I came to the ICU after a 2-month long maternity leave. And in that time I felt like I forgot all of medicine. The vocabulary and memory came trickling back, although a bit slowly. Dr. Ahmed was patient to my baby brain. Top cases to reflect on in the future:
1. 42 yo female s/p intracranial bleed and renal failure from severe preeclampsia. She came to ICU after suffering MI with no electrical activity for over 20 minutes. Diagnosed with anoxic brain damage. While in the ICU, she suffered from what might have been red man's syndrome from quick infusion of Vancomycin. She also had myoclonic jerks, which suggests a very poor prognosis. Husband let her go after a week, although her parents fought him over it.
2. 18 yo male with PMHx of ornithine transcarbamylase deficiency came in with delirium s/p vomiting episode. Any type of stress to the body can cause urea cycle buildup which sends patients with this deficiency into hyperuremic state. Treated with fluids and anti-nausea. Patient supposed to return to normal after 4-5 days.
3. 68 yo indian female with chylothorax from Gorham's syndrome. Gorham's syndrome is a uncontrolled proliferation of vascular channels or lymphatic channels in the bone which leads to resorption of bone. Patients often present with chylothorax which shows up with high TGs on throracentesis. No treatment other than avoiding high protein diet and preventitive strategies.
4. 58 yo Asian female presented in septic shock of unknown cause, likely from skin infiltrate. Gram cultures came back positive for cocci in clusters and chains. Treatment of vasopressors (dopamine), fluid, and antibiotics. Patient developed lower extremity ischemia due to poor circulation. Vascular surgeon called in to discuss possible amputation. Also developed renal failure and put on dialysis.
Themes:
- Get them hemodynamically stable --> pressors, fluids, HTN control, pH, and airway
- Almost everyone is on anticoagulants
- Start on diet (tube or TPN) within 24-48 hours
- CPAP trial prior to extubation
- ABGs run regularly
- GI prophylaxis with PPIs or H2 blockers
- Pneumonia prophylaxis
- PICCs preferred over central lines to decrease infection (due to drier lines and less chance of infection). CVP measured via PICC or central lines
- IJ over Femoral for decreased infection
1. 42 yo female s/p intracranial bleed and renal failure from severe preeclampsia. She came to ICU after suffering MI with no electrical activity for over 20 minutes. Diagnosed with anoxic brain damage. While in the ICU, she suffered from what might have been red man's syndrome from quick infusion of Vancomycin. She also had myoclonic jerks, which suggests a very poor prognosis. Husband let her go after a week, although her parents fought him over it.
2. 18 yo male with PMHx of ornithine transcarbamylase deficiency came in with delirium s/p vomiting episode. Any type of stress to the body can cause urea cycle buildup which sends patients with this deficiency into hyperuremic state. Treated with fluids and anti-nausea. Patient supposed to return to normal after 4-5 days.
3. 68 yo indian female with chylothorax from Gorham's syndrome. Gorham's syndrome is a uncontrolled proliferation of vascular channels or lymphatic channels in the bone which leads to resorption of bone. Patients often present with chylothorax which shows up with high TGs on throracentesis. No treatment other than avoiding high protein diet and preventitive strategies.
4. 58 yo Asian female presented in septic shock of unknown cause, likely from skin infiltrate. Gram cultures came back positive for cocci in clusters and chains. Treatment of vasopressors (dopamine), fluid, and antibiotics. Patient developed lower extremity ischemia due to poor circulation. Vascular surgeon called in to discuss possible amputation. Also developed renal failure and put on dialysis.
Themes:
- Get them hemodynamically stable --> pressors, fluids, HTN control, pH, and airway
- Almost everyone is on anticoagulants
- Start on diet (tube or TPN) within 24-48 hours
- CPAP trial prior to extubation
- ABGs run regularly
- GI prophylaxis with PPIs or H2 blockers
- Pneumonia prophylaxis
- PICCs preferred over central lines to decrease infection (due to drier lines and less chance of infection). CVP measured via PICC or central lines
- IJ over Femoral for decreased infection
