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    The Critically Ill Patient

    Uploaded by

    Ali Sohail
    The patient presented with respiratory distress and was initially admitted under medicine for diabetes, hypertension, and drug use. Upon further examination, a groin abscess was discovered which was thought to be the cause of septic shock. The patient's condition was deteriorating so surgery was contacted for transfer. A journal article was summarized that found no significant difference in mortality between early (<6 hours) versus late ICU admission for in-hospital sepsis patients. However, early admission resulted in less patients being discharged to long-term care facilities.

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    The Critically Ill Patient

    Uploaded by

    Ali Sohail
    30 views12 pages
    The patient presented with respiratory distress and was initially admitted under medicine for diabetes, hypertension, and drug use. Upon further examination, a groin abscess was discovered which was thought to be the cause of septic shock. The patient's condition was deteriorating so surgery was contacted for transfer. A journal article was summarized that found no significant difference in mortality between early (<6 hours) versus late ICU admission for in-hospital sepsis patients. However, early admission resulted in less patients being discharged to long-term care facilities.

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    The patient presented with respiratory distress and was initially admitted under medicine for diabetes, hypertension, and drug use. Upon further examination, a groin abscess was discovered which was thought to be the cause of septic shock. The patient's condition was deteriorating so surgery was contacted for transfer. A journal article was summarized that found no significant difference in mortality between early (<6 hours) versus late ICU admission for in-hospital sepsis patients. However, early admission resulted in less patients being discharged to long-term care facilities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    30 views12 pages

    The Critically Ill Patient

    Uploaded by

    Ali Sohail
    The patient presented with respiratory distress and was initially admitted under medicine for diabetes, hypertension, and drug use. Upon further examination, a groin abscess was discovered which was thought to be the cause of septic shock. The patient's condition was deteriorating so surgery was contacted for transfer. A journal article was summarized that found no significant difference in mortality between early (<6 hours) versus late ICU admission for in-hospital sepsis patients. However, early admission resulted in less patients being discharged to long-term care facilities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 12

    The critically ill patient

    A case study and journal quotation


    By Dr Ali Ahmed Sohail PGR Anesthesia, pain management and ICU SIHS
    Call to Anesthesia and SICU

     A call was received from the medical HDU to Anesthesia on 4/7/23 at 2 30 pm


     With regards to an admitted patient requiring urgent critical care admission
    due to ongoing acute deterioration of vital signs and possibility of acute
    inflammatory/vs/septic process etiology of which was thought to be surgical
    in nature
     Upon visiting the patient immediately thereafter in the MHDU it was noted
    that the patient was in respiratory distress and was admitted under medicine,
    endocrinology.
     Immediate action was taken to stabilize the patient and provide intensive
    care as soon as possible
    Case history
    Pt name Ehsan ullah, k/c of DM,HTN, recreational drug use (poorly controlled)was admitted
    under medicine on 3/7/23
    With the following Presenting complaints
    SOB with exertional dyspnea
    Chest heaviness
    Diaphoresis
    Decreased urinary frequency since 3 days
    b/l creps on inspiration with decrease air entry bi baseler
    Vitals on admission
    Bp 110/50
    spO2 93 at RA
    Hr 90 bpm
    Temp was not recorded
    No examination was done to rule out organic cause other then chest auscultation
    h/o of present illness and general exam
     On arrival in MHDU
     55 year old male pt, well built with tall stature lying in bed, extremely irritable and agitated with
    rapid shallow breaths rr approx. 40. distended abdomen, and skin cold and clammy to touch, qSOFA
    >2 (> 10% mortality)
     CNS GCS fluctuating between 15 and 12. complaint of SOB during lucid intervals
     RESP Auscultation revealed b/l decreased air entry up till upper zone raising the suspicion of silent
    chest
     CVS no positive finding on auscultation
     On exposure there was ulcerated tender nodular skin lesion extending from groin to thigh (R side)
    WARM to touch
     Pt was an uric
     Vitals available
     spO2 86 at RA
     HR 100 bpm
     BP N/A
     No cyanosis, clubbing or lymphadenopathy
    Spot diagnosis and action in response to
    call
     As the condition observed previously. Spot diagnosis of resp distress with
    concomitant/secondary to septic shock was made. Cause most likey to be groin
    abscess, differential forniers gangrene, fasciitis, as such it was a surgical ailment
     Immediate call to surgery was made and care of patient was to be shifted to them
     This was important more so for the reason that this patient could not be
    transferred under care of SICU unless primary care team was surgical
     Incase of delay patient was to be shifted to medical ICU with immediate effect
    until surgery took over
     Immediate start of SSC bundle was initiated, large bore iv with 30ml/kg fluid, pt
    was already on broad spectrum ntibiotic
     Baseline investigations including (cbc,lft,rft,coag profile, s/e, blood culture ) with
    cm for 2 pints whole blood and ABGS
    Information relay
     The acute nature and urgency of response for the patient was relayed to Duty
    doctor, The surgery team , The Anaesthesia team and the SICU team
     Relevant consents for ICU care, mechanical ventilation, inotropic support and
    detail health education regarding abysmal prognosis of the condition was
    done by all 3 teams in tandem to the family/guardian of the patient.
     The surgery team had documented shift of care and as such without delay the
    patient was shifted to SICU where SSC bundle was done and mechanical
    ventilation constituted.
     The above actions effectively stopped a code blue
    Journal quotation

    Does early shifting of the patient to ICU reduce mortality in sepsis? If so then how
    early in the disease process?
    Association between the timing of ICU admission
    and mortality in patients with in hospital sepsis

     Nation wide cohort study


     Source journal of intensive care ( European journal of critical care, biomed
    central pool)
    Methods
    nation wide cohort, 13 hospitals with adult patients admitted from inhospital
    to ICU for sepsis
     Inhospital sepsis was defined as sepsis diagnosed in general ward
    Results

     Early admission where median time to admission in ICU was 1.9 (0.8 to 3.2)
    hours after diagnosis
     Late admission where median time was 12.9( 8.6 to 24.4) hours from
    diagnosis
     Primary outcome
     There was no significant difference between mortality of both groups
     Even in centres with RR teams available
    Secondary outcome

     There was no significant difference in ICU stay for both groups aswell where
    patients survived
     Early admission 11 to 38 days
     Delayed 9 to 37 days
     However early admission did result in less patients who survived being
    discharged to a nursing and or palliative care facility
     The study itself however did not have enough data to discredit the 6 hour
    derivative of the SSC campaign with regards to shifting to ICU
    Conclusion

     In the study above early admission to icu did not show decreased mortality in
    comparison to delayed admission
     However there was morbidity benefit to those admitted within 6 hours of
    diagnosis and the data provided is not enough to completely disprove that
    early admission to ICU for the septic patient does not give mortality benifit

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