Miracles of Care

A Life saved in the ER!

Successful revival & treatment of a patient who underwent Cardiac arrest in the ER

A 61-year old male patient came to the ER of KD Hospital with a complaint of left-side chest & shoulder pain since half an hour. Investigative ECG showed ST Elevation from V1-V3 indicating Anteroseptal Myocardial infarction & the 2D Echo showed LVEF (Left ventricular ejection fraction) of 10-15%. An ejection fraction below 40 % indicates a failing heart.

Suddenly, the patient went into cardiac arrest in the ER itself. The medical team under the guidance of Dr Vivek Nanda, Consultant Emergency Medicine, rushed to revive the patient with the help of continuous CPR and shock (electrical cardioversion), by 360J unsynchronized current. With electrical cardioversion, a high-energy shock is sent to the heart to reset a normal rhythm.

Later, the return of spontaneous circulation (ROSC) was achieved & the patient was then admitted under the care of Dr. Abhishek Rajpopat, Consultant Cardiology for further management. A Coronary angiography diagnosed the patient with Acute coronary syndrome, Double vessel disease, Acute anterior wall myocardial infarction, Cardiogenic shock & Severe LV dysfunction.

Understanding the urgency & delicate condition of the patient, the Cardiologist performed Percutaneous transluminal coronary Angioplasty (PTCA) in the left anterior descending artery (LAD) on intra-aortic balloon pump (IABP) support.

An intra-aortic balloon pump (IABP) is a type of therapeutic device, that helps the heart pump more blood. IABP therapy is used to treat Cardiogenic shock.

Later the patient was stabilised in the ICU and was sent home walking after a stay of just 5 days.

A 59-year-old uncontrolled diabetic & morbidly obese patient was referred to KD Hospital in a hypoxic state on maximum ventilatory support - for consideration of ECMO following severe pneumonia secondary to H1N1 influenza (Swine Flu) infection. Based on her critical situation, she was admitted under the care of Dr. Harjitsingh Dumra (Consultant Pulmonary & Critical Care) & Dr. Mansi Dandnaih (Consultant Critical care er LiverTransplant Intensivist).

Weighing the risks/benefits involved with ECMO (An advanced technique to improve oxygen in patients failing ventilator support), a decision was made to give her a trial of prone positioning ventilation (patient lying flat on the stomach) to facilitate oxygenation. She required two sessions in the first 3 days (for 18 hours/day). It was challenging to glue Prone Ventilation in this case as she was morbidly obese (104 hg Bodyweight) e having acute kidney Injury (Creatinine: 3.40 mg/dL). The experience and skill of the treating team made this herculean task possible. Under the continued supervision of the ICU staff and timely decisions relating to appropriate antibiotic, fluid, hemodynamics and ventilator therapy, the patient eventually made a complete recovery.The patient required 14 days of ventilatory care, 20 days of ICU & total of 27 days of Hospital stay.

This monumental task was only possible because of seamless coordination between different specialties involved & implementation of state of the art protocols. The painstaking & untiring efforts of the entire ICU Team not only led to the survival of the patient but also led to avoidance of ECMO, which would have added a substantial burden to the cost of therapy. This was surely a Miracles of Care !

A UNIQUE CASE OF LEFT KNEE OSTEOARTHRITIS IN A 40-YEAR OLD PATIENT

A 40-year male patient visited KD Hospital's Department of Orthopaedics with a complaint of pain in the left knee for 15 years, debilitating his life. Upon consultation with Dr Amir Sanghavi and undergoing a diagnostic X-ray, he was found to suffer from Left Knee Osteoarthritis with fixed flexion deformity of 25 degrees.

After thorough counselling and weighing the benefits of surgical intervention, the patient underwent left-side Robotic Knee replacement surgery, which involves resurfacing a knee damaged by arthritis. Robotic surgery helped in perfect alignment and ensured the longevity of the implant. After surgery, he returned home pain-free & stable.

The uniqueness of this case reflects in the fact that for a better quality of life, the patient underwent Knee surgery at a relatively younger age. Due to several myths surrounding knee replacement surgery, the patient did not consult a specialist at an early stage. If he had consulted sooner, he would have suffered less pain & have not lost several years to reduced mobility.

A unique case of patient with Gestational DM, Fetal distress & Dengue fever

A 35-years old female patient, known case of gestational diabetes mellitus, came to KD hospital. She was 37 weeks pregnant, with Feuer, extreme weakness reduced fetal movements. Her blood work showed Dengue positive status, severely low platelets (15,000/mm3) & elevated liver enzymes. Additionally, baby's heartbeat tracing showed Fetal distress.

It was a situation of distress because she needed emergency delivery by Caesarean to save the baby. But any major surgery with such low platelets is very high risk for the mother as she may bleed profusely. ICU admission platelet transfusions were given & emergency Caesarean was done by Dr Ankita Jain (Consultant Obstetrician and Gynaecologist). Postoperatively she received more platelet & blood transfusions & was stabilized in ICU.

A baby boy was then delivered & admitted in NICU under the care of Dr Snehal Patel, Consultant Neonatal Paediatric Intensivist due to Respiratory distress as result of MSAF (Meconium stained amniotic fluid) & dengue positive status of mother. Baby's platelets were 9000/mm3 on admission e- dengue viral load was very high. The Respiratory distress settled within next 2-3 days with supportive care, but his platelets were breaking down and required multiple transfusions. The baby also had low BP & reduced cardiac output which was managed aggressively with fluid & ionotropic support. He showed signs of Liver failure due to dengue hepatopathy as well. Gradually with proper intensive care, his liver enzymes & platelets improved & finally the mother was involved for feeding the baby.

Both mother & baby were discharged in stable condition due to the promptness & expertise of our expert Doctors.

A successful treated case utilizing Laparoscopic Adrenalectomy

A 49-year old male patient with incidental detection of large left adrenal mass, came to KD hospital, Ahmedabad. Based on his condition & history of presenting illness he was admitted under the care of Dr. Darshan Shah, Consultant Urologist Dr Darshil Shah, Consultant Urologist.

He was suffering from transient ischemic attack (TIA) headache, which is a temporary period of symptoms similar to those of a stroke. Upon investigation it was found that the patient had Left Adrenal Myelolipoma. Depending on investigative reports & after weighing the treatment options, the Urologists decided on excising the adrenal mass.

He was treated with Laparoscopic left adrenalectomy & an adrenal mass of site 10 x 9 cm approx. was removed. Laparoscopic Adrenalectomy (LA) is a minimally invasive surgical approach that has almost replaced the open adrenalectomy in the management of small and medium-si3ed adrenal lesions. The patient was then relieved of his severe symptoms & was discharged in a stable condition.

The advantages of Laparoscopic adrenalectomy in such cases include shorter hospital stays, decreased postoperative pain, improved recovery times, and better cosmetic results.