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AngelsSix
01-22-2009, 15:49
WOW!:( Is it possible they could have done something different?


Model Loses Hands, Feet to Severe Infection

Thursday , January 22, 2009

A 20-year-old Brazilian model, who was a finalist to represent her country at the Miss World contest, had her hands and feet amputated after contracting a severe urinary infection.

Mariana Bridi da Costa fell ill on Dec. 30, and was initially diagnosed with kidney stones, Agence-France Presse reported Thursday.

But, it turned out she had come down with the infection pseudomonas aeruginosa bacterium, which can often prove fatal.

The infection quickly spread, causing her to go back to the hospital for tests. That’s when doctors discovered septicemia had set into her limbs, cutting off circulation, the news agency reported.

As a result, doctors were forced to amputate.

Septicemia is the presence of bacteria in the blood. It’s a serious, life-threatening infection that rapidly gets worse. It can arise from infections throughout the body, including infections in the lungs, abdomen, and urinary tract, the National Institutes of Health said on its Web site.

Bridi da Costa was placed on an artificial respirator following the procedures, according to several media reports.

RichL025
01-22-2009, 19:37
Impossible to know without more information. A LOT more information.

Was the distal necrosis from pressors? Septic emboli? HITT and arterial thrombi?

So many things can go wrong, and in response to your question "could anything have been done differently" - the retrospecto-scope is unfailingly accurate. How the hell does an otherwise healthy 20 year old get pseudomonas, that's MY question.

x SF med
01-22-2009, 20:07
A not so quick search of the WHO database showed that pseudomonas aeruginosa is actually endemic in Brazil, and the rodent population is the main carrier. With the great number of eco tours in the area, infected waters are more prevalent from fecal contamination (rodentia, human, and other mammals).

Ok, I'm a geek, shoot me.

AngelsSix
01-22-2009, 20:51
Hate to say this, I looked it up in the medical dictionary. :D
I have heard of Septicemia, and understand that it is deadly. What I never heard of was someone loosing their LIMBS over it. I need to do more research on Septicemia.

My first impression when I heard that it stemmed from a UTI was unprotected sex.:confused:

72_Wilderness
01-24-2009, 08:03
RIO DE JANEIRO, Brazil – Health officials say a Brazilian model whose feet and hands were amputated because of an infection has died.

Officials said in a statement early Saturday that 20-year-old Mariana Bridi's condition deteriorated overnight. She died at 2:30 a.m.

The Espirito Santo State Health Secretariat said in the statement she died from complications related to a generalized infection. It was caused by the bacteria Pseudomonas aeruginosa, which is known to be resistant to multiple kinds of antibiotics.

Bridi had been in the hospital in the city of Serra in southeastern Brazil since Jan. 3. She fell ill in December and doctors originally diagnosed her with kidney stones, local media said.

Bridi was twice a finalist in the Brazilian stage of the Miss World pageant.

Red Flag 1
01-24-2009, 09:12
A not so quick search of the WHO database showed that pseudomonas aeruginosa is actually endemic in Brazil, and the rodent population is the main carrier. With the great number of eco tours in the area, infected waters are more prevalent from fecal contamination (rodentia, human, and other mammals).

Ok, I'm a geek, shoot me.


That having been said, I have to ask why would one not r/o pseudomonas from the get-go? Without knowing more, IS hard to look at this tragic loss objectively; and as Rich said, the "retro-spect-a-scope" is just that.

My $.02.


RF 1

SF_BHT
01-24-2009, 09:31
You just have to remember that outside the US there are a lot of infectious deceases that the locals know about but in the 1st World we have rarely or never heard of. It does not effect us so research has not been done to the extent that we do in the good old USA. We are so blessed for the level of health care we have. ;)

I live overseas and in the last week have been in the Hospital with my mother and they are complaining about service and attention. I have been looking at it in a different light. I see attentive staff, prompt test, doctors and RN's that are there answering your questions. Aggressive medical care so they can get you back on your feet and out the door back home. I really appreciate it and it reminds me why I have fought to protect the country.
Mom looks at it as the bed is not like home, the recliner is old and hard, the medicine is not brought on her normal schedule, the food is lousy.... Honestly this is a very leading edge hospital but she is in a private room that they gave her at the last minute and it is in the old wind. I think it is great. They even have WIFI for you there. It is great being american....:lifter
OK Back to the thread......

jasonglh
01-24-2009, 16:17
I live overseas and in the last week have been in the Hospital with my mother and they are complaining about service and attention. I have been looking at it in a different light. I see attentive staff, prompt test, doctors and RN's that are there answering your questions. Aggressive medical care so they can get you back on your feet and out the door back home. I really appreciate it and it reminds me why I have fought to protect the country.
Mom looks at it as the bed is not like home, the recliner is old and hard, the medicine is not brought on her normal schedule, the food is lousy.... Honestly this is a very leading edge hospital but she is in a private room that they gave her at the last minute and it is in the old wind. I think it is great. They even have WIFI for you there. It is great being american....

Thank you

...................................


I had some Deja Vu when I read this story about the model since it hasn't been long since I read this article:

NYC Woman Loses Hands, Feet In Hospital 'Mistake' (http://cbs13.com/cbsnational/brooklyn.hospital.lawsuit.2.871000.html)

I wonder if the ER in the NY case had done blood cultures (if they really didn't) would they have gotten results in time to call her back before she came back on her own.
........................................

We had a septic patient on my unit last year that lost both hands after being septic so its not really that unheard of.

Doc Dutch
01-25-2009, 12:35
No matter what the organism, a urinary tract infection can become systemic and with her, she went into profound cardiovascular shock. Any bacteria if the infection becomes systemic, can be bad enough to cause this to occur. In this dire scenario which is more common then people know, to sustain her blood pressure and to perfuse her brain and heart, they placed her on vasopressors in addition to her fluids IV. Common vasopressors are Levophed and Epinephrine and Dopamine intravenously as drips. These cause vasoconstrition of the blood vessels. Anyone working with these knows how potent they are. The physicians must have been resusciatating her with fluids, pressors and antibiotics, but the prolonged effects of the vasopressors, and the decreased blood pressure, hurt the perfusion to the kidneys and she developed acute renal failure and therefore no urine output, so they then started the support of her kidneys with dialysis. This is a bad sign. With the prolonged vasoconstriction, the hands and feet, the most distal structures of the arterial tree saw little to no blood flow and must have died after prolonged ischemia. The body preferentially shunts blood away from the extremities to vital organs like the brain and the heart anyway in these cases. Essentially, the extremities once they start necrosing become "dead meat" and look necrotic (black or deep purple with mottling). They are cold to the touch and get stiff. This becomes a source of "food" for bacteria and then any organism including yeast can gain a hold and spread as an opportunistic infection to the body. So, amputation becomes essential. The necrotic hands and feet must be removed as they also become a metabolic load for the body to contend and the body must now fight off the dying/dead tissue and the potential spread of infection from them.

Once these events start occuring, plus she was probably on a venilator for respiratory insufficiency means that she was not long for this world. Respiratory insufficiency, renal failure, and necrosing limbs represents multiple system organ failure. Younger people are more resilient but we do not know if she had any underlying medical issues such as diabetes or other immunologic problems.

Now, Psuedomonas is everywhere. It is in North American hospitals and in the ICU's and is a major source of morbidity and mortality. Hospitals look for these organisms and are careful in choosing antibiotics to treat them. I have seen it in Landstuhl Regional Medical Center, in UC Davis, Univeristy of Kentucky, UCLA, Maricopa Medical Center, the Mayo Clinic, and Mercy San Juan. Many patients get it and are effectively treated with antibiotics. It is usually found in patients intubated for a prolonged time (> 7 days). It is the sepsis that can kill when coupled with low blood pressure leading to Multi-System Organ Dysfunction/Failure.

She must have been very sick and they did what they could to save her. I have been here several times in US medical centers and as a critical care surgeon, it is heart-breaking to see this progress and despite all of your best efforts watch the patient slip away.

My God bless her soul and help the family through this difficult time.

Dutch

Razor
01-26-2009, 12:03
Amen, brother.

You just have to remember that outside the US there are a lot of infectious deceases that the locals know about but in the 1st World we have rarely or never heard of. It does not effect us so research has not been done to the extent that we do in the good old USA. We are so blessed for the level of health care we have. ;)

I live overseas and in the last week have been in the Hospital with my mother and they are complaining about service and attention. I have been looking at it in a different light. I see attentive staff, prompt test, doctors and RN's that are there answering your questions. Aggressive medical care so they can get you back on your feet and out the door back home. I really appreciate it and it reminds me why I have fought to protect the country.
Mom looks at it as the bed is not like home, the recliner is old and hard, the medicine is not brought on her normal schedule, the food is lousy.... Honestly this is a very leading edge hospital but she is in a private room that they gave her at the last minute and it is in the old wind. I think it is great. They even have WIFI for you there. It is great being american....:lifter
OK Back to the thread......

AngelsSix
01-27-2009, 15:24
Doc D,

Thanks for the explanation. Becoming a Paramedic is an amazing route in understanding WHY things happen. I appreciate the input immensely. It is sad that such a beautiful young woman lost her life so early.

Doc Dutch
01-27-2009, 20:41
I wanted to share this with you. There is a recent paper out of BAMC (Brooke Army Medical Center in Texas) by Steven Wolf, their former burn director. The study looked at burn victims in OIF/OEF (military) compared to US civilain burns treated at BAMC and the organisms that could infect and kill these patients.

What they found in this large study was that Pseudomonas was one of the big bacterial killers of both types of patients (military versus civilain). It did not matter where you came from, but that if you got Pseudomonas or another one of these bad organisms with alarge burn, your mortality went up drastically.

So, South America, North America or anywhere in the world Pseudomonas is a killer . . .

D-

RichL025
01-27-2009, 21:14
Sure, pseudomonas is evil alright, and if someone with a huge immuno-supressing burn or ventilator-dependant catches it, that's expected.

But what bothers me about this model is that she had no obvious cause for her infection - no "reason". At least none that they are giving out to the public.

Of course, MRSA used to be just a "hospital" problem also...

Doc Dutch
01-28-2009, 21:32
All good points. I do not believe we are being told everything. It would not be unheard of and I think there is more to the story, however, this is the family's decision and should be respected.

Also, your points about MRSA are true. Community acquired MRSA is worse in its virulence than hospital acquired MRSA. Often called a spider bite when it presents for lack of other etiology, MRSA can be fulminant and a very nasty soft tissue infection, however, again, immunocompromised individuals suffer much more than those that are not immunocompromised.

Tragic and sadly all of this is part of the human condition . . .

Dutch