Psychiatry and Psychological Syndromes

Biography

Biography: Guy Hugues Fontaine

Abstract

The case of my wife, a 73 year-old psychiatrist, experienced OHCA on June 2011 in the living room where she was watching the BBC world channel on TV. I immediately laid her down on the floor. There was no femoral pulse. I initiated standard CPR including chest compression (90 compressions per minute) for about 30 seconds followed by mouth to mouth breathing. I then resumed cardiac massage since she did not regain consciousness and there was no femoral pulse. I had a defibrillator in the basement of my house because of my interest in the Fulguration procedure. Since I had no gel to apply between the electrodes and the skin to decrease the impedance, I applied saliva to the electrodes and then gave a third shock. This last shock was successful, and the femoral pulse returned strong and regular. The femoral pulse remained stable, regular and strong. I estimated that about 6 minutes elapsed between her loss of consciousness and the return to a stable circulation. I then addressed the issue of possible brain protection. Fortunately, I had a smaller portable bottle now called the “Fontaine bottle” that was designed with a gas regulator to be used with a nasal cannula inserted into the nose to provide protection of the brain by nasal cooling. When the injector was in position I opened the valve of the cylinder and induced nasal cooling by expansion of the CO₂. Her hospital course was notable for repeated episodes of ventricular fibrillation with the same ECG pattern of Torsade de Pointes-like tachycardia degenerating in Ventricular Fibrillation in a few seconds. The absence of Troponin release demonstrated that she had no acute myocardial infarction which was my main concern. When sedation was stopped, she was fully awake and the tracheal tube was removed. Psychological test showed that she had absolutely no neurologic deficit. In particular, she could remember 9 telephone numbers. During the follow-up, she experienced three more episodes of sudden death with drop (one with injury of the face) immediately converted by the defibrillator leading to an increase of Bisoprolol. No more episode of arrhythmia up to now almost 7 years since the SD episode.