Christmas 2012: Tomorrow’s World

Case report of E.T.—The Extra-Terrestrial

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8127 (Published 18 December 2012)
Cite this as: BMJ 2012;345:e8127

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Marc Moritz Berger1 and Gwendolyn Gramer2

1) Department of Anaesthesiology, University of Heidelberg, Germany
2) Department of General Paediatrics, Division for Inborn Errors of Metabolism, University of Heidelberg, Germany

Scott and Presswood (1) present a unique case report of Steven Spielberg’s science fiction legend E.T. - the extra-terrestrial, who stranded in a suburban region of North America (2). The authors suppose that ET’s newfound and haphazard Western diet may have led to profound malnutrition. This serious concern is supported by observations on another extra-terrestrial film-legend, namely Gordon Shumway, better known as ALF from planet Melmac. After almost every food intake ALF has to belch audibly, which may be interpreted as impaired gastric accomodation and intolerance to Western food. While belching is a common symptom in otherwise healthy humans, it is more frequently observed in patients with dyspepsia and gastroesophageal reflux (3). In context with ALF’s enormous appetite for cats it therefore appears plausible that Western diet is not suitable for extra-terrestrials, and indeed causes nutritional and metabolic complications as suggested by Scott and Presswood (1).

After arrival on earth ET became critically ill and hypoxic, ultimately deteriorating until cardiac arrest occured. Advanced cardiac life support was initiated, including administration of oxygen and ventilation with bag mask. The authors address that management of the arrest was in line with the standards of that time (i.e. 1980s). However, being aware that to date no data exist regarding evidence based medical care for extra-terrestrials, we feel it is critical to administer oxygen to an alien who – according to general perception – probably derives from a territory where no oxygen atmosphere exists. Exposure to high oxygen concentrations (PaO2 >300 mmHg) following cardiac arrest results in increased in-hospital mortality in humans, a finding that was attributed to increased creation of reactive oxygen species (ROS) upon hyperoxia (4). Numerous laboratory investigations have shown that excessive oxygen concentrations after re-establishment of spontaneous circulation worsen neurological deficits. Given that an alien is not adapted to an oxygen-rich environment, this effect can be expected to be aggravated in this species. Indeed, after re-establishment of circulation ET showed verbal perservations, which may reflect frontal lobe damage resulting from ROS-meditaed ischemia-reperfusion damage of the brain. Therefore we suggest that, if a practitioner comes into the unlikely situation to resuscitate an extra-terrestrial, ventilation should be performed with room air as opposed to 100% oxygen, as also suggested by several international guidelines for resuscitation of human newborns (e.g. 5). If, despite effective ventilation, there is no return of spontaneous circulation, application of oxygen should be considered.

References
1) Scott G and Presswood E: Case report of E.T. – The extra terrestrial. BMJ 2012; 345: e8127.
2) E.T.-the extra-terrestrial [film]. Spielberg S, director. Universal Pictures, 1982.
3) Lin M and Triadafilopoulos G: Belching: dyspepsia or gastroesophageal reflux disease? Am J Gastroenterol 2003; 98(10): 2139-45.
4) Kilgannon JH et al: Realationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation 2011; 123: 2717-272.
5) Richmond S and Wyllie J: European Resuscitation Council Guidelines for Resuscitation 2010. Section 7. Resuscitation of babies at birth. Resuscitation 2010; (81): 1389-1399.

Email for correspondence: marc.berger@med.uni-heidelberg.de

Competing interests: None declared

Marc M Berger, anaesthesiologist

Gwendolyn Gramer, Department of General Paediatrics, Division for Inborn Errors of Metabolism, University of Heidelberg, Germany

Department of Anaesthesiology, University of Heidelberg, Germany, Im Neuenheimer Feld 110

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Congratulations to the authors on an excellent article.

We do however, feel they missed an important treatment option in ET's care. With his trunkal obesity he is at high risk of developing type II diabetes. When ET arrested, after assessing and treating his airway, breathing and circulation, they should have remembered DEFG - "Don't ever forget glucose". This is the fourth "H" - hypoglycaemia which requires treatment. Whilst hypoglycaemia is unlikely in type II diabetes it may occur following overuse of insulin.

Regards,

Adam Shonfeld,
Mike Spiro.

Competing interests: None declared

Adam M Shonfeld, Anaesthetic Registrar

Mike Spiro

National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG

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To the authors. Many thanks for this Christmas present. We shall analyze in detail this case report during our next session of bibliography.

I have just one concern about the ET's chest wall bioluminescence! Is the defibrillation useful for extraterrestrials? and if yes, at which level of energy?

Season's greetings

Competing interests: None declared

Francois Sztark, Head of Dept of Anesthesiology and Intensive Care

University Hospital of Bordeaux, France

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