|
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
|