NIGHTMARE – BEYOND THE EDGE OF A TRAUMA SURGEON. A story of a trauma surgeon - in an emergency. drawaneesh.blogspot.com

1. NIGHTMARE – BEYOND THE EDGE OF A TRAUMA SURGEON.
I was discussing with my senior and juniors, how we would be doing our duties on Holi? Holi
is a festival of colours in India, people enjoy, play colours, and youngsters celebrate with
alcohol too. Since I am a trauma surgeon – I was worried about accidents. Especially on this
day accidents increase, and unfortunately, it was my duty that day. My seniors suggested I
replace my duty with one of the juniors, but I denied it. He was disappointed with my decision
and replied – “as you wish.”
On March 10, 2020, it was Holi, the institute was closedexcept our emergency, we were ready
to receive all kind of patients in the emergency. It was around 2 pm and to our surprise, we
are sitting in the emergency department (ED) without any patient, one shift of nurses was
happily over by them. I was wondering “why I am here”. Suddenly sounds of gurney started
coming – triage officer entered into the red area –the patient was severely drunken sustained
severe head injury beaten by some unknown persons. At the time of presentation, GCS was
E1V1M2, we secured his airway. At the same time, the cervical spine was immobilized, the
rest of the vitals were stable, but ABG was suggestive of severe metabolic acidosis, we
continued fluid therapy and blood replacement therapy.
Though the patient sustaineda severe head injury, he was continuously deteriorating. Hence,
we decided to shift the patient to the CT room to confirm the diagnosis and handed over to
our neurosurgery colleague. I asked my nursing team leader, Mr Pankaj, to shift the patient
to CT with two nurses (Ms Bhawana and Ms Mansi) and one ward attended (Mr Kedar). I was
the only senior resident with 4 more junior residents. After that, I just turned back to see my
nightmare coming true, everyone was busy, the whole emergency was full of patients. We
received 15 patients in the next two hours entire EDbecame chaotic with a variety of patients,
but on a positive note, none were having life or limb-threatening injuries; instead, each
patient was intoxicated with alcohol, mostly having chest and limb injuries. We stabilized all
patients, finished with dressing. Everyone was relaxed meanwhile I went to the doctor’s duty
room to get some snacks, as soon as I grabbed my 1st bite I heard my name being called
frantically. “call Awaneesh Sir – we received a brought dead patient” nursing officer Mr Om
Prakash shouted. In the background, the continuous sound was coming – “please save him,
he is a doctor”. I rushed to the red area – I saw around a 30-year-old man with wet cloths –
no recordable pulse and blood pressure, pupils were fixed and dilated, cyanosed, no sign of
life. We immediately started chest compression, and alongside we secured the airway by
intubation, we continued chest compression, carotid pulse came back after 20 mins of CPR,
lung functions seemed optimum by the response.
His brother was shouting outside – “he is a doctor, please save him”, After returning of
spontaneous circulation(ROSC) – I took brief history- they (victim with his fiancé, his brother,
and sister ) came to Rishikesh almost 600km away from home on the occasion of Holi, came
to enjoy holidays, it was the last day of their trip, and they were going back. For them it was
a beautiful day until then, the river between the mountains made an excellent view. He had
just stopped his car to take a selfie and accidentally slipped into the holy river Ganga having
high water current. Because of Holi fewer people around them and being new to the place,
they had blacked out what to do. After wasting nearly 30 minutes, they could reach to rescue
team, which took another 10 minutes to come and rescued him from the river after 45
minutes. They took 15 minutes to reach our hospital emergency. His brother was not ready

2. to listenand seemed far from the reality of the condition of his patient. He might be imagining
his brother’s recovery in a filmy way, where the actor comes gives 3-5 chest compression,1-2
mouth to mouth breaths and everything is back to normal, but this only happens in films and
not in real life. It was tough for me to explain to him about hypoxic brain injury that was
already done because it was almost one hour before he presented to us. We shifted the
patient to the CT room, CT was suggestive of global hypoxic brain injury. A lot of recoveries
were seen in the lungs, kidney, liver, intestines, etc. but the brain was grossly affected. Urine
output was good means kidney recovered well. Saturation was good with proper pulmonary
functions, the overall patient was recovering from the shock, noradrenaline tempered and
stopped in 24 hours. But the patient was having intractable seizures, and responding to
benzodiazepines and other antiepileptics.
I have never seen a man revived after 1 hour of drowning, maybe I am not that experienced.
Though I reviewed many articles in different journals, I didn’t find that anywhere else. I was
delighted that I revived a man after almost dying, but was unhappy too to imagine life after
such hypoxic damage. I know that recovery after such damage (basal ganglia) is practically
not possible still hoping beyond the science. I read many articles related to hypoxic injuries.
Few had good outcomes – in a nutshell, the result was directly related to the time of the
cardiac arrest to CPR.
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