Central Referral Hospital successfully treats first COVID 19 case

In these trying times of the ongoing pandemic, doctors often have to take very bold decisions against a slew of challenges. This was one inspiring example

During the ongoing pandemic people are scared and inhibited to undergo hospitalization for treating other acute diseases and emergency medical conditions. The fear is that the virus will invariably be transmitted during medical or surgical procedures. However, a heartening incident that recently occurred in Gangtok translates to a fresh lease of hope and life for many such people
A 55 year old man from Gangtok who had sustained a severe head injury after a fall was successfully treated at Central Referral Hospital (CRH) recently even after he tested positive for COVID19.
The patient was brought to the emergency ward of CRH in an unconscious state after the accident. On seeing his serious condition immediate measures were taken by the emergency doctors and an endotracheal tube was inserted within minutes to secure the airways. He was then put on mechanical ventilation.
An emergency CT scan of the brain revealed an Extradural Hematoma (EDH), a massive collection of blood in the left side of the intracranial space (space between the skull and the outer protective lining that covers the brain). It usually occurs because of a head injury and is a serious condition requiring emergency treatment. Death is imminent, if surgery is not done in time.
The patient was rushed to the ICU where he was stabilized and once that was achieved he was posted for the life saving emergency brain surgery whereby Dr. Pranav Rai, neurosurgeon, department of neurosurgery, CRH cut open his skull and drained the blood collection to reduce intracranial pressure.
The patient required ventilator even after his surgery and was expected to require mechanical ventilation for many more days.
However, soon after his surgery, his test reports (samples were sent earlier) revealed that he was COVID  positive. CRH is a non COVID hospital, meaning that the hospital is not equipped with resources as well as the specific manpower to handle COVID positive patients. As per the guidelines given by the central authorities all such patients have to be referred to the nearest facilities designated as COVID hospital.
CRH is a non COVID hospital, meaning that the hospital is not equipped with resources as well as the specific manpower to handle COVID positive patients
The STNM Hospital is the only COVID hospital in Sikkim. The difficulty now that arose was that in the immediate post-op period, the patient's condition was too serious for him to be shifted to STNMH. He was infact on a ventilator.
Representative image
Image: Representative image
The judgment call from the acting medical superintendent, Dr. Yogesh Verma and the infection control team had to be immediate and bold. The infection control team led by Dr. Dheeraj Khatri and staff nurse Pema Laden Bhutia, Karma Dolma Bhutia and Akki Lepcha put the patient's life first and decided to treat the patient at CRH itself till he was stable enough to be transferred to STNM hospital.
Commitment to this decision set them up with the monumental task of arranging manpower. Two nurses, one house keeping staff and a doctor were to be present at all times with the patient. They had to remain inside the containment zone and treat the patient for 7 days following which they would have to remain in isolation for another 7 days.
Only after testing negative would they be allowed to get back to the normal world. Despite being ill-equipped the entire neurosurgery ICU and operation room complex were isolated for 10 days. Nine brave nurses and two housekeeping staff and a doctor, Dr. Zigmee Bhutia, senior resident, department of neurosurgery, stepped up to the task without hesitation. Risking exposure to the dangerous virus and infection they worked morning, day and night to save the patient's life.
Incidentally the patient had also tested positive for Hepatitis B antigen. The CT scan of his chest also showed signs of active tuberculosis. Joint efforts with the department of medicine and pulmonary medicine made sure he received treatment for all his ailments without hampering his already challenged system.
The situation was dicey and things could go wrong anytime. Treatment had to be precise and accurate. The treating team too had to be protected. However, the dedication and teamwork of the health professionals paid off. The patient made slow and steady improvements. All complications were prevented even though the risks were high. The anesthesia teams were successful in removing the patient from the ventilator. Sutures were removed and the huge scar on his head healed perfectly.
He was eventually discharged from the hospital after 10 days of admission and referred to STNM Hospital for further treatment of COVID 19 infection. He was conscious and stable as he left CRH. All of the health professionals who looked after the patient are now in strict isolation, away from home and families, hoping to reunite them healthy and safe soon. The selflessness and helpful attitude of these frontline warriors are nothing less than heroic and their commitment towards service to humanity should never be forgotten.

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