Wednesday, December 3, 2008

sakit hati

A 60 year old gentleman was unfortunate enough to fall very ill from a bad foot infection, had a heart attack in hospital and nearly died. he needed close to 15 minutes of CPR, cardiopulmonary resuscitation and by all the books, he should have died.
He defied the odds and now he alive. He's wide awake and hooked on to a ventilator. he's blood pressure is just holding with a ton of inotropes.( drugs that are infused to support heart rate and blood pressure in ill patients are called inotropes. Stop infusing them in people who still need them and they can die
His kidneys have failed to function and he needs dialysis.
The problem is he has a very sick heart. his ejection fraction is only 10%. a mere 10% of blood that enters his heart is being pumped out-ejected. that's barely compatible with life....most patients with similar heart function wouldn't be alive. but he is.
and he is awake and aware.
He cant breath very well on his own but that's not really the problem, our ventilator is connected to his lungs via an endotracheal tube and it does a good job helping him breath.
An ejection fraction of 10% isn't enough for the heart to pump blood at adequate pressure to reach all his organ.no matter, our inotropes are helping. Like super turbocharged amphetamines, grade A rocket fuel for his heart, they are being infused into his blood stream 24/7.
Now his kidneys have failed him and he cant produce urine to remove excess fluid and waste water. No matter, we have a super gentle and efficient dialysis machine that sucks and filters blood and returns it clean.
through it all he remains awake and aware.
the problem is how long do we continue? his family has been told but did i do a good enough job in explaining to them the gravity of the situation? did i paint the full picture clearly? its really not easy to tell people looking for any bit of hope that there's only a small chance of him getting well.
Small but possible. He is alive so far. I really hope he gets well.......

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