On admission patient’s vital: BP 130/70, HR 126, SPO 290%, RR 28 and was conscious and oriented.
Baseline Investigation: CBC, KFT, LFT, PT INR, Leptospira IgM,Urine routine and culture.
Diagnosis: Dengue Positive, HTN, Primigravida 17-week pregnant, Retro Placental Hematoma, Melena.
First line of treatment: Immediately advice was given by Critical Care team from eNexticu command Canterand management of the patient in the form of supportive therapy IV fluid, Antibiotics, Oxygen and infusion Inj. Pantocid stared were started.
Management and outcome
The supportive management between the Tele-ICU command center team spoke hospital was aggressively continued for next 48 hours. On day 2 USG Abdomen was suggested by the command team which revealed Mild B/L pleural effusion with Hepatomegaly and antibiotics were upgraded to Inj. Meropenem and Inj. Doxycycline. On Day 3 PV Bleeding and Melina was persistent and platelets were on lower side so 1 SDPC & 4 FFP were transfused. On day 6 an ECHO was advised to look the heart function which was normal LVEF was 55-60% and treatment was continued. On day 6 due to aggressive management by Tele-ICU critical care team, patient’s condition was improving,Malena and PV bleeding was stopped. On Day 10 all antibiotics were stopped and was maintaining on room air. Finally On day 14 patient shifted out from the ICU with stable condition and got discharged after few days.
This shows how a 24*7 availability of tele-intensivist through Tele-ICU model can not only save lives but also provide cost effective solution and affordable critical care services to remote areas where the intensivists cannot reach physically.