Critical Care WAarticles

The Case A 78 year M was admitted with history of fall at home under orthopedic surgeon. He was a KCO HTN, Hypothyroidism and CKD. There were no symptoms suggestive of COVID-19. RT PCR was test was done as a routine during pre anesthetic checkup which came out as positive. Case was transferred under respiratory physician and operation was postponed until he is COVID-19 negative and ready to be operated. During hospital stay his oxygenation levels started falling. He was given medical care as per the best standard of care. He required Oxygen by mask, then Hi mask, then BiPAP/ NIV and invasive mechanical ventilation. He expired on 24th day of admission with cause of death as COVID-19 (Critical). -==- COVID-19 is a variable disease. COVID-19 stands for -=- COVI -Coronavirus D -Disease -19 -of 2019 -=- This was the acronym used for the disease which is caused by SARS-Cov-2 virus. As on date it has been found that this is a very variable disease and has been classified into the following fi

            The Case A 47 year old M was admitted with COVID-19 disease. His constitution is obese with very difficult peripheral venous access. Central venous access is fraught with air embolism in a respiratory distress patient and is considered to accompany more complications.   *Midline catheters* How it is inserted   Generally the basilic or cephalic veins are too deep to be visualized superficially. Therefore, ultrasound is used to place the cannula.   This required skill and practice. -==-     Dr. Prashant Kumar

  The Case A 75 year old M known case of HTN, Post PTCA now a COVID-19 patient presented to another hospital with gradual blackening of the left lower limb gradually progressing to dry gangrene. Below knee amputation was required to save life. He developed mild AKI and vision has reduced to 50% as complained by him. He is fully conscious oriented with oxygen saturation adequate. After 25 days of initial symptoms his systemic symptoms have not resolved.     Hb- 10.7 gm/dl TLC-12.22/ mm N77 Urea 68 mg/dl Cr- 1.4 mg/dl UA 4.1 mg/dl Na- 129 meq/L K 4.03 meq/L PO4 4.49 mg/dl Alb 2.65 gm/dl Ferritin 222 ng/ml IL6 18.88 pg/ml CRP 4.17 D-dimer 2.44 LDH 272 IU/L Vit D3 121 nmol/L   == COVID-19 is now recognized to involve almost every organ of the body. The most common classification of severity is based on oxygen requirements. Generalized symptoms such as fatigue, neuropsychiatric illness, and depression have persisted.   Loss of taste has been we

How often do you test Vitamin D levels and does it matter in your ICU?     Vitamin D is essentially needed in general population and the critically ill. This vitamin has significant role in maintaining immune function, cardiovascular state, glucose control and mucosal barrier function etc.     70 to 100 % have vitamin D deficiency in the ICU.   Vitamin D supplementation is safe in general population and ICU patients. Hypervitaminosis D should be avoided through correct replacement regimen.   Normal desirable levels: Labs report Vitamin D3 levels in two different units; ng/mL & nmol/L   1 ng/mL = 2.5 nmol/L   Normal value 30-100 ng/mL (75 to 250 nmol/L) Anything over 100 ng/ml (250 nmol/l) for a prolonged period may be harmful. Dietary supplement upto 4,000 IU or less per day is considered safe.   Supplements comparisons and dose schedules   Oral Orally administered Vitamin D3 partially gets metabolized by the hepatic 25- hydroxylase enzyme a