So, what do I do now? Cases in Cerebrovascular Medicine.

Book Review

  • BOOK REVIEWER Oxford Neurological Society


It is about midnight as you’re writing up notes for the patient you’d just seen in A&E. You were hoping to get an easy and relaxed night shift this sunday evening, but the reality of filling in for your sick colleagues, in the already understaffed department, quickly verified your plans.

As you finish drafting the plan for the patient, a woman rushes through the door of the resus room and cries off the top of her lungs:

“Help! My husband has had a heart attack on the parking! I think he’s dead!” she exclaims and approaches you, desperate for anyone with a vague resemblance of a doctor.

Armed with your knowledge of resuscitation, you call the arrest team and plough forward to the hospital parking lot, where you find a 58-year-old man who is pulseless and unresponsive. You are happy to see that the daughter had already begun the CPR and you quickly diagnose the ventricular fibrillation rhythm.

He is promptly intubated and defibrillated, with a return of spontaneous circulation in 10 minutes. Happy with this, you complete the workup and notice that he is moving his limbs and localizes to pain. The team is ready to send him off for the PCI. After the procedure, his sedation is withdrawn to reassess his neurological status.

You stand at the bedside and observe with mounting fear as his arms and legs are completely unresponsive to any noxious stimuli. You ask yourself this crucial question: “What do I do now?”