Saturday, July 18, 2009
From the initial radio call to my initial view of this patient to this CT Scan above, this was a bleed from the get-go. I was about to intubate when the family showed. It was hard for them to follow this patient's advance directive but they did. By resisting the temptation to have us 'do everything' they spared him two to thirty days on the ventilator, a 'bolt' in the brain (a catheter inserted to decompress the blood), and death by progression of the bleed, ARDS, or a host of other life-enders that come when your brain is full of blood and your breathing is directed by a machine.
This patient was a textbook case, he fell unconscious, and by the time we saw him had spiked his blood pressure up into the mid 200's systolic... the body's attempt to perfuse the brain against pressure, and then his pressure dropped, his respiratory rate dropped, his heart rate dropped, and he died.
We are good at 'doing everything' but don't often have the opportunity to 'do nothing'. We did, of course, keep him comfortable as best we could with a few different medicines, but finding the line was difficult.
Posted by 911DOC at Saturday, July 18, 2009