Called by panic stricken receptionist yesterday morning 9.50 am. Patient
collapsed on arriving at the reception/waiting room. An elderly man whom I
recognised immediately. COAD, hypertensive, IHD. Asked the five waiting
patients to leave. His convulsion lasted a few seconds: put in recovery
position. He went into respiratory arrest. Managed to get his dentures out
within seconds, and put an airway in and started breathing for him. Feeble
pulse. Cardiac massage. 999 call for paramedics who arrived less then 5
minutes later. Laryngoscope from Paramedics: patient intubated and given
oxygen. Could not get venflon in; collapsed veins. ECG monitor showed
ventricular fibrillation (VF). Shocked. Flat trace on ECG; few seconds
later VF again. Shocked again. Flat trace. The second shock caused
extubation. Intubated again. Scooped and transported to A & E unit 3
minutes drive away. Resusc team alerted. They worked on him for half an
hour without success.
Went to his house with the Practice Nurse (who helped through the
resuscitation procedure). Broke the news to his wife. She had sent him over
to the practice to pick up a prescription for her eye drops and was fine
when he left home just after 9.30. They were due to go to Spain for a
holiday in 2 weeks time; their first holiday in 20+ years. Very pleasant
people.
How often does this happen in General Practice ? What resuscitation
equipment and drugs do you keep ? Do you get equipment cost reimbursement
from the Health Authority ? Would you intubate ? Is Cord Transection that
much of a risk that it should not be attempted except in a hospital
scenario ? Would you have done things differently ? What resusc training is
given to Practice staff ? Single handed practice. Small premises. I am
reviewing the whole incident. Private email replies will be kept
confidential.
Javed Sheikh
GP
Morden, Surrey.
emails: [log in to unmask]
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