CASE REPORT - GLOBAL HEALTH CITY CHENNAI

[Deepak Arjunan]

  One ECMO is running in our organization

  CASE DETAILS :
 
   Ms. X a 23 years old female patient admitted on 12-04-14 with the complaints of high grade fever X 4 days, H/O nausea, vomiting, giddiness & cough. patient is having previous history of winter seasonal asthma. prophylactic treatment started, inj. Augmentin 1.2 gm iv BD, anti emetics and fluid NS 0.9% @ 100 ml/hr started. Patient had breathing difficulty in between the days and put on NIV.initally tolerrated the NIV.patient intubated SIMV mode.Chest X-RAY shown consolidation in both lungs and bronchoscopy reveled as purulent discharges,ABG - shown  hypoxemia. Spo2 maintaining low level . culture shows salmonella typhi and patient diagnosed as Typhoid fever , ARDS WITH PANCYTOPENIA, Echo shown EF - 30% and enteric myocarditis.

LAB VALUES

12-04-14                              13-04-14                        13-04-14 (6pm)          14-04-14                  14-04-14(6pm)         15-04-14    
Hb - 9.4                                Hb - 8.8                        Hb - 8.7                     Hb - 8.6                   Hb - 8.3                  Hb - 8.3
TLC - 1250                            TLC - 1770                    TLC - 3320                TLC - 3770               TLC - 4320              TLC - 15480
PLATELET-35000                  PLATELET - 37000        platelet - 29400          platelet - 227400       platelet - 50000       platelet - 94400

16-04-14                                     
 Hb - 7.5                    
 TLC - 7900               
 Platelet - 75400       

on 24-04-14 @ 2pm elective  ECMO started.now the patient is on VV - ECMO support with basic ventilator settings Fio2 blender - 100%, sweepgas - 6lt, RPM - 3700 . sedation on flow. ACT maintaining normal. No cannulation site bleeding. patient is on antibiotics. today is the 3rd day of ECMO. Spo2 maintainig 100%.  Chest X - ray shown still consolidation.
 
LAB VALUES :
 Hb - 8.3
 TLC - 12800
 Platelet- 243000