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Re: Update (12/10): Status of patients from the JCO Criticality
REMOVE US
!!!
----- Original Message -----
Sent: Monday, December 13, 1999 4:41
AM
Subject: Update (12/10): Status of patients from
the JCO Criticality
> RADSAFERS,
>
>
Bjorn Cedervall has generously offered a space on his web page for JCO
>
criticality accident patient status. We are working together to make
this
> change. This task is made easier because he was already in process
of making
> such a web page. I am also making corrections to my earlier
postings. So far I
> found some minor errors to my translation, but
nothing critical. I hope we can
> make this transfer by end of the
week.
>
> 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
>
------------------------------------------------------------------------------
>
12/03/99 17:00
> BP: 165/70 mm Hg (w/ blood pressure controlling
medication), Pulse: 120/min.,
> Resp: 24/min., Temp: 37.4 C
>
Continuing with sedative and ventilation. WBC count in small blood vessels
is
> 5,400/mm^3. On continuous hemodialysis due to the state of
hypouresis. Despite
> the transfusion, the rate of RBC increase is
low. Hemophagocytic syndrome (HS)
> was diagnosed, and plasma was
exchanged today. The cause of HS is suspected to
> be viral infection and
fat dysbolism (sp?) due to inadequate liver function,
> etc. Currently
investigating the cause. (HS is condition in which RBC, etc., are
>
engulfed by macrophage.) There is slight improvement trend 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.
>
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.
>
> 12/04/99
17:00
> BP: 121/62 mm Hg (w/ blood pressure controlling medication),
Pulse: 127/min.,
> Resp: 30/min., Temp: 38.6 C
> Continuing with
sedative and ventilation. WBC count in small blood vessels is
>
5,200/mm^3. On continuous hemodialysis due to the state of
hypouresis. Plasma
> was exchanged again today to counter
hemophagocytic syndrome (HS). The cause of
> HS is suspected to be viral
infection and fat dysbolism due to inadequate liver
> function, etc. There
is slight improvement trend 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.
Bleeding
> from digestive tract continues, the patient requires massive
amount of fluid and
> blood products transfusion daily.
> 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.
>
> 12/05/99
17:00
> BP: 150/73 mm Hg (w/ blood pressure controlling medication),
Pulse: 112/min.,
> Resp: 30/min., Temp: 36.5 C
> Continuing with
sedative and ventilation. WBC count in small blood vessels is
>
4,200/mm^3. On continuous hemodialysis due to the state of
hypouresis. Plasma
> was exchanged again today to counter
hemophagocytic syndrome (HS). There is
> slight improvement trend 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. Due to bleeding from digestive
> tract
and hemophagocytic syndrome, the patient is on continuous transfusion.
>
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.
>
> 12/06/99
17:00
> BP: 142/63 mm Hg (w/ blood pressure controlling medication),
Pulse: 114/min.,
> Resp: 30/min., Temp: 38.6 C
> Continuing with
sedative and ventilation. WBC count in small blood vessels is
>
3,300/mm^3. On continuous hemodialysis due to the state of
hypouresis. Plasma
> was exchanged again today to counter
hemophagocytic syndrome (HS). There is
> slight improvement trend 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. The patient is on continuous
>
transfusion due to bleeding from upper digestive tract and
hemophagocytic
> syndrome.
> 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.
>
> 12/07/99 17:00
> The patient's
circulatory function has become unstable and blood pressure is
>
fluctuating. Sepsis is suspected to be the cause.
> BP: 167/68 mm Hg (w/
blood pressure controlling medication), Pulse: 137/min.,
> Resp: 30/min.,
Temp: 38.6 C
> Continuing with sedative and ventilation. WBC count
in small blood vessels is
> 2,200/mm^3. On continuous hemodialysis
due to the state of hypouresis. Plasma
> was not exchanged today due
to unstable circulatory 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. The patient
is on
> continuous transfusion due to bleeding from upper digestive tract
and
> hemophagocytic syndrome.
> 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 have
> recovered, but the condition has become critical,
requiring even more vigilance.
>
> 12/08/99 17:00
> BP:
141/43 mm Hg (w/ blood pressure controlling medication), Pulse:
123/min.,
> Resp: 30/min., Temp: 37.0 C
> The patient is in state of
lactic acidosis. The blood pressure has become even
> more unstable than
yesterday, and from the characteristics of circulatory
> condition,
progression of septic shock is suspected. Continuing with sedative
> and
ventilation. WBC count in small blood vessels is 1,100/mm^3. On
continuous
> hemodialysis due to the state of hypouresis. 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. The patient is on continuous
> transfusion due to bleeding
from upper digestive tract and hemophagocytic
> syndrome.
>
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 are
> maintained, but the
condition has become critical, requiring more vigilance.
>
>
12/09/99 17:00
> BP: 116/47 mm Hg (w/ blood pressure controlling
medication), Pulse: 131/min.,
> Resp: 30/min., Temp: 37.4 C
>
However, the systolic blood pressure fluctuates widely between 110 mm Hg and
190
> mm Hg. Lactic acidosis has progressed and blood is now acidic.
Septic shock
> resulting from change in circulatory condition is
suspected. Continuing with
> sedative and ventilation. WBC count in
small blood vessels is 1,100/mm^3. On
> continuous hemodialysis due
to the state of hypouresis. 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. The patient is
on
> continuous transfusion due to bleeding from digestive tract and
hemophagocytic
> syndrome.
> Treatment Direction: 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 are
> maintained, but the condition
has become critical, requiring more vigilance.
>
> 12/10/99
17:00
> BP: 114/53 mm Hg (w/ blood pressure controlling medication),
Pulse: 120/min.,
> Resp: 30/min., Temp: 37.5 C
> The systolic blood
pressure continuing to fluctuate. Lactic acidosis condition
> has
improved slightly. Continuing with sedative and ventilation. WBC
count in
> small blood vessels is 1,100/mm^3. On continuous
hemodialysis due to the state
> of hypouresis. 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. The patient requires continuous transfusion due to bleeding
>
from digestive tract (especially blood in stool) and hemophagocytic
syndrome.
> Treatment Direction: 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 are
> maintained, but there is no change to the
critical scondition that require
> vigilance.
>
>
>
> Mr. B 4.96 Sv
>
-------------------------------------------------------------------------
>
12/03/99
> Conscious, lucid, with good spirits, and no major change to
examination result.
> RBC transfusion given because of anemia.
> BP:
144/62 Pulse: 100/min, Temp
(peak): 37.7 C WBC count:
>
11,980/mm^3 Hemoglobin: 7.9
g/dl
> Platelet: 49,000/mm^3
>
> 12/06/99
> Conscious,
lucid, in good spirits as usual. There was a bowel movement. No major
>
change to examination result. Continuing fever and inflammation.
Examination
> reveals epidermis recovering but tend to bleed
easily.
> BP: 132/70 Pulse:
120/min, Temp (peak): 39.0 C WBC
count:
> 8,930/mm^3
>
> 12/08/99
> Conscious, lucid, in
good spirits as usual. There was a bowel movement today. No
> major change
to examination result. Continuing fever in 39 deg C range.
> BP:
138/80 Temp (peak): 39.2
C WBC count: 8,930/mm^3
>
>
>
-------------------------------------------------------------------------
>
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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