Clinical medicine practice is one of the best charming jobs any doctor wishes. This is the speciality that makes u deal as the primary doctor in the rural setting of India, while in corporate or institutional setup it makes u deal as a secondary or tertiary doctor to manage the medical ailment.
Medical science is expanding every day; the process of fineness is ongoing in terms of understanding pathogenesis and the development of newer treatments. The scope of expansion is never-ending.
Benjamin Franklin truly states " TIME IS MONEY". It’s a well-known fact that getting treated at an appropriate time gives the best yield. Let's have a glance at a few medical magics which bring the patient back from Lord Yama!!
1. First is the simplest but most deadly if not handled appropriately in a given span of time i.e Hypoglycemic Episode. Hypoglycemia is defined as serum glucose less than 54 mg/dl. Our majority of the tissues depend on glucose as their source of energy. When sugar gets low, our neurons of the brain dies. It can manifest with a multitude of clinical symptoms from mild dizziness to life-threatening seizures i.e hypoglycemic encephalopathy. It is common in patients with diabetes, binge alcoholic, chronic kidney disease etc. The longer the time span of hypoglycemia more grave will be the injury. The most commonly affected part of the brain is the hippocampus, basal ganglia, posterior limb of the internal capsule, parieto occipital cortex. Injury is typically bilateral and can be detected by MR Imaging. This all can be prevented by timely diagnosis and management of hypoglycemia. All we have to give sweets if he is conscious or if the unconscious rush to a nearby hospital and get the glucose/dextrose infusion which can be life-saving.
2. Second comes the grave acute myocardial infarction. Clinically it can present with typical chest pain (Anginal pain) or atypical symptoms like sudden onset breathlessness or hypotension or conduction blocks. Risk factors are multiple like diabetes, hypertension, old age, dyslipidemia etc. The reason for infarction is the blockage of a vessel supplying cardiac tissue. Blood provides nutrition to tissue in terms of oxygen, glucose etc. Here also time plays a major role. For causing irreversible cardiac injury to 20 minutes is enough. Our target is to prevent surrounding tissue which is at the threat of impending damage i.e Ischemic Penumbra. And the method is to revascularize by unblocking the block via Thrombolysis (window period - 12 hours) or PCI (percutaneous intervention; window period - 24 hours). Time appropriate intervention will prevent the extent of damage, cardiac complications and might prevent death.
3. Third one is also a life-threatening condition i.e ischemic cerebrovascular accident. It can present with headache, dizziness, hemiparesis, hemiplegia or sometimes can be immediately life-threatening. Old age, dyslipidemia, diabetes, hypertension, smoking etc are the common risk factors. The cause of this story is also the same i.e blockage of a vessel supplying the brain. Neurological tissue is much more labile and undergoes irreversible damage more rapidly than cardiac tissue. Here also our target is to prevent brain injury by revascularizing vulnerable tissue i.e Ischemic penumbra. It can be done by thrombolysis (window period 3 to 4.5 hours of the event) or mechanical thrombotic endarterectomy (window period 6 to 8 hours).
Time-appropriate intervention can prevent complications and might prevent death.
Moral of this story - As the medical knowledge is expanding, understanding of the disease pathophysiology is improving. Better management strategies are now available to prevent deadly or morbid outcome if treated on time.
Very nice presentation.
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