On December 18th, 2022, at precisely 11:45 PM, a sense of urgency filled the air at the NTPC Telehealth Center. The worried faces of a young man’s parents as they rushed their 22-year-old son through the doors. The young man, feeling his heart race uncontrollably for the past hour, was in need of immediate medical attention.
Attending to the distressed patient, a dedicated paramedic swiftly recorded his vital signs. It became apparent that his heart was beating at an alarming rate of 199 beats per minute, coupled with low blood pressure measuring 98/58 mm Hg. Symptoms of sweating, syncope, and even vomiting had plagued the young man earlier that day, his palpitations had become too worrisome to ignore.
Dr. Dhirendra Mishra, an experienced medical officer from Apollo, wasted no time and performed a thorough examination of the patient. After careful consideration, he prescribed immediate intravenous medications to address the urgent nature of the young man’s condition.
Administering Inj.Pantop 40 mg IV stat to alleviate gastric distress and Inj. Emeset 4 mg Stat to quell any lingering nausea, Dr. Mishra recognized the need for a more comprehensive evaluation. He ordered an electrocardiogram (ECG) and a test to measure the levels of Trop-I, a protein marker indicating cardiac damage.
The ECG results revealed a troubling finding—broad complex tachycardia. Furthermore, the Trop-I level indicated an elevation, reaching 1.22 ng/ml. Realizing the gravity of the situation and the need for immediate intervention, Dr. Mishra urgently reached out to an emergency physician at Apollo Hospitals in Chennai, seeking their expert opinion and guidance.
After assessing the patient’s precarious condition, the seasoned emergency physician determined that the young man was hemodynamically unstable, with blood pressure measuring 90/50 mmHg. Swift action was imperative. In consultation with Dr. Mishra, the emergency physician recommended administering Inj.Midazolam 4 mg IV stat and initiating DC synchronized cardioversion—a controlled electrical shock to the heart delivered in sync with the cardiac cycle. Dr. Mishra took the time to explain the significance of delivering the shock promptly. Understanding the gravity of the situation, the parents eventually gave their consent.
As the medical team prepared for the life-saving intervention, Dr. Mishra also ordered the administration of a Ringer lactate solution as an intravenous bolus to ensure proper hydration and stabilize the patient’s condition. The importance of maintaining fluid balance in this critical moment could not be overstated.
With the parents fully aware of the urgency and the medical team prepared, the stage was set for the delivery of the DC synchronized cardioversion shock. Under the watchful supervision of the connected emergency physician, an Apollo doctor expertly delivered a 100-joule shock to the young man’s heart. The tension in the room was palpable as the fate of a life hung in the balance.
After the successful delivery of the shock, relief washed over the room as the vital signs of the young man began to stabilize. His blood pressure rose to a healthier 110/70 mmHg, his heart rate settled to 101 beats per minute, his blood oxygen saturation reached 98% on room air, and his temperature held steady at 98.6°F. It was a triumphant moment for the medical team and a hopeful sign for the young man’s recovery.
A follow-up electrocardiogram revealed sinus bradycardia with specific abnormalities in leads V2-V3, including a broad complex and inversion in leads V5-V6. Responding promptly to this new information, the emergency physician prescribed a loading dose of medications to mitigate further complications. The regimen included Tab. Atrovas 80mg PO stat, Tab. Clopidogrel 300mg PO stat, and Tab. Aspirin 300mg PO stat.
Furthermore, to ensure continuous support and stability, the medical team initiated IVF NS 0.9% (Intravenous Fluid Normal Saline) at a rate of 100 mL per hour. Concerned about the young man’s falling blood oxygen saturation levels, which reached 90% on room air, the doctors promptly connected him to a 3-liter oxygen supply per hour, in line with their expert advice.
With the young man’s condition gradually stabilizing, preparations were made for his transfer to a hospital in Guwahati. Ensuring his comfort and safety, he was transported via an Advanced Life Support (ALS) ambulance, equipped with a constant oxygen supply of 3 liters per hour and an IVF Normal saline drip at a rate of 100 mL per hour.
The young man remained under the watchful care of the hospital. During follow-up visits, his parents gratefully relayed their son’s stable condition, their voices tinged with relief and gratitude. The timely and expert treatment provided by the medical team had truly saved their beloved son’s life.
