Index: OLEYSON’s Medical Anecdotal Report [05-03]

 Title: A Joke That Is Meant To Kill.

 Period of Medical observation: March 2005

 Narration:

             It was about 5 pm in the afternoon during my tour of duty, when a 27-year-old male was brought at emergency room from falling from  6^th floor of the building where he used to work. Patient was unconscious, no blood pressure, no pulse, no respiration with multiple cranio-facial injuries.  We instituted immediately cardio-pulmonary resuscitation and did facial mask ambu-bagging. Two large-bore needle was inserted simultaneously while doing the cardio-pulmonary resuscitation. Pupils were dilated and non-reactive.  We intubated the patient but to no avail, too much blood drenched from his oropharyngeal area and our suction machine in the emergency room needed an overhaul.  It took sometime when we finally got a suction machine that is working. 

While we are doing CPR, I ordered the code in surgery emergency room and timely arrival of an anesthesiologist for the intubation.   Immediate intubation was tried but with difficulty because the facial deformity was too severe so thought of Initially  doing a “tracheostomy” for the patient.  I have the indication to do the tracheostomy however, when  12 lead ECG  was taken, the result was a flat-line. 

I approached the person who accompanied the patient, and he said that he is not a relative rather a supervisor of their company. I informed him of the present condition of the patient and death is inevitable.  I later learned from his co-worker that they were playing a game on the 6^th floor of a newly constructed building. The patient apparently was only kidding when he said he will jump off the building.  Unfortunately, for unknown reason, he suddenly fell off and his life ended there.

Insights (Reinforcements, Stimulus, Discovery)( Ethical, Phsychosocial, Physical)

                   “Pri mum non nocere” is “ first do no harm” was in my mind then when were doing CPR. Although at the back of my head I had the indication of doing the  procedure but everything came late  because the patient was  already dead.  We were thought of the indication to do tracheostomy which includes to bypass an upper airway obstruction at the level of oropharynx, larynx, cricoid and 1^st and 2^nd tracheal ring, to promote an airway in patients with severe oropharyngeal trauma, to promote suctioning of tracheobronchial secretions, and lastly to promote long-term mechanical ventilatory support.

                  Although medium-head and neck cases are very much needed in the departments accreditation, our conscience dictates doing the procedure is unethical because the patient is already demised. Heroic measures maybe done on these kind of patient with a physical score of V (moribund), if with still vital signs and in respiratory distress.

                  It is traumatic to think however, the way how he died especially on the part of  patient’s family. This could give us a lesson that such a joke is a threat to life. There are good jokes and bad jokes but jokes are not made to kill yourself so prevent from taking risk of bad jokes especially when your life is at stake.