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ICU, brain injury, fever, low platelet count, ventilator. Treatment ?

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Pediatrician
Practicing since : 1997
Answered : 379 Questions
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Respected Sir/Madam,

We have a 28 yr old patient who is in ICU for last 3 months. The patient case study is as follows:
1. patient met with an accident on 23 march 2011 & had brain injury.
2. Since accident he is having fever
3. It keeps varying rom 101F to 107F highest being 106.6F
4. Doctors say the fever is because of infection but source of infection is still unknown.
5. Brainwise he is improving.
6. All types of antibiotics have been given to him.
7. Recent blood culutre and urine culture are negative.
8. For the past 3 weeks the ventilator was off but since 14June 2011 his BP came down, Platelet count came down and ventilator is put on.
Kindly request you if you can guide us in the case or refer us someone who can guide us. I can send you the recent reports so that you can go thru them. Please help us by guiding us in this case. we will be very thankful to you.

Regards,
XXXXXXX
Posted Tue, 17 Apr 2012 in Head Injuries
 
 
Answered by Dr. Santosh Kondekar 4 hours later
1. patient met with an accident on 23 march 2011 & had brain injury.
=== specify if you know any details about what severity or paste the CT or MRI report here
2. Since accident he is having fever
==== exactly from day 1 till now 90 days of fever? for detailed info in this critical case i would like to know number of days no fever in last 3 months and also whether the fever is 1 or 2 or 3 times a day
3. It keeps varying rom 101F to 107F highest being 106.6F
=== every day? be clear. also does he have paralysis with respiratory support? pons (a part of brain )injury is known to cause such high fevers.
4. Doctors say the fever is because of infection but source of infection is still unknown.
=== often infection is cause in ICU and infection cant be pciked up and proven in 60 percent cases.
5. Brainwise he is improving.
=== you mean he can walk and talk? please detail the weakness.
6. All types of antibiotics have been given to him.
== again there are 27 types of antibiotics. i think all is a very loose word. specify names. Most such patient may need antifungal therapy at such stage of infection.
7. Recent blood culutre and urine culture are negative.
== good

8. For the past 3 weeks the ventilator was off but since 14June 2011 his BP came down, Platelet count came down and ventilator is put on.
=== thats suggest some degree of hospiatl acquired infection in addition. often the organisms are pseudomona, klebsiella and fungi or MRSA.

Kindly request you if you can guide us in the case or refer us someone who can guide us. I can send you the recent reports so that you can go thru them. Please help us by guiding us in this case. we will be very thankful to you
=== you may post all details to doctor@healthcaremagic with SUB: ATTN Dr. Kondekar.

I will be able to reply.
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