Mohammad Z Rahman We had a very interesting case in our hospital today..I saw this for first time...
11yrs old Brittany...16.2 kgs refered to our hospital from local clinic.
she had a history of previous bladder surgery due to removal of blader mass.
upon PE was suspected uroabdomen- fluid was found in abdomen in ultrasound correlated with... uroabdomen. Drinking and urinating more than normal, she has history of elavated liver enzyme.
on presentation she was depressed, vitals with in normal limits excepts mildly elavated heart rate. MM pink, normal CRT. Unbalanced, relectant, painfull and tense on abdominal palpation.
Diagnostics:
In house blood work: Increased BUN,normal creatinine, Increased Mg and Na, Normal Kidney value
PCV/TS- 40% and 7.8 g/dL
BP- 165mmHg
PLAN: fluid therapy, Cefazolin 350mg q 24 hr IV, fantanyle 2mg/kg/hr IV, ketamine 2mg/kg/hr.
urinary catheter placed to monitor UOP. Free fluids removed via abdominocentesis whish is cloudy yollow- brownish in color.
placed under general anaesthesia, Cystogram was performed. This revealed the leakage of Trigone. During Exploratory leakage was identified and sutured closed. then ABD lavage with normal saline. BP mildly low during surgery but was normal post operatively.
then she was monitor in ICU for post oparative recovery and monitor UOP. CRIs changed every 4 hrs equal to UOP. She almost back to normal with in 72 hrs after surgery.
Gautam Unny likes this.
Gautam Unny
doc, would appreciate it if u tell us how much the entire procedure costs
09 February at 08:50
Mohammad Z Rahman
Doc..I m not really sure but its huge our hospital charged owner about 1950 dollars.
but I guess the entire cost is like about 600 dollars...
but I guess the entire cost is like about 600 dollars...
09 February at 09:02
Gautam Unny
hmm thats what i thought, about a lakh in Indian currency, probably the one and main reason why we are unable to provide a better level of care. maybe in a few years things will change.
09 February at 09:14
Mohammad Z Rahman
yes I hope so..all of us should try for that change
09 February at 09:17
Swarupmay Majumdar
this is a great case, thanks to zillur. Zillur can u tell us how do u monitor BP?
09 February at 18:09 ·
Mohammad Z Rahman
Thanks Doc..we use an integrated device combine with ECG, pulse OX, and BP on a same screen for continuous BP monitoring...
Although we use the conventional Doplar BP device but it gets only systolic...but rhe integrated device shows systolic, dystolic and mean...so we usually prefer that in ICU.
Although we use the conventional Doplar BP device but it gets only systolic...but rhe integrated device shows systolic, dystolic and mean...so we usually prefer that in ICU.
10 February at 01:20
Swarupmay Majumdar
thank u zillur.
10 February at 16:49 ·
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