Citation

Windsor JS. Wilderness Environ. Med. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Elsevier Publishing)

DOI

10.1016/j.wem.2023.06.002

PMID

37474358

Abstract

I've spent the majority of my medical career working in critical care. Rarely has a week passed by when I haven't treated someone who's suffered an out-of-hospital cardiac arrest (OHCA). My approach to treating these patients has barely changed over the years. If the patient is unconscious, they're intubated and ventilated for 72 h and provided with all the organ support they need. Throughout this time, they remain fully sedated and their temperature is carefully controlled. Once we've identified and treated the cause of their cardiac arrest, we step back and leave the nursing staff to get on and deliver the essential day-to-day care that the patient needs. At the same time, we also sit down with friends and relatives and explain what's going on. We try our best to avoid raising expectations. A figure of 10% is often quoted--that's an estimate of the percentage of patients with OHCAs in the United Kingdom who survive to hospital discharge. To lower expectations even further, we warn loved ones that many of those who make it are often left with life-changing complications. When the sedation is eventually stopped, it soon becomes clear that most patients have suffered a catastrophic neurological insult, and with the family's support, plans are carefully made to move toward palliative treatment.

Language: en