Workshop/Conference

  2017 Workshop/Conference Title: 59F with nocturnal episodes of altered sensorium Active participants:  Rakesh Biswas  ,  Avinash Kumar  , ...

Saturday, 6 March 2021

65yrs male known DM, HTN, COPD, Parkinson's and Sepsis

 

65yrs male known DM, HTN, COPD, Parkinson's.
H/o fall followed by # neck femur. Hemiarthroplasty done. Patient discharged after 4 days on Amoxyclav but found drowsy on discharge so brought to another center and admitted under me. On examination 103F temperature and GCS 12/15, Mild generalized rigidity, anemia, few crepts bilaterally, tenderness in operation site and large bed sore.Gave Paracetamol, fever came down and patient became 15/15 GCS.
Thinking of Hospital acquired infection gave him Meropenem + Doxy + Clindamycin for 1 week. But fever recurs as soon as PCM/NSAIDS is stopped.
Hb 8, TLC 13500, PLC 200000, ESR 125, CRP 200. Malaria, Dengue, Blood cs, Urine cs all negative. CXR, USG abdomen NAD. Renal and LFT normal.
Did CT chest small effusion and small consolation left lower zone. Did CT of operated hip. Small collection near femur. Too little fluid for diagnostic tap.
CRP is progressively increasing (now 320) with normal Procal (1) and high Ferritin (5300). TLC was 10500. Albumin 2.4, Sugar well controlled. Now on Colistin + Tigecycline + Linezolid.
Orthopedic surgeons say no intervention from their part. Bone marrow planned.
Would be grateful for ideas in further management.
Rakesh Biswas and 2 others
19 comments
Like
Comment

Comments

  • Rakesh Biswas
    Admin
    How is the patient now? A fever pattern data on regular monitoring would have been useful
    • Like
    • Reply
    • 1 y
  • Arvind Alaga
    Any ECHO?
    • Like
    • Reply
    • 1 y
  • Denis English
    Needs to try some yoga right askay 
    Akshay Anand
    1
    • Like
    • Reply
    • 1 y
  • Sushma Sapkota
    Did we rule out Still’s disease.May be we can get Rheumatologist opinion
    • Like
    • Reply
    • 1 y
    • Like
    • Reply
    • 1 y
  • Uttam Biswas
    I think u re in the right track.... See response of current antibiotics....
    • Like
    • Reply
    • 1 y
  • Ambarish Bhattacharya
    Thank you everyone.
    Patient has expired few days back. Overwhelming Sepsis
    • Like
    • Reply
    • 1 y
    • Nitin Garg
      Ambarish Bhattacharya
       sorry to hear that. Any CSF analysis done as these procedures are done under spinal anaesthesia to rule out meningitis?
      • Like
      • Reply
      • 1 y
    • Anupam Halder
      Sir do we rule out meningitis in absence of any localizing history of meningitis?
      • Like
      • Reply
      • 1 y
  • Gaurav Sharma
    Sorry to hear the patient expired...read this message only today...I have been associated with a cardiac centre where I routinely manage ortho cases with such morbidities.
    If the duration between the occurance of fracture and admission to hospital is prolonged...such cases very commonly come to hospital with bedsores and a bad chest. Optimization of such patients to near normal..no matter how long it takes to do so...is the key to prevent SIRS n MODS.
    Also in such cases one has to keep the duration of surgery short.
    • Like
    • Reply
    • 1 y
  • Gaurav Sharma
    I wished to throw some light on the prevention part rather than the treatment hence this post
    1
    • Like
    • Reply
    • 1 y
  • Rakesh Biswas
    Admin
    Thanks 
    Gaurav Sharma
     for the valuable inputs above.
    1
    • Like
    • Reply
    • 48 w
  • Tarun Chakrabarti
    Did you ask for CPK? NMS could be superimposed on sepsis.
at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)