A

1. A Case of Injection Abscess Left Gluteal Region – B/L
lower limb cellulitis- Sepsis
Team involved:
Dr.
Dr.
Dr. Arthi (PG)
Dr. (PG)

2. Brief History :
Diagnosis:
Surgical Procedure:
Comorbidities
&
Drug history
K/C/O SHT – 6 years on regular treatment
Recently diagnosed as DM - 3 days
• H/O Injection Abscess developed 10 days before(3/12/17)
• C/O fever , pain & swelling over left leg x 5days
• H/O I&D – Left gluteal region (13/12/17)
• On 14/12/17 – pt developed breathlessness
• C/O Palpitaion, Abdominal discomfort
AGE : 72/M WEIGHT: 75 KG
HEIGHT :160 cm
BMI:

3. Consciousness
Orientation
No P +I C C L E+
Others- B/L
pitting pedal
edema
PR :102/min
RR :40/min
NIBP :140/90mmHg
SpO2 : 100% room
air
Temperature : 101F
RS – B/L AE +
B/L Basal Crepts
CVS – S1S2 heard No
Murmer
P/A – Diffuse tenderness +
CNS- NFND
Mouth opening : Adequate
MPC : 2
Nasal patency : patent
Mentohyoid : 3FB
Teeth :No loose tooth
GPE
AIRWAY EXAMINATION
VITALS Systemic examination

4. Hb :9.9
TC :17,500
DC : N /L /M /E
ESR :
Blood urea :85
S creatinine:1.15
Na: 129 K:5.0 Cl:103
RBS :156 mg/dl
BT: CT: INR: 1.53
CXR : Normal Study
ECG : NSR
Routine investigations
Chest X ray: Normal Study
Others :-
PusCulture (12/12/17) -
Streptococcus Pyogens
Which was sensitive Vancomycin,
Linezolide , Teicoplanin
Urine :Ketone –ve
Pus cells – 8-10Bacteria – Ocassional
LL venous doppler – No E/O DVT
Right Bakers cyst
USG Abd: R pleural effusion, Left
Paraumblical & L iliac subcutaneous
collection
Other investigations
F
Fio2 – 40%
Cross consultations
Ph PcO2 PO2 Lactate Bicarbonate
7.43 33 120 1.3 21.9

5. ANAESTHETIC PLAN
Peri-op Risk Factors
 Old Age - Poor Effort
Tolerance
 Anemia
 HT
 DM
 SEPSIS
 AKI
 Coagulopathy
 DEHYDRATION
 Stress of Surgery 4-
7 mets
 Right lateral
position
• Oxygenation- Low
FRC – High
Abdominal
Pressure, pleural
effusion-
athelectasis
• Prolonged
Ventilation post
surgery- sepsis
• Hypotension
Patient factors surgical factors Anaesthesia factors
General Anaesthesia
Vasopressor support for maintianing hemodynamic stability
.

6. • Antibiotics changed from Augmenti & ciprofloxacin to Inj.Vancomycin
• Oxygen Supplementation
• Adequate Fluid Resuscitation
PRE-OP OPTIMIZATION

7. • Thoracic Epidural was secured at T4-T5 space
• Patient
Anaesthetic Management

10. COURSE IN ICU
• Post procedure patient was shifted to icu for
ventilator support & Monitoring
• Infusion. Noradrenalin was tappered & stopped on
the same day
• Patinet was weaned off from ventilator on 1 POD
• Anterior Erector Spinae catheter was placed for pain
management on POD 2
• ABG post Extubation on 40% Venturi
Ph PcO2 PO2 Lactate Bicarbonate Na K Hb
7.40 40 121 1.2 28.4 129 3.1 8.4