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Update (12/02): Status of patients from the JCO Criticality
RADSAFERS,
December 2 update for Mr. A. Translation of Mr. A's cardiac arrest last
Saturday (11/27) was supplied to me by Dr. Atsushi Funahashi of Mazda Affiliated
Occupational Health Center in Hiroshima City, Japan. I hope I did not botch it
up when I rewrote it while revising the 11/27 update.
Tosh Ushino
ICN Dosimetry
tushino@icnpharm.com
==========================================================================
RBC = Red Blood Cell WBC = White Blood Cell BP = Blood Pressure
Temp = Temperature Pulse = Pulse Rate Resp = Respiration rate
CRP = C-reactive protein
Mr. A: 9.06 Sv
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11/26/99 17:00
BP: 124/80 mm Hg, Pulse: 128/min., Resp: 20/min., Temp: 39.0 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,900/mm^3. Radiation damage to intestine and skin is extremely critical
problem. Because of this, the patient requires massive amount of fluid and blood
products transfusion daily. Continuing problem with large volume of fluid
seeping out from the areas of injuries due to radiation burn. We have again
transplanted cultured human skin tissue provided to us from other university.
The volume of blood in bowel worsened (990 gm from midnight to 4:00 PM). The
source of blood is thought to be the festering injuries due to radiation burn.
Festering wound in duodenum is also suspected be the source of blood. Volume of
fluid in stomach of unknown origin is increasing.
Treatment Direction: Attempting to stem blood loss through intestine. Covering
small areas of radiation burn area at a time with cultured human skin . Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Currently, blood pressure, pulse rate and other vital signs remain
somewhat stable, but the overall condition is very critical, requiring continued
vigilance.
11/27/99
- Today, at 7:02 AM, patient experienced sudden bradycardia and
electromechanical dissociation and the patient fell into state of cardiac
arrest. Cardiopulmonary resuscitation (CPR) commenced immediately (external
cardiac compression, manual ventilation, and medication). Heart resumed normal
(sinusoidal rhythm) at 8:14 AM after five electric defibrillations.
- At 10:00 AM, BP: 102/66 mm Hg, Pulse: 150/min., Resp: 27/min.
- Due to prolonged lack of circulation, we are conducting evaluation of central
nervous system function.
- The result of the 6:00 AM blood sample gas analysis showed no abnormality.
- The cause of cardiac arrest is unknown. No abnormality to heart was found. No
indication of high level of inadequate respiration. Involvement of (???reflex of
nerves through blood vessels???) strongly suspected.
- We will continue with evaluation of central nervous system function and
support of overall condition.
11/27/99
- 4:30 PM: Circulation relatively stable. With medication, BP: 115/71 mm,
Pulse: 150/min, Resp: 25/min (breathing on own).
- Maintaining breathing on own and there is reflex reaction to light.
- Hemodialysis was intiated because of the state of hypouresis.
- Electrocardiogram, etc., ruled out the possibility that acute cardia
infarction and pulmonary embolism led to sudden cardiac arrest. The progression
of hypoxemia by the pulmonary edema and the vaso-vagal reflex appeared to the
cause of the rapid hypotension and the cause of the cardiac arrest.
- Drainage of water in stomach, circulation, respiratory function evaluation,
aggressive treatment.
11/28/99 17:00
- 4:00 PM: Circulation remaining relatively stable. With medication, BP: 154/98
mm, Pulse: 128/min, Resp: 28/min.
- Some improvement in respiration.
- Breathing on own and there is reflexive reaction to light, CNS function is
maintained.
- On continuous hemodialysis due to the state of hypouresis.
- Since there is low volume of urine, patient will be on dialysis machine
continuously.
- Liver function deteriorated This is suspected to be due to cardiac arrest.
- Radiation damage to intestine and skin remains a critical problem.
- Blood in stool decreased, and the severity also decreased (440 gm from
midnight to 4:00 PM). Bleeding is observed using tube inserted into stomach
through nose (550 gm from midnight to 4:00 PM). This is thought to be from
festering wound in stomach and duodenum.
- Continuing problem with large volume of fluid seeping out from the areas of
injuries due to radiation burn.
- Because of this, the patient requires massive amount of fluid and blood
products transfusion.
- Patient continues to remain in critical condition.
11/29/99 17:00
BP: 151/92 mm Hg, Pulse: 121/min., Resp: 25/min., Temp: 37.7 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
12,700/mm^3.
Liver function has deteriorated to the point where there is essentially no liver
function. Radiation damage to intestine and skin remain extremely critical
problem. Because of this, the patient requires massive amount of fluid and blood
products transfusion daily. Continuing problem with large volume of fluid
seeping out from the areas of injuries due to radiation burn. volume of blood
collected through tube inserted into stomach increased (1,285 gm from midnight
to 4:00 PM).
Treatment Direction: Continue massive volume of transfusion and continue with
dialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but due to inadequate liver function, increase in bleeding
observed, becoming even more critical to maintain vigilance.
11/30/99 17:00
BP: 136/74 mm Hg, Pulse: 118/min., Resp: 25/min., Temp: 36.4 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
12,700/mm^3. On continuous hemodialysis due to the state of hypouresis. Liver
function has deteriorated to the point where there is essentially no liver
function. Radiation damage to intestine and skin remain extremely critical
problem. Because of this, the patient requires massive amount of fluid and blood
products transfusion daily. Continuing problem with large volume of fluid
seeping out from the areas of injuries due to radiation burn. Bleeding from
upper digestive tract increased (1,285 gm from midnight to 4:00 PM).
Treatment Direction: Continue massive volume of transfusion and continue with
dialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but due to inadequate liver function, increase in bleeding
observed, becoming even more critical to maintain vigilance.
12/01/99 17:00
BP: 131/69 mm Hg, Pulse: 119/min., Resp: 29/min., Temp: 37.2 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
7,700/mm^3. On continuous hemodialysis due to the state of hypouresis. Slight
improvement in liver function. Radiation damage to intestine and skin
continues. Continuing problem with large volume of fluid seeping out from the
areas of injuries due to radiation burn. Because of this, the patient requires
massive amount of fluid and blood products transfusion daily. Bleeding from
digestive tract decreased and the severity decreased (176 gm in bowel, 435 gm
through tube through nostril, from midnight to 4:00 PM).
Treatment Direction: Continue massive volume of transfusion and continue with
dialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/02/99 17:00
BP: 132/55 mm Hg (w/ blood pressure controlling medication), Pulse: 122/min.,
Resp: 30/min., Temp: 37.4 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
6,800/mm^3. On continuous hemodialysis due to the state of hypouresis. Slight
improvement in liver function. Radiation damage to intestine and skin
continues. Continuing problem with large volume of fluid seeping out from the
areas of injuries due to radiation burn. Because of this, the patient requires
massive amount of fluid and blood products transfusion daily. Bleeding from
digestive tract worsened again, patient on continous tranfusion.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
Mr. B 4.96 Sv
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11/26/99
With steroid medication, fever and inflammation improved. Feeling of exhaustion
strong. Some improvement observed in damaged skin. No major change to
examination result.
BP: 150/100 Pulse: 120/min, Temp (peak): 38.3 C WBC count:
12,100/mm^3 Hemoglobin: 8.6 g/dl
11/29/99
With steroid medication, fever and inflammation improved. Although skin of
entire body affected, improvement beginning to be observed over large area of
damaged skin. Damaged to liver function thought to be the result of medication
observed.
BP: 140/92 Pulse: 116/min, Temp (peak): 38.3 C WBC count:
16,620/mm^3 Hemoglobin: 8.8 g/dl
Bilirubin: 3.6 mg/dl
12/01/99
Conscious, lucid, with good spirits, and no major change to examination result.
BP: 140/82 Pulse: 120/min, Temp (peak): 38.3 C WBC count:
12,040/mm^3 Hemoglobin: 7.3 g/dl
Bilirubin: 3.4 mg/dl
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Toshihide "Tosh" Ushino, CHP Tel: (800) 548-5100 x2413
Product Development Manager Fax: (714) 668-3149
Dosimetry Div., ICN Biomedicals, Inc. Email: tushino@icnpharm.com
3300 Hyland Ave., Costa Mesa, CA USA 92626 tushino@hotmail.com
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