Case Study 4

A 37-year-old male was admitted as a transfer from an outside hospital. His initial complaints included acute onset abdominal pain that rapidly progressed to vomiting and then hematemesis. He went into septic shock, was coded and intubated at the outside hospital.

 

He was started on low dose Levophed. The patient developed a blanching rash over his torso, cyanotic discoloration of feet and large bilateral ecchymosis on bilateral knees. He was transferred with concerns for vasculitis. Admitting diagnosis upon admission included:

• Sepsis

• Acute Respiratory Failure with concern for ARDS

• Renal Failure requiring CRRT

• Small Bowel Obstruction

• Multifocal Pneumonia

 

The patient was admitted to the ICU with catastrophic illness. Rheumatology, hematology, infectious disease, palliative care and vascular were consulted. Two weeks after admission, the patient underwent Bilateral BKA.

 

Barriers to ventilator weaning included severe critical illness myopathy, peripheral vascular disease s/p bilateral amputations, renal failure requiring dialysis and only speaking Vietnamese.

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Special Care Unit

The patient was admitted to our unit ten days after the amputation for aggressive ventilator weaning on the following setting:

• Mode: SIMV

• Ventilator Rate: 10

• FIO2: 30-40%

• PEEP: 5

 

With quality nursing care and multidisciplinary treatment from Physical Therapy, Occupational Therapy and Respiratory Therapy, the patient was successfully weaned in 17 days. He transitioned to inpatient rehab with his trach capped and plans to de-cannulate within the week. 

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