Sunday, June 5, 2016

BALIOSPERUUM462MONTANUM(MR) conversational clinical decision support on social media

Rakesh Biswas Priyam and Yogesh i hope you are able to see this patient (record linked above) that we admitted in the morning and discuss his progress here now. Deepika he (Priyam) is from your college and this is one of the reason we are trying to keep him in our unit. 
Rakesh Biswas He is currently in the ICU
Priyam Sharma sir his urine output is 775ml
cvp- 7cms
insulin- 114mg/hrly
UnlikeReply1May 16 at 8:24pm
Rakesh Biswas Thanks Priyam. I did get this current information fromYogesh on email but good that you also updated it here as all these inputs will go to the patient's record.
LikeReply1May 16 at 8:27pm
Rakesh Biswas If you go through the entire patient record linked above and particularly this document: you will find how his Insulin requirement has gradually come down from 12 Unit hourly to 1 unit hourly
Rakesh Biswas Arun please update the document above and share it here
Rakesh Biswas Priyam here: is the algorithm that was followed. Check out page 2, algo 2.
Rakesh Biswas Continue to give normal saline to maintain the CVP between 5-10. Arun please add the image of his hourly fluid intake and output here Priyam
Arun Chaudhary Pulse - 96 ...98 /min

RR - 23/min...See More
See Translation
UnlikeReply1May 16 at 8:33pm
Priyam Sharma intake is 2350ml
UnlikeReply1May 16 at 8:33pm
Arun Chaudhary Sugar charting of pt
UnlikeReply1May 16 at 8:37pm
Rakesh Biswas Good ArunPriyamYogeshMadhavi. I feel the ICU team particularly Biren has done a very good job on this patient. I am glad we shifted him to the iCU in the morning. 
LikeReply2May 16 at 8:38pm
Arun Chaudhary Abhi 8 baje 64 mg/dl aaya h ..isliye abhi DNS chal ri h ...abhi per hourly charting chal ri h
UnlikeReply1May 16 at 8:38pm
Arun Chaudhary Thanxxxxx sir
Rakesh Biswas Arun any chart showing hourly CVP?
Arun Chaudhary No sir ...vo ventilatior pe to ni h ..n no aany other charting ...otherwise I read it ..n upload it
Rakesh Biswas Arun CVP ke saath ventilator ka koi connection nahi hai. 
LikeReply1May 16 at 8:45pm
Arun Chaudhary Sir ...but tell me something about CVP or CVP charting ...
Rakesh Biswas Ek bar brother se pooch kar dekh lo CVP line kaun sa hota hai aur kaise CVP dekhte hain aur fir unke hourly CVP values yahan post karo. PriyamYogesh please guide. Baki CVP ke baare mein google karke bhi adhik jaankari le sakte ho
Rakesh Biswas Surendra please go through the history here (that you took?): and translate and share again in English
Rakesh Biswas Well done history Surendra
Rakesh Biswas Arun update total and hourly urine output and hourly CVP and insulin given
Arun Chaudhary HB % level ..decrease ..
Arun Chaudhary ABG report ...
Arun Chaudhary Sugar charting ..n insulin given in night ..
Arun Chaudhary CVP charting ...
Arun Chaudhary Pulse - 74 /min

Spo2 - 99%...See More
See Translation
Arun Chaudhary Pulse - 128/min

Spo2 - 95%...See More
Arun Chaudhary RBS charting of today ...
Arun Chaudhary CVP charting
Rakesh Biswas Thanks Arun. Please update the ventilator settings of the patient now.
Arun Chaudhary Sure sir
UnlikeReply1May 18 at 6:41am
Rakesh Biswas Extensive cavitory pulmonary TB with cervical Pott's spine (MRI images Madhavi?) and Steven Johnson syndrome due to ATT making the treating team to halt ATT for a while. A regular pot boiler worth reporting? ShachiBhavikPriyamAmy. The patient presented with severe metabolic acidosis as a result of urosepsis and ARF.
Rakesh Biswas
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Rakesh Biswas Not sure why and who wanted to plan a CSF examination in this patient. 
Rakesh Biswas
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Arun Chaudhary Today's charting ...
Arun Chaudhary Past I/O n BP n pulse charting.
Arun Chaudhary Sugar charting of night ..
UnlikeReply1May 20 at 6:54am
Arun Chaudhary CVP charting. .
UnlikeReply1May 20 at 6:54am
Arun Chaudhary Pulse - 91/min

Spo2 - 95%...See More
See Translation
Arun Chaudhary Sugar charting of pt ..
Arun Chaudhary Today ..CVP charting of pt
Arun Chaudhary BP - 136/89 mm/hg

Pulse - 97/min...See More
Madhavi Rawat S=> pt is feeling hungry,
He want to eat fruits specialty banana & orange.
Feet better today....See More
Rakesh Biswas Thanks Madhavi Yes he can eat his choice of food stuffs
Rakesh Biswas S and O here are very well done Madhavi
LikeReply1May 21 at 12:30pm
Rakesh Biswas
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Arun Chaudhary Pulse - 126/min

Spo2 - 100%...See More
Rakesh Biswas We can ask the ICU doctors to reduce his FiO2 Arun. Hopefully he shall start eating, his albumin will improve, creatinine will improve and his TB will be controlled on the fresh ATT and he will not develop another 'Steven-Johnson's reaction." MadhaviPriyamShachi
Rakesh Biswas Also hopefully his diabetes will be controlled on a less rigorous regime of insulin (other than the algo1 he is getting now) Yogesh
Madhavi Rawat S=> feel Hungary ,
Feel better ...See More
UnlikeReply1May 22 at 9:49am
Rakesh Biswas Thanks Madhavi if he eats well we shall switch him to basal-bolus-insulin regime and stop Algo1 by tomorrow.
Madhavi Rawat Sir pani dia tha to thaska lg RHA he abhi viren sir ka kahna he wo kuch kaha Nhi payenge abhi
UnlikeReply1May 22 at 9:57am
Rakesh Biswas
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Rakesh Biswas Good to see his creatinine coming down Madhavi
Rakesh Biswas Patient names from the MRI need cropping Madhavi.
Rakesh Biswas
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Arun Chaudhary Pulse - 126/min

BP - 108/71 mm/hg ...See More
See Translation
Arun Chaudhary CVP charting of pt
Arun Chaudhary RBS charting of pt
Arun Chaudhary I/O charting of pt
Rakesh Biswas Arun is he not shifted to casualty yet?
Arun Chaudhary No sir. ..abhi ni kiya h ...
Rakesh Biswas He has again developed acidosis. I wonder what precipitated it again?
Madhavi Rawat Sir CVB- 3.5
RBS- 363
Regular insulin-6unit
Madhavi Rawat Sir isonex tab.Jo 100mg de rhe the aaj dose complete ho gya he,next kya plan kr skte he sir
Rakesh Biswas Unko INH 300 mg tak maximum dose hona hai aur fir Rifampicin add karna hoga aur fir Pyrazinamide.
Rakesh Biswas Arun unka dekhna tablet INH kitna dose mein chal raha tha?
Rakesh Biswas INH sambandhi sister aur doctors dono ke notes upload kar diiye Arun
Rakesh Biswas Arun sabse important hoga inka INH dose check karna aur unka LFT report bhi upload karna.
Arun Chaudhary Pulse - 128/min

BP - 135/90 mm/hg ...See More
Rakesh Biswas Arun it should be 100 mg 3 tablets. Is that what you mean? What is that 150 x 100 mg?
Rakesh Biswas Also doesn't look like we are giving him enough fluids. His CVP is still quite low. 
Arun Chaudhary Yes sir ...
Rakesh Biswas How much fluid has he received since morning Arun. How much ml/hour is his current fluid intake Arun?
Rakesh Biswas Arun can you ask the patient's relatives as to how much INH has he exactly consumed? Was it given through ryle's tube?
Arun Chaudhary Yes sir ...ryles tube se hi de rahe h ...vese to ...

Arun Chaudhary Total input 2100 ml h ...
Total output 1900 ml h ..sir ...
UnlikeReply1May 24 at 9:50pm
Rakesh Biswas ml/hour abhi kitna NS ja raha hai? Agar 100 ml per hour ja raha hai to 200 ml per hour karwa dijiye
Rakesh Biswas
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Rakesh Biswas INH ke baare mein specifically poochna. Waise patient abhi subjectively kaisa hai? Objectively RR to zyada aur SpO2 bhi kafi kam lag raha hai. Kya abhi O2 nahi de rahe hain?
Arun Chaudhary Patient to acha h sir ...baat b kr rha h ..baitha h ..n O2 ni chal ri h usko ....
UnlikeReply1May 24 at 9:53pm
Rakesh Biswas Good to hear this Arun. He was pretty bad on the morning rounds today isn't it Abhishek?
Rakesh Biswas Update on this patient Arun
Rakesh Biswas Particularly his CBC and RFT sent yesterday
Rakesh Biswas ArunAbhishek would be good if you can update all his ABGs in one online record.
Rakesh Biswas Arun please update his CBC report sent yesterday and let me know how much fluid has gone till now
Arun Chaudhary Yes sir
Rakesh Biswas Rajesh we shall also need to localize a fresh source of his sepsis
Arun Chaudhary NS - 150 ml/hr

Pulse - 115/hr ...See More
Rakesh Biswas Yeh aajka CBC hai ki kalka Arun?
Arun Chaudhary Aajka h sir
Rakesh Biswas
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Rakesh Biswas Inko Algo 2 dena hoga Arun. Please dekho chal raha hai ki nahi.
Arun Chaudhary Chal rha h sir ...inko ...infusion se
Rakesh Biswas Kitna chal raha hai abhi Insulin (Algo1 ya Algo2)?

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