In anticipation of episode number 44 on the highlights of the 2014 Whistler Conference, we

have with us the return of Dr. David Carr, and he's going to tell us one of his best case

ever's.

Dr. Carr, let it rip.

Thanks, Anton.

This is a case that I still think about, and it's a case that I think is one for the ages.

I'm working a busy Friday shift in the emerge, and this family brings in their loved one in a car.

And it's always amazing to see who brings people in versus who calls EMS.

So they bring this guy, and he's got quite an interesting story. On Christmas

day, the year before, he had a V-Fib cardiac arrest that left him with a hypoxic brain injury. He's a young

guy, is like 60 years old. And he goes home to a rehab facility the night before his visit in the

emerged at ICU. So now we're in mid-March and he goes home the night

before his first day home with his young family, his wife, his kids, and it's his first night at home. His wife says, you know, he was a little sleepy, didn't seem himself and he wanted to go to bed early at 6 o'clock. And this is a guy who had hypoxic brain injury, but was, apart from short-term memory, was doing pretty well. So he goes to bed at 6 p.m. The wife goes to her bed. She retires in the evening. At midnight, he's kind of unresponsive. At 6 a.m., the next day, he's kind of unresponsive. By 1 o'clock, p.m., he's still not responding. So she starts to panic. This is her first night at home

with her husband after three months. So she kind of scoops him with her teenage son and they bring him

to the emerge. So I see this guy in the emerge. And apart from his cardiac arrest, he's a diabetic.

He comes in and he's just, he's off. But his GCS is about three or five, three to five.

He's got occasional facial grimaces, maybe occasional grunt sounds, but not really anything else.

And he looks in absolutely no distress. You kind of plug him up. The nurse does his vitals.

He's 150 over 70, 69 pulse. He's 8 February out 36. He's not Tachypnic, not hypoxic. He's got a normal sugar. And I kind of don't know what to do with him. And he's one of these guys where I also don't know how aggressive to be with him because I, am I intubating this guy? I mean the textbook and the exam answer is you're going to intubate them. But, you know, the wife doesn't really want him to go through that again.

So I said, the textbook and the exam answer is you're going to intubate him.

But, you know, the wife doesn't really want him to go through that again. So I said, okay, well, I don't know what's going on. He certainly looks normal. I do a real good exam. Chess, cardiovascular, abdo, completely normal. Neuro exam, he's got no focal abnormalities, but obviously he's not following commands.

So I kind of order my confuser gram,

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