Status Epilepticus: an intractable case with a successful outcome

A thirty-two-year-old male patient with a history of fever presented with generalized tonic-clonic convulsions and a low Glasgow Coma Score [GCS]; an endotracheal tube was inserted to secure his airway. The patient had malignant generalized tonic-clonic convulsions for six weeks, he was diagnosed as status epilepticus [SE] on the electroencephalogram [EEG]. Achieving control was very difficult even with various antiepileptic medications. More than six antiepileptic drugs were used in addition to continuous infusion of anesthetic medications to control the convulsions. After four-months in the ICU, the patient became fully conscious with no residual neurological deficit and good control of convulsions but with generalized muscle weakness. The patient was eventually transferred to the regular ward and was discharged after few days

Misunderstanding of the term [DNR] in a middle-eastern teaching hospital

Do-not-resuscitate [DNR] order has been practiced for many years; though it is one of the most commonly misunderstood and misinterpreted orders in medical practice. It has many ethical, legal, geographic, religious and cultural aspects that contribute to this misunderstanding. To assess the perception amongst the acute specialties who deal with DNR orders. A Cross-Sectional Questionnaire Type Study. Setting: King Hamad University Hospital, Bahrain. Anonymous questionnaire was designed. Physicians working in the acute specialties were included. The questionnaire included several general questions about when DNR should be implemented and what are the appropriate aspects of management that should be given. Fifty doctors completed the questionnaire; 49 [98%] of the physicians thought that a hospital should have a DNR policy, 23 [46%] of the physicians believed that the DNR decision lies in the hands of the responsible doctor, 10 [20%] of the participants thought that it is a family decision only, whilst 17 [34%] thought that it is a joint decision by the family and the physician. All of the physicians agreed that there should be no code blue activation in case of cardiopulmonary arrest of a DNR labeled patients. The term DNR should not be used as it is confusing and liable to misunderstanding. In addition, we need to educate healthcare professionals about the terminology of the management of end-of-life situations