdoses, we would like to urge everyone that, for facial rejuvenation, crease-free and scar-free look in the ‘mask free world’, do visit the plastic surgery departments now.”

Unconfirmed sources have claimed that SoBo (South Bombay) ladies are still in shock thinking it is an April fool joke by the government, and are left wondering what to do with their designer masks and diamond studded mask chains now.