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Dr Amruth D- Critical care Specialist

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Dr Amruth D- Critical care Specialist

Critical Care Specialist working in a team with 24/7 service in INTENSIVE CARE UNIT of Nanjappa Hospital ,Shivamogga

12/06/2022

What is Ventilator? Is it Useful?Kindly read the article for the answer

27/05/2022

PART 2 ...

20/05/2022

SMALL Effort to create ICU Awareness

15/05/2022

ARTICLE ON Nanjappa MICU TEAM

23/11/2021

A 55 year old patient presented with fever, breathlessness, generalized weakness and accelerated hypertension. He was a known case of IHD S/P PTCA, CKD , Type2 diabetes mellitus and hypertension..On Examination he had bilateral coarse crepitations. Pulmonary edema was suspected and was immediately diuretics given to relieve congestion.Ecg showed old IHD Changes. He continued to be tachypneic and desaturating on oxygen with facemask...Chest xray showed opacity in right mid lower zone region. Abg showed metabollic acidosis with respiratory alkalosis. Poor prognosis explained to relatives. He was intubated and put on Ventilator in view of acute respiratory failure. Preliminary investigation showed raised Trop I , pro Bnp levels, raised Procalcitonin levels, deranged renal function tests. His regular Antiplatelets were continued and heparin was added. Emperical antibiotics were put and infective work up were sent.
Gradually his lung condition improved day by day with decrease in infiltrates on right side. Serial Abg were done to asses the oxygenation level .Serial Renal function tests were done to keep check on kidney injury. Blood culture showed Burkholderia species sensitive to empirical antibiotic.
All routine ICU care was given as per ICU protocol..On Day 4 of admission he was taken out of ventilator and observed with strict vitals monitoring...After 24hrs of observation he was shifted to ward with stable vitals...

This was possible mainly due to right decisions taken at right time...This patient presented to ICU at 11pm in night..Presence of Critical Care Specialist in an ICU 24/7 will allow to do right things even at odd timings....24/7 presence of ICU specialists is the need of hour ...

Our team
Dr Rakesh ML
Dr Amruth D
Dr Ajay GM
Dr Srinivas S

28/10/2021

A 58 year old patient presented with fever, breathlessness and altered sensorium. He was chronic alcoholic. He was admitted into MICU in view of Poor GCS and Breathlessness. His vitals were unstable with tachycardia and hypotension requiring fluids and vasopressors support. On Examination he was febrile with pallor and icterus present. On Auscultation of chest he had bilateral crepitations. ABG Showed Respiratory alkalosis with metabolic acidosis. His urine output was poor and also he passed blood in stools ( Malena)

He was immediately intubated and put on mechanical ventilation. Routine investigations showed Severe Anemia , Thrombocytopenia, hyponatremia, high Procalcitonin levels, Deranged Renal function test( RFT) and Deranged Liver function test ( LFT). All infective work up ( including tropical fever) were sent and empirical antibiotics added.Nephrologist opinion taken and Hemodialysis done as per Nephrologist advice. Infective work up showed he was positive for Leptospira IgM antigen. Antiencephalopathy measures added in view of decompensated chronic liver disease ( CLD)

Patient sensorium didn't improve over 24 hrs. His CT Brain showed no acute intracranial findings. CT abdomen showed features of CLD, mild splenomegaly and ascites. Poor prognosis explained to relatives. Hemodialysis continued as per Nephrologist orders after assessment of ABG report and urine output daily.Blood products were given during Hemodialysis.

His serial investigations showed optimisation of RFT and LFTs, uptrend in Hb and platelets. Serial Abg showed correction of acid base levels.

On 26th October he became conscious oriented and was obeying verbal commands. He was taken out of ventilator and observed with strict vitals monitoring for next 24 hrs. On 27th October he was shifted out to ward in stable state.

Evidence based management at right time with presence of 24/7 Critical care Specialists ( INTENSIVISTS)in ICU and Closed loop communication with Nephrologist team helped in successful outcome of this patient

10/10/2021

A 78 yr old elderly male with no comorbidities admitted in ward in view of fever, generalized weakness and cough with sputum from 3 days....Abg had borderline Po2 levels with left lower lobe infiltrates on chest xray..Routine investigations showed leucocytosis with thrombocytopenia...Infective work up were sent ( sputum , blood and urine culture along with tropical fever work )

Next day he developed shortness of breath , shifted to ICU in view of desaturation....Our ICU TEAM quickly assessed the need of mechanical ventilation...He was tachyneic, Abg showed Severe hypoxia with increased lactate levels..Chest xray showed significant increase in infiltrates in both lungs..He was immediately intubated and put on Ventilator....He was restless post intubation ,hence he was knocked down with muscle relaxants and sedation...His fresh investigations showed High procalcitonin levels ( 44.80) with leucocytosis and low platelets...Antibiotics were escalated to Piperacillin and tazobactum and doxycycline was continued in suspicion of tropical fever ....
Later his Leptospira IgM antigen came positive with other culture reports were awaited...

He was sedated and paralyzed for 48 hrs for smooth ventilation...His ABG showed significant improvement with significant rise in Po2 levels day by day....Xray also showed significant improvement with decrease trend in lung infiltrates ...

Gradually His ventilator supports were reduced over one week and his sedation was stopped , made him awake , was conscious and oriented, was obeying verbal commands....

Finally On Day 8 of ventilation, he was given weaning trail after going through Chest xray and ABG reports ....He was extubated and put on simple Face mask with oxygen and observed strictly for 24 hrs before shifting to ward....

His total counts had come down with platelets gone above 1lakh and Procalcitonin levels came down to 1.44 (from 44)....Family counseled daily in detail about progress of patient ...

This was possible due to right management at right time....With 24/7 in house presence of Critical Care Specialists made easier and earlier recovery of this patient from Respiratory failure..

Our 24/7 ICU Team

Dr Rakesh ML
Dr Amruth D
Dr Ajay GM
Dr Srinivas S

17/09/2021

Dear Friends, I am starting this new page of mine to create awareness about Critical care Specialists role In ICU which is very much needed at this hour especially during this Pandemic...Presence of qualified Specialist 24/7 in intensive care unit itself saves a lot of lives ,which is proved by many studies....This Speciality is completely ignored in our country..Especially non metro cities have been denied quality service in INTENSIVE CARE UNITS due to various reasons..
Hope with this page I will be able to reach more people ...I will be posting various cases successfully managed by our team in intensive care unit....

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