I. Somnath Das:
This 17 years old boy, S/O Mr. Dulal Das, who is one of our group â€˜Dâ€™ staff in Ward No. 3, got admitted in ITU on 17/03/2012 with the Complaint of Sudden onset drowsiness with fever for 2days. On detailed hiostory it has been found that he is a known Drug addict, including I.V. Drugs, Dendrite inhalation etc. C. T. Scan brain, Studies has been unremarkable except Lymphocytosis in CSF. On clinical examination, consolidation has been found over left basal area. It has been confirmed by chest X-Ray & advised antibiotics & other supportive therapy keeping in mind the diagnosis to be Community Acquired Pneumonia. On third day general condition deteriorated. Glasgow Coma Scale came down to be 3(E1 M1 V1), O2 Saturation in Blood came down to 60% with O2 Supply @10lit/min, B.P. â€“ 60/38mmhg, pulse- 142/min, highly Febrile. He was put on ventilator in IPPV mode with FIO2 40%. Suction sent from endotracheal tube sent for culture & sensitivity. Report came to Acinetobacter. Antibiotics started according to the Sensitivity report. Gradually he recovered but again deteriorated on 8th day of ventilation. Tracheostomy done. Again E.T. suction sent for c/s. report came to be infected with i) Pseudomonas aeruginosa & ii) Acinetobacter, which is resistant to all antibiotics. Keeping in mind the fact that in-vitro & in-vivo sensitivity deffers, Clindamycin has been started with brilliant result. On repeat c/s both were negative & E. coli could be isolated. Successfully weaned off from ventilator & discharged to home 28/04/2012.
II. Tuktuki Prajapati:
This 26 years old lady presented with high fever, oliguria, respiratory distress on 23/04/2012. On detailed history, it has been found that, she has undergone abortion 1 week back. On detailed clinical examination, ABG analysis & other investigations she has been diagnosed to be suffering from,- ARDS with Acute Renal Failure due to septicemia due to septic abortion. She has been put on ventilator with IPPV mode with inverse ratio ventilation. Forced diuresis with high preload instituted. Gradually her urine output increased. Successfully weaned off from ventilation & discharged to home on 5/05/2012.
III. Runa Saha:
This 43 years old lady, who is herself a nursing staff at Baharampur District Hospital, has been admitted to this ITU on 05/04/2012 with hugely distended & respiratory distress. On History taking it has been found to be like this, she has undergone Hysterectomy operation in vision care hospital 26/03/2012 & on 3rd day she got discharged from hospital. On 4th day her abdomen got distended with Obstipation & returned back to Vision Care Hospital. There on X-Ray Abdomen & C. T. Abdomen it has been diagnosed to be Volvulus of the transverse colon & treated conservatively. The distention did not get relieved; instead Patientâ€™s condition deteriorated & Was put on ventilator due to ARDS due to Sepsis. After continuing treatment over there for a period of 7 days, party became unable to bear the cost of treatment & brought the patient to this ITU. Here on detailed examination she found to be suffering from ARDS due to septicemia due to peritonitis due to perforation of volvulus with high diabetes mellitus. She has been continued on ventilator & peritoneal drain has been put by the Surgeon under whom she has been admitted. On first day of drain, total drain has come out to be 6.0lt which is fecal matter. Her insulin requirement got as high as about 100u/day & that is also through I.V. route. Tracheostomy done. On different cultures of E.T., Peritoneal drain different organisms have been isolated. Antibiotics instituted as per Sensitivity reports. Keeping insulin replacement, nutritional support, other care system patient recovered. Today after a period of 21 days, she has been successfully weaned off from ventilator, afebrile, Tracheostomy closed, abdominal drain closed, urinary catheter removed, taking food by mouth, can sit up without support. Now is still admitted in order to fix her insulin doses & to take care for her kidneys where mild degrees of pyelonephritic changes have been found. She has been discharged from hospital successfully on 09/06/12 after a series of incidence of impaired renal function (Creatinine â€“ 2.9). According to latest information she has joined her duties on 01/08/12.