Sep 10

Dr. Castellanos’s Most Unusual Experiences

Case Two

Around 1980 working with a group in Orange County, California.
I was called to evaluate a patient in the emergency room at Canyon General Hospital.
The history was that he was involved in an auto accident. Apparently, he lost control of his car on the 55 freeway and ended on the side of the offramp. There was no history of an actual collision.
My initial evaluation of the patient was a middle-aged man with no complaints. His vital signs were normal my physical exam including neurological exam was normal.
As a precaution, I ordered a basic lab test and an EKG.
A medical disaster begins!
The patient begins to have a cardiac arrhythmia.
Within a few minutes, he also starts having respiratory difficulty.
Then he starts having disorientation.
I ordered a CAT scan of the brain. Back in those days, those early CAT scan machines would take 3 to 4 hours to have some results. The CAT scan results were read by the radiologist as normal.
By now I had to intubate the patient and place him on a respirator.
He also became comatose.
I had requested consultations from a cardiologist, an internist, a pulmonologist, and a neurologist, all we’re unable to provide a diagnosis.


I go back-and-forth reviewing with my colleagues, repeating some lab test, continuing to monitor his cardiac rhythm, and most importantly I repeat my physical exams:
His cardiac exam continues to be erratic with multiple PVCs.
His lung sounds some clear.
He still needs to be on the respirator.
And he is comatose.


I react empirically: gut feeling! (Or was it my training with the Undersea group at San Diego Navy) My diagnosis: air embolism to the central nervous system!
My colleagues consulting do not agree.

I order the patient to be transferred by helicopter to Western Medical Center which has a hyperbaric chamber.
I travel by car to Western Medical Center.
I’m going through the hallway into the ICU several family members of the patient are encircling me and grabbing my arms wanted to know if their loved one was going to survive. They had witnessed all the tubes attached to his body.
I stormed into the ICU, and to my surprise, the orders that I had written with his transfer to be placed in the hyperbaric chamber had not been executed by the nurses.
Instead, I find the patient with several residents and chief neurosurgeon Dr. S. at the patient’s bedside.
The Chief was an imposing figure, I introduce myself as the patient’s physician and I ask why the patient is not been treated in the chamber.
The Chief states that the patient does not need to be in the chamber did not agree with the diagnosis of air embolism, the patient needed to have a monitor of CNS pressure with a needle catheter and treated for Edema with steroids.

Who am I?

Even though I had known this patient only for the last six or eight hours, I felt that it was I
that would have to answer to the patient’s family regardless of the outcome.
I had developed a connection and responsibility with the family Throughout his worsening status.

So who am I?

Yes, I’m this patient’s doctor.
So after I heard the Chief’s explanation and plan, I reasserted my position:
I’m this patient’s doctor, and I strongly advise that you do not interfere with the order given for this man’s treatment.

It was very clear by the Chief’s mannerisms that I needed to say more!

I followed with “if this patient, my patient, is not in the chamber within the next couple of minutes, I will transfer him to Catalina Island to be treated at that chamber.
If something happens to my patient in route, I’m sure the family will have questions for you.”
The chief and residents all leave the bedside! The head nurse of ICU follows the orders. Three to four Nurses Place the patient on a special gurney and placed him inside the hyperbaric chamber with 4 to 5 Atmosphere of pressure (if I recall correctly).
Within 15 to 20 minutes the patient’s cardiac monitor converted to normal sinus rhythm.!
Soon after he begins to move extremities.
He is coming out of his coma.
he was out of the chamber, he was in the ICU for a couple of days, was extubated, and soon thereafter discharge with no neurological deficit’s.

Thank you God!

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