A 60-year-old patient, day four after the hip endoprosthesis surgery on the right side. The operation was performed in spinal anaesthesia without insertion of a central venous catheter. Bleeding out of surgical drain appeared during the postoperative period – conservative approach, two transfusions of packed red blood cells. The patient was transferred to ICU due to high inflammatory markers.
COPD Gold III, chronic cor pulmonale, hypertension, state after hysterectomy
The patient was conscious during admission. She presented with fever of 38.1 °C. No sign of neurological pathology. Auscultation revealed silent breath sounds with prolonged expiration bilaterally, above basal parts no hearing was audible at all. Without respiratory discomfort. Good blood supply to peripheral regions, capillary refill time approximately 1 second. Sinus tachycardia with numerous supraventricular extrasystoles. Blood pressure 130/60 mmHg without the necessity of administration of catecholamines. Abdomen did not show any pathological sign; peristalsis was well audible. Both upper limbs were swollen in the cubital region after paravenous administration of the crystalloid solution. Oedema of right thigh, surgical wound was calm, without secretion. Its surrounding did not show redness. Adequate blood supply to peripheral regions, no oedema. Adequate sensitivity and motility.
Lab results: leucocytes 12 000, CRP 340, procalcitonin 0.9 ng/ml, hepatic and renal values were normal. Lactate 0.6 mmol/l, blood saturation sampled at the end of the central venous catheter 76 % (blood was taken after the insertion of a new central venous catheter). Haemoglobin 91 g/l. Normal coagulation.
Without antibiotic therapy at that time.
Looking for a focus of infection:
Lung ultrasonography:
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The case continues here.