When you have to examine your new postoperative patients transferred to you at the Surgical ICU, you have to evaluate him from head to toe. Not only the physical examination, you have to ask the relevant essential information from the medical team who took care of your patient before handing him/her to you as well. After you have all the important informations, you then can make an SICU plan for your patient, what the diagnosis would be, which priority you have to look for and get rid of first, and what interventions your patient is really need at the moment.
At the moment we have a previously healthy young man delivered to us at the SICU after an emergency abdominal procedure, the main problem besides sepsis is we cannot wake him up, he did not respond to voice, deep pain, and had lost important brainstem reflexes. After a long period behind last dose of anaesthetics and opioid for acute pain control, he still suffered from prolonged emergence which should not belong to the anaesthetics effects, a throughout neurological examination was performed, and we made a conclusion that he need an emergency CT scan of his brain. Because he had the problem of azotaemia, so we asked for non-contrast CT brain, however, we did not see any important cerebral pathology from that test.
Today is 72 hours after his anaesthetics, he seems to be better than he was, some brainstem reflexes have gained responses, he can open his eye from voice, however, he still have some fluctuation in his consciousness. We have some more details of his history from his wife and mom about heavy alcoholic consumption, hopefully, it will help us to better rescue him from this sleep.
At the moment we have a previously healthy young man delivered to us at the SICU after an emergency abdominal procedure, the main problem besides sepsis is we cannot wake him up, he did not respond to voice, deep pain, and had lost important brainstem reflexes. After a long period behind last dose of anaesthetics and opioid for acute pain control, he still suffered from prolonged emergence which should not belong to the anaesthetics effects, a throughout neurological examination was performed, and we made a conclusion that he need an emergency CT scan of his brain. Because he had the problem of azotaemia, so we asked for non-contrast CT brain, however, we did not see any important cerebral pathology from that test.
Today is 72 hours after his anaesthetics, he seems to be better than he was, some brainstem reflexes have gained responses, he can open his eye from voice, however, he still have some fluctuation in his consciousness. We have some more details of his history from his wife and mom about heavy alcoholic consumption, hopefully, it will help us to better rescue him from this sleep.
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