THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DEIDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[4:37 pm, 31/01/2026] PPM 1: 66M Currently admitted with @PPM3 @PPM4
[4:40 pm, 31/01/2026] PPM 1: This patient inspired a new project where we look into the factors in terms of event details as to what makes certain patients survive CPR well and some patients not survive at all vs some patients survive with persistent vegetative state or currently better known as Unresponsive wakefulness syndrome.
Handwritten notes during first admission with left ventricular failure and a diagnosis of CKD since three months. Patient was taken up for dialysis soon after admission by PPM5
[5.08 pm, 31/01/2026] PPM 1: @PPM3 can you clarify on why the CPR has been labelled as two cycles? 
[4:46 pm, 31/01/2026] PPM 3: He was previously admitted under us and was discharged sir, now he was again admitted for maintenance hemodialysis sir
[4:47 pm, 31/01/2026] PPM 5: That’s my handwritten notes.
[4:49 pm, 31/01/2026] PPM 1: From admission on 5/1/26 followed by discharge and then readmission on 26/1/26 he had a few dialysis sessions but had a sudden event during dialysis on 26/1/26 which was a republic day holiday. There is no note about the events before the intubation while the intubation note does mention that the patient was drowsy.
Can @PPM5 @PPM3 @PPM4 tell us more about that particular event which led to the intubation?
[4:51 pm, 31/01/2026] PPM 3: Morning till he was connected to hemodialyzer he was fine sir, 2 mins after that he complained of pain at the IJV Catheter site, and after that he suddenly became unresponsive and was in gasping state sir.
[5.00 pm, 31/01/2026] PPM 1: Well done CPR documented at 6:40AM by PPM3
Patient progress with ABG rtc on handwritten notes this republic day
Further notes on 27/1/26 @PPM6 @PPM7 note the mnemonic fast hugs bid handwritten by @PPM3 and share it's significance in this patient if possible
[5:11 pm, 31/01/2026] PPM 3: Return of spontaneous circulation was achieved after 2 cycles sir
[5.11 pm, 31/01/2026] PPM 1: On 29/1/26 our team of local doctors started planning extubation
@PPM6 @PPM7 check the extubation criteria noted by @~Poreddy Jahnavi and comment in relation to this patient's supplied data if possible
https://youtu.be/zd6bmRYk8Rk?si=tM5vRKWCv14i7WQf
[5.17 pm, 31/01/2026] PPM 1: His metabolic syn phenotype[1.53 pm, 01/02/2026] PPM 1: 👆@PPM3 please answer the question above. I'm not sure who actually witnessed the patient just before CPR and intubation but I'm assuming it's you. The events before the CPR is not documented in the file and hence we are trying to at least document it here.
The patient is walking today
[5:16 pm, 31/01/2026] PPM 1: While gasping what did you notice about his pulse, heart rate?
Was the monitor showing a flat line while he was gasping? Was he in the dialysis room when he was gasping and perhaps he was not connected to a cardiac monitor there? Was he shifted to the ICU from the dialysis room before CPR was started? If not cardiac monitor what about carotid pulse? Apical impulses? Heart sounds?
How much CPR time did rosc (return of spontaneous circulation) take? 40 seconds?
[2:55 pm, 01/02/2026] PPM 4: Patient was shifted to ICU from the dialysis before cpr was started
There was no carotid pulse before cpr or any pulse on cardiac monitor
[3:35 pm, 01/02/2026] PPM 6: Album
Found it sir
This is a daily ICU care mnemonic, not a diagnosis or treatment, but a checklist to prevent ICU-related complications.
🧠 FAST HUGS BID expanded:
Letter
Meaning
F
Feeding
A
Analgesia
S
Sedation
T
Thromboembolism prophylaxis
H
Head-up elevation
U
Ulcer (stress ulcer) prophylaxis
G
Glycemic control
S
Spontaneous breathing trial
B
Bowel care
I
Indwelling catheter review
D
De-escalation of drugs / Delirium
📌 It ensures holistic ICU care, not just survival.
[3:36 pm, 01/02/2026] PPM 8: Sudden event = sudden cardiac arrest?
[3:44 pm, 01/02/2026] PPM 1: Wish we could see the microscopic events before the macroscopic cardiac arrest
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