Tuesday, January 6, 2009

Heaven



"The ruptured abdominal aortic aneurysm was severe.. he got huge hematoma inside his peritoneal cavity... but Thank God we went in quite early" Joe the relatively young surgeon looked happy.


"What worried me is his blood pressure was on the low side for 2 hours post-intubation.. and now I suspect the kidneys are failing" a veteran anaesthetist voiced his concern.


"What's the urine output?" Joe began to sweat.


"Not much.. the CVP is low, even after 1 pint of Hartmann challenge, now he's already had positive fluid balance by 5 litre.. " another anaesthetist walked into the room.



"Better call in the nephro team. Make sure the primary team make the referral, just in case we need to dialyse him" Joe concluded the afternoon ward round.


Outside the ICU, rain is pouring down from heaven.

6 comments:

doc said...

nephro team so soon?

was any of the following considered?
1) colloid challenge +/- blood
2) renal dose dopamine +/- adrenaline
3) mannitol infusion

there was one cold night many years ago, like the one described in your post when i had 3 AAAs (yes, THREE!) in a row. only one survived, while 2 died on the table.

KL MEDICINE said...

good call..
he's already on inotropes

he suffered from hypotensive ATN

these days not many ppl believe in renal dose dopamine :)

mannitol infusion isn't the right way to go but he should be on lasix if he's euvolaemic

:)

doc said...

i have to say that i've never lost a patient with AAA to ATN. the emergency ones die of hypovolumia/DIVC while the elective ones, of sepsis.

KL MEDICINE said...

Actually bro,he later died of sepsis/DIVC, my friend in nephro team started him on CVVH dialysis for 24 hours. So it's not the ATN that killed him.

HaNi said...

may i link ur blog to mine?...please

SE7EN said...

go ahead.