November 20, 2017
I am on the way to my clinic after a home visit of 91 years aged female, a resident of Chembur.
After reviewing her today, i felt like sharing this post with you all regarding an amazing experience i had few days back at our esteemed Zen Hospital.
This 91 years aged female, belonging to a respectable family suffered a sudden fall at her home at Chembur, in the early evening around 15 days back, she developed CLW on her rt.temporal region, which started bleeding and she appeared to be in confusion after the fall.
I was informed about this accident on phone while i was in my evening OPD, I directed the family to immediately shift her to Zen Hospital Casualty. Patient reached Zen within minutes and was quickly assessed by Casualty Medical Officer, Dr Vilas, who took wise decision of shifting her instantly to ICU as her systolic BP was almost beyond 200 mm of Hg !!
In the ICU as a swift response from Roy Sir’s Surgical team, Dr. Pranav and Dr. Vineet took sutures and bleeding was arrested in no time, Parallely, ICU Intensivist Dr. Soneji and Dr. Narendra got blood pressure and other vitals stabilised.
Followed by this, she was taken to Delta Imaging on ground floor for CT scan Study of Head and Brain, the Delta team conducted the study quickly and reported of “counter coup effect ” in left temporal area of brain as she had suffered the fall on right temporal region, CT further revealed no active bleed or any CVA as such.
The patient was back in ICU where she was seen by Dr. Vikrant Shajji, Dr. Anil Venkatachalamji (Neurophysician), and Roy Sir himself,
The three specialities together arrived at differential diagnosis of
? Benign Paroxysmal Positional Vertigo (BPPV) due to ? VBI
? Neurogenic syncope
? Cardiogenic Syncope as RBBB was noted by Dr.Vikrant
Friends, patient had reached zen at 9.30 pm and before 11pm, i.e almost within Golden hour she was not only stabilised but D/D was also arrived at, Next morning Dr. Narayan Gadkarji was requested to evaluate her and conduct 2D echo study, Dr. Gadkar opined to consider Artificial Pace Maker Implant to treat her cardiac arrhythmias and provide support to heart to beat at normal rate and rhythm. The Ejection fraction was found be around 55% !!
Incidentally the patient revealed that her 65 years aged son has already had permanent pace maker implant in his chest wall since last 2 years and her 80 year aged sister residing at USA too is on medication for the same malady, the Consultants collectively decided to go ahead with pacemaker implantation, to treat cardiogenic syncope as her actual cause of sudden fall, and therefore Dr. Ameya Udyavar D.M, DNB (cardiiology) an interventional Cardiologist, specialized in Cardiac Electrophysiology was called in.
The procedure was scheduled for a day after tommorow in the afternoon, In the meanwhile the expert Healthcare team in ICU and state of art technology was providing best possible support to her, to the extent that twice she went in Complete Heart Block, with severe bradycardia, hypertension, slight haemodynamic instability and early signs of heart failure, but the situation got picked up instantly and managed very well by expert efforts of Dr. Vikrant Shajji, Dr. Sandeep and Dr. Narendra who even applied defibrillator at one instance!
In fact Dr. Sandeep, ICU intensivist, kept Central line ready for temporary pace maker in case of any Emergency. Finally, as scheduled Dr. Ameya implanted Permanent Pace Maker in Zen Cath lab in presence of Dr. Narayan Gadkar, simultaneously the Coronary Angiography was performed too, which revealed no blockages.
The patient was back in ICU after procedure for monitoring for 2 days and then shifted to suit room where she was mobilised quickly and finally discharged on last Sunday and she actually moved out of hospital on her feet !!
Friends, Patient is 91 years aged, so obviously no Mediclaim benefits, yet the total bill was very much reasonable in the words of her son who had paid bigger amount for his own similar treatment two years back at one of corporate hospital.
Today she is asymptomatic and comfortable. She actually is a founder trustee of one of very reputed Educational institution of Chembur since last 50 years, and she has been leading a very active life and used to attend her office daily from 9.30 am to 3.30 pm.Now She is again feeling so fit that she wants to go back to her office from 1st December, At her age of 91, the zen team managed to bring her out of life threatening situation with almost no residual effects, this is commendable and remarkable
She, her family and the management of institution have thanked and extended good wishes to Zen Hospital. Its Angels i.e, Dynamic team of Doctors and Supporting staff !!
Wishing you all wonderful weekend ahead .and Thank you for sparing time to read this Post,
Dr. Prakash Lulla