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 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.
Rakesh Biswas If you go through the entire patient record linked above and particularly this document:https://3.bp.blogspot.com/.../s1600/IMG_20160516_154942.jpg you will find how his Insulin requirement has gradually come down from 12 Unit hourly to 1 unit hourly
Rakesh Biswas Priyam here:http://www.tdctoolkit.org/.../15... 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
Rakesh Biswas Priyam can you interpret this ABG?https://2.bp.blogspot.com/.../s1600/_20160516_194629.JPG
Rakesh Biswas Good Arun, Priyam, Yogesh, Madhavi. 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. :-)
Arun Chaudhary Abhi 8 baje 64 mg/dl aaya h ..isliye abhi DNS chal ri h ...abhi per hourly charting chal ri h
Arun Chaudhary No sir ...vo ventilatior pe to ni h ..n no aany other charting ...otherwise I read it ..n upload it
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. Priyam, Yogesh 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?):https://4.bp.blogspot.com/.../s1600/IMG_20160516_194123.jpg and translate and share again in English
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? Shachi, Bhavik, Priyam, Amy. The patient presented with severe metabolic acidosis as a result of urosepsis and ARF.
Madhavi Rawat S=> pt is feeling hungry,
He want to eat fruits specialty banana & orange.
Feet better today....See More
He want to eat fruits specialty banana & orange.
Feet better today....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." Madhavi, Priyam, Shachi
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
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
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 sabse important hoga inka INH dose check karna aur unka LFT report bhi upload karna.
Rakesh Biswas Also doesn't look like we are giving him enough fluids. His CVP is still quite low. :-(
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?
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
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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?
Rakesh Biswas Good to hear this Arun. He was pretty bad on the morning rounds today isn't it Abhishek?
Rakesh Biswas Arun please update his CBC report sent yesterday and let me know how much fluid has gone till now
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