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Urgent Care (Expert Forum)
Problem due to low oxygen
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Problem due to low oxygen
by Saket, Sep 15, 2007 05:06AM
Sir
I am sending you one of my friend case summary & wants your help regarding problem & its diagnosis.
Case summary: 23 year old male was admitted to Tata main hospital - Jamshedpur- India with in 3hrs following a road traffic accident on 25/08/07 with severe tenderness & swelling in left knee. There was no definite history of head injury & he did not show any deterioration in GCS. Clinically a arthroscopy with ACL repair on 28/08/07.
Arthroscopy & ACL repair was performed under sub-arachnoids block with ASA grade-1 risk. Interpretatively, At 3hrs patient developed nausea, vomiting, shivering/ seizures during which SPO2 fell to 44% oxygen supplementation through facemask did not show significant improvement in SPO2 there fore he was intubated & ventilated with 100% O2. SPO2 remained less then 90% for about 3mins with a heart rate of 55/min. Blood pressure was maintained during this period & thereafter. Dilantin Na infusion was started & I.V mannitol was also given in O.T.ABG taken immediately showed Ph= 7.24, PCo2=35.8, Po2=96, BE= -11.0, Na=137.5, k=4.09, CA=0.942. The surgery lasted from 8am to 12.30pm.
At 1.05Pm in the immediate postoperative period he was obeying commands, moving all limbs with a GCS of 13/15. The cardio-respiratory parameter ware stable and he was shifted to the critical care unit for monitoring. During postoperative period he had 3 episodes of focal seizures invelving right upper limbs in the same afternoon. However he remained awake and oriented. By evening his GCS improved to 15/15 and he was warm with cardio-respiratory stability. There ware no seizure thereafter. He was alert; oriented. Taking oral feeds and was shifted to post operative ward on30/08/2007.
On 01/09/07 (4th postop day), He complained of difficulty in deglutition, sore throat and giddiness on sitting. Examination revealed only a mild left side facio brachial weakness.
On 2/09/07 as the patient was listess, abulic with GCS of 13/15 [ E4 M6 V3 ], a CT scan brain was done to rule out any intercranical injury. The CT scan brain was normal and he was shifted to CCU. He remained aphasic with a GCS of 11/15 with all other parameter normal.
As he was still with GCS of 11/15 , an M.R.I brain was done on 3/09/2007
Which revealed bilateral putaminal hypodensity.
Currently his GCS is 12/15 [E4 V2 M6 ] and other organ system are functioning normally. He obeys simple command, is purposeful in his posture and movement and is making attempts to speak but is not able to articulate. He is tolerating Naso-Gastrics feeds and is medication with Tab Piracitam, Dilantin Na and Multivitamins
I am sending you one of my friend case summary & wants your help regarding problem & its diagnosis.
Case summary: 23 year old male was admitted to Tata main hospital - Jamshedpur- India with in 3hrs following a road traffic accident on 25/08/07 with severe tenderness & swelling in left knee. There was no definite history of head injury & he did not show any deterioration in GCS. Clinically a arthroscopy with ACL repair on 28/08/07.
Arthroscopy & ACL repair was performed under sub-arachnoids block with ASA grade-1 risk. Interpretatively, At 3hrs patient developed nausea, vomiting, shivering/ seizures during which SPO2 fell to 44% oxygen supplementation through facemask did not show significant improvement in SPO2 there fore he was intubated & ventilated with 100% O2. SPO2 remained less then 90% for about 3mins with a heart rate of 55/min. Blood pressure was maintained during this period & thereafter. Dilantin Na infusion was started & I.V mannitol was also given in O.T.ABG taken immediately showed Ph= 7.24, PCo2=35.8, Po2=96, BE= -11.0, Na=137.5, k=4.09, CA=0.942. The surgery lasted from 8am to 12.30pm.
At 1.05Pm in the immediate postoperative period he was obeying commands, moving all limbs with a GCS of 13/15. The cardio-respiratory parameter ware stable and he was shifted to the critical care unit for monitoring. During postoperative period he had 3 episodes of focal seizures invelving right upper limbs in the same afternoon. However he remained awake and oriented. By evening his GCS improved to 15/15 and he was warm with cardio-respiratory stability. There ware no seizure thereafter. He was alert; oriented. Taking oral feeds and was shifted to post operative ward on30/08/2007.
On 01/09/07 (4th postop day), He complained of difficulty in deglutition, sore throat and giddiness on sitting. Examination revealed only a mild left side facio brachial weakness.
On 2/09/07 as the patient was listess, abulic with GCS of 13/15 [ E4 M6 V3 ], a CT scan brain was done to rule out any intercranical injury. The CT scan brain was normal and he was shifted to CCU. He remained aphasic with a GCS of 11/15 with all other parameter normal.
As he was still with GCS of 11/15 , an M.R.I brain was done on 3/09/2007
Which revealed bilateral putaminal hypodensity.
Currently his GCS is 12/15 [E4 V2 M6 ] and other organ system are functioning normally. He obeys simple command, is purposeful in his posture and movement and is making attempts to speak but is not able to articulate. He is tolerating Naso-Gastrics feeds and is medication with Tab Piracitam, Dilantin Na and Multivitamins
