A FREEZING NIGHT, A SMOKY ROOM AND A COMATOSE ARMY OFFICER - A DOCTOR'S REAL LIFE EXPERIENCE
This is the true story from the 1990s, of an Army Colonel from one of the Gulf countries, who survived Carbon Monoxide poisoning, due to timely and apt resuscitative measures sans sophisticated gadgets. I was working as an anesthesiologist there and by sheer coincidence I was picnicking on site at the time. I guess, without my prompt actions and quick thinking, saving his life would have been impossible. As the local people put it, it was a miracle. And for miracles you don’t need any sophisticated technology, your bare hands and the basics of emergency care are enough.
It was 14th January 1992. We were picnicking at “The Green Mountain”, a hilly part of Al Hajar mountain range in Ad Dakhiliyah. This mostly limestone mountain .is one of the highest points in Oman and Eastern Arabia. The range is mostly desert, but at higher altitudes receives around 300 mm (12 in) of precipitation annually — moist enough to allow the growth of shrubs and trees and support agriculture. This is what gives the mountains their "green" name.
It is a very cold place, with temperature falling to as low as 0 degree Celsius, Hence, residential building of senior officers come with fireplaces. The chimneys of these fire places get clogged from lack of regular usage and frequent cleaning.
On that eventful day it was unusually cold. The Army officer, married less than a week ago, wanted to talk to his newly wed wife. So, for privacy, he got into the room with the fire place for using the phone. The room was almost sealed, and the fire place was lit with fresh burning coal after some months of inactivity.
While engrossed in talking with his wife, he probably got disoriented progressing to stupor and dropped the receiver. The next thing we heard was the frantic phone call from his wife, who rang up his Senior Officer, to say that whilst talking with her husband, their conversation was cut abruptly and all on a sudden there was no response from him.
Everybody, including me, quickly sprang into action. We reached the place and broke open the doors to be greeted first by a gush of smoke. Initially we couldn’t see anything clearly but managed to reach him. We lifted and carried him to the Medical Treatment Room, nearly 200 meters away. As the whole area is terraced the ambulance could not have reached quicker anyway. He was fully comatose, and in a
pugilistic pose, completely black. In the treatment room I immediately intubated him and pumped fresh oxygen through the Ambu (Artificial Mechanical Breathing Unit) bag. In the beginning, he was pulseless. After oxygenation, I could feel the Carotid artery and hear feeble heart sounds. Gradually, his body became pink and his still body started to move. Within five minutes of intubation and ventilation, he gestured at me to take out the endo-tracheal tube. Since his pulse and blood pressure were stable, I did extubate him without any hesitation.
And to my surprise, he sat up on the bed and asked me not to transfer him by helicopter to the main hospital. The place where I revived him was not well equipped and all I had was a laryngoscope, an Ambu bag, and an oxygen cylinder.
Throughout the night I picnicked along with the nursing assistants and the above officer. And in the morning when I came back after my toilet rituals, I found his bed empty. He walked himself to his room, and by 8 AM I found him sitting in his office attending to his duties.
For a Doctor, this incident has important lessons. For managing an emergency like this you do not always need sophisticated instruments or gadgets. Even the very basic facilities would suffice. In these situations, presence of mind and quick thinking are your best allies.
In an emergency, first and foremost, keep calm. Approach the patient in a logical and methodical way. And do not hesitate to deviate from the conventional approach or drug to resuscitate the “dead”. Whether it would do any good may be in doubt, it certainly can’t do any harm to the “irrevocable”.
But these lessons go beyond medical emergencies and the message applies equally well to diverse life situations. In any emergency, maintaining calmness and approaching the problem in a methodical manner sets you on the path to success. And don’t always stick to Text book teachings. Above all, never give up.
[Dr. (Major) B. C. Nayak is an Anaesthetist who did his MBBS from MKCG Medical College, Berhampur, Odisha. He is an MD from the Armed Forces Medical College, Pune and an FCCP from the College of Chest Physicians New Delhi. He served in Indian Army for ten years (1975-1985) and had a stint of five years in the Royal Army of Muscat. Since 1993 he is working as the Chief Consultant Anaesthetist, Emergency and Critical Care Medicine at the Indira Gandhi Cooperative Hospital, Cochin]
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