An Elevator Story!!!

R. Niveda

Second-year Emergency Medicine Resident, Kauvery Hospital, Chennai, India

On the elevator

I was posted in CCU, on a routine afternoon shift. When I was on my way to visit my ER team on the seventh floor, I got dropped off on the sixth floor and walked to the seventh floor using the stairs. When I stepped onto the seventh floor, the elevator door was wide open, and there was a small group of people holding an unconscious, unknown person. I immediately called for help, to give a hand to the people who were carrying him from the elevator to the ED. Within those few seconds of shifting, my brain was bombarding me with questions: “What happened? Who’s he? When did this happen? Is there anyone with him?”. Soon I was sensing my own adrenaline-provoked tachycardia in my chest as my heart raced, wondering what was really wrong with this man…

Meanwhile, in the ED…

He was rushed into the resuscitation bay 1. He was a gentleman with few grey hairs; I saw him gasping, profusely sweating, cyanotic, and with cold peripheries. There were no signs of breathing, carotid pulse was absent.

Monitors showed asystole. Initial vitals were unrecordable, capillary blood glucose was 137 mg/dl.

As usual, we jumped in, performing high-quality CPR as per AHA ACLS protocol. It was 7:30 pm. He was Intubated with an 8 mm size endotracheal tube, fixed at 22 lip level.

And to our joy, ROSC was obtained after 3 cycles of CPR at 7.40 pm. Post intubation, his vitals were stable.

His 12 lead ECG was showing Sinus rhythm, Left axis deviation, and an unimpressive T inversion in aVL. We wondered whether V1 and V2 were showing Q waves, indicating an old septal infarction.

ECHO showed adequate RV function, global hypokinesia of LV, and EF, 35%. CHEM8 showed Na, 138; k, 3.9; BUN, 27; Creat, 1.2; Hb, 16.3.

Trop-I was 0.03 (borderline)

ABG showed severe metabolic acidosis with lactates of 17.4

Cardiologist’s opinion was obtained and planned for a Coronary Angiogram (CAG).

CT Brain & Chest were normal

In view of severe acidosis and high lactates and uncertain neurological recovery, we planned to stabilize him first and do the CAG later. So, he was shifted to CCU for further care.

Next day in CCU, as his vitals were stable, he was extubated, and was put on NIV.

He underwent CAG, which showed triple vessel disease. Hence, CTVS opinion was obtained, with a CABG in view.

Simultaneously, As the workup panel for CABG was in progress, on day 3, He suddenly started complaining of throat pain. But his vital parameters were stable, with a normal oxygen saturation level.

Nevertheless, a CT Chest was taken.

I was aghast at what showed up in the CT-chest, my mask masking my incredulity at what I saw there!

A radio-opaque foreign body in the thoracic esophagus at the D4 level- “DENTURES”!!!

This was probably dislodged during extubation or when on NIV support, as the previous CT Chest image didn’t show this radio-opaque shadow.

An urgent Medical Gastroenterologist opinion was obtained and he was planned for endoscopy and the aspirated foreign body was removed.

On day 5 of hospitalization – CABG was done successfully by the CTVS team. Post-operative period was uneventful and he was discharged with nil neurological deficit and a proper well-functioning heart.

It was indeed all about teamwork right from the start – involving the senior consultant, my colleagues, nurses, paramedics, other hospital staff, and other specialists- that revived this patient successfully.

Let’s now learn a bit more about who he was

The patient was a doctor by profession, a Diabetologist!

He was a 62-year gentleman, known to have diabetes, hypertension, and Chronic Kidney Disease, who had walked into the hospital alone with complaints of severe retrosternal chest pain soon after dropping his wife at home. On the way to the ED, he suddenly collapsed in the lift.

“One doesn’t ask of one who suffers

What is your country and what is your religion?

One merely says – you suffer,

that is enough for me,

You belong to me and I shall help you”

– Emergency Department

Acknowledgment

I extend my heartfelt gratitude to Dr. Aslesha Sheth, Consultant and Clinical Lead, Department of Emergency, and Dr. Niveanthini, Consultant, Department of Emergency, for helping me to draft this article.

An Elevator Story!!!