Acute Respiratory Distress Syndrome

Last Updated on 08/08/2018 by Vivien Ayinotu

Acute respiratory distress syndrome commonly known as ARDS is a life-threatening medical condition whereby the lungs cannot provide sufficient oxygen for the body.
Causes
This condition develops when the lungs has become infected or sustained an injury leading to inflammation. The inflammation causes fluid from nearby blood vessels to leak into the tiny air sacs in the lungs, making breathing increasingly difficult.

Inflammation can be caused by:

  • Sepsis
  • Pneumonia
  • Severe chest injury  
  • Accidental inhalation of vomit, smoke or toxic chemicals
  • Acute pancreatitis
  • Blood transfusion reaction
Clinical Features
Theses can occur within 24 to 48hrs of illness and can include:
  • Severe shortness of breath
  • Rapid, shallow breathing
  • Low blood pressure
  • Tiredness, drowsiness or confusion
  • Feeling faint
  • Organ failure
Normally, these patients are so sick that they cannot complain of symptoms.

Diagnosis

A full assessment is carried out and include the following:
  • Physical examination
  • Blood test to ascertain oxygen saturation and check for signs of infection
  • Arterial blood gases(ABG) for continous monitoring of respiratory state, blood volume and electrolytes.
  • Blood and urine culture
  • Pulse oximetry test for continuous monitoring of oxygen saturation
  • Chest X-ray and a computerised tomography (CT) scan – to look for evidence of ARDS
  • Echocardiogram to picture the heart ; to rule out heart failure.
  • Sputum culture and analysis
  • Broncoscopy can be carried out in certain cases.

Treatment
-Admission into intensive care unit for breathing support via Ventilator. 
-Antibiotic administration to fight infection.

*Prone position have been found to be appropriate in the management of ARDS.

My Encounter with ARDS patient
I had to look after after a Mr. X diagnosed with ARDS and Intracranial hyperosmolar. It turned out to be a very busy and interesting shift.  

  • Cardiovascular: Blood pressure was initially high but was supported with Noradrenaline infusion and it was managed. – 
  • Respiratory: Was intubated and ventilated. Settings include: pressure control mode of 24, peep 14, FiO2 70%, respiratory rate 15,  peak 38. The above high settings were changed slightly throughout the day. ABG revealed; high PCO2, low O2, high hydrogenbicarbonate, high base excess, high sodium, low potassium and high glucose. All electrolytes were replaced and a slidiing scale was in place to control his blood glucose level.
  • Neurologically, he was sedated and paralysed using Propofol and Actracurium infusions.  Fentanyl was given for pain. Pupils were 2 and nonreactive. Richmond sedation agitation score was -5(deeply sedated and unarousable)
  • Nutrition: on nasogastric feed- Nutrison  and ng water at 40ml and 30ml respectively 
  • Elimination: Good bowel movement and urine output. However, furosemide was given to push more fluid out of the lungs. 

I hope you are getting the gist? I am not going to bore you with my nursing care bits. So, let me wrap it up by telling you the issues and plan for that day. 
Problems:

  • ARD
  • Septic shock
  • Neutral fluid balance(off target)
  • Electrolyte abnormalities
  • Permissive hypercapnia
Plan:
  • PC Ventilator settings – sedated and paralysis
  • Manual recruitment post sunctioning
  • No nebs – Suction 6hrly
  • Ng water @ 30ml/hr
  • Furosemide infusion Urine output greater than 100ml/hr
  • Continue antibiotics Meropenem and Teicoplanin
  • Discuss with microbiology daily.

Lastly, ARDS is a killer illness. I was practically on my feet throughout the shift as Mr. X was unstable and I had lots of infusions that were running out at different times amongst other tasks. Suctioning was quite scary that day as Mr. X could desaturate within secs. Oh! I ended up staying 45mins extra to do my documentations.

References 
NHS Choices (2015)

P.S.
Thanks for reading. Sorry for the medical jargons- I tried to minimse them. When your loved ones or friends are sick or look unwell, please encourage them to go the hospital to get a medical assistance.Ours lives are so precious. 

Disclaimer: This cannot substitute for a professional medical advice and treatment. 

Think Positive No Matter What

Last Updated on 12/11/2017 by Vivien Ayinotu


I was speaking with a friend the other day and for some reasons she seemed to be full of negative views and perceptions of life. She tried to narrate most of her encounters to me; which she found very displeasing. There was so much bitterness and a sort negative energy as she spoke and almost every scenario seems to be worthless or have some negative news in stock for her.

However, as I listened to her I felt her pain to an extent but I do not think my friend is handling the situation the best way she could. To be honest, she can only jeopardise the beautiful future that I can see that lies ahead of her and most importantly would fail herself.

I have known this friend back in the days and I tried to remind her of situations where she made very good decisions/choices and when she had encouraged other people. ‘You are the still same person and can do whatever you convince yourself to do; just start from somewhere’, I said to her.
I tried to let her see that all those instances she has termed bad luck were not necessarily bad luck. ‘Sometimes, things happen for a reason and there are times they just happen. How we cope is what differentiates us from another,’ I told her.

In my opinion, there are lots of things one ought to be grateful for; if not for anything: the gift of life, shelter, clothes and food on our table. Being able to drive expensive cars and go on vacation yearly should not be a yardstick for measuring a good life.
Nonetheless, as humans, there are times we are faced with difficult challenges and think all seems bleak and the future doomed, that too will come and go. I strongly believe that no situation is permanent, what matters is what we make out of any given situation. 
As I and my friend chatted, I asked her about her faith and encouraged her to muster the strength to fight her battles. ‘You are still young, have your career and have a very supportive family – all of these should serve as a drive for you. When for you feel down-casted, look back and thank God for all you have.  ‘I think you already have a lot’, that made her laugh. 
I made her realise that she cannot give up on her life goals and most importantly not to give up on herself. Finally, I encouraged her go to God in prayers and leave all that troubles her with Him.  
The conversation reminded me of a book I read some time ago ‘The Secret’ by Rhonda Byrne. I encouraged my friend to go through it. This book speaks in great volume about positive thinking; how thoughts and feelings creates one’s life, how feeling good sends a good signal into the universe and attracts good things to the individual. It mentioned things like having secret shifters i.e. list of things that can help change how one is feeling in a snap such as funny moments, favourite music, someone you love etc. 
The book comprises of collections from different writers. It is a nice piece of work. 

Have a beautiful August my Lovelies.

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No Child Deserves To Suffer

Last Updated on 12/11/2017 by Vivien Ayinotu

While I was in a shopping mall in Enugu; Shoprite to be precise, I heard a car alarm system going off and some security guards were at the scene. As I walked past the car park, it turned out to be that a child was left in the back of the vehicle (Suv) that was locked.

Photc credit: Nairaland.com
Photo credit: Panoramio.com
Let me elaborate further, the child who you can hardly make out if they were  a boy or girl should be about ten years old. With the assistance of the security men and much persuasion the child was able to come out of the vehicle. He was boiling in there but was very scared of leaving because I would assume he was warned to remain in the vehicle. 

This incident took place in April, 2016 in Nigeria and the temperature was as high as 40 centigrade and above; anybody that was in Nigeria around that time can agree with me on this. So, you can imagine how sunny it was and what this child must have experienced while being locked up at the back of Suv.

So many questions kept coming into my mind, like:
– Why would someone lock up a child at the back of their car?
– Is this child not presentable enough to parade with them in the shopping mall?
– Why is it that some adults don’t treat their maids like humans?

I felt really sad for what I saw that day. To be honest, within 30secs of taking a glance at the little boy, I struggled to work out his sex. He was wearing a cafetan (a free flowing gown), his hair was uncombed lowcut and on his feet a pair of brown rubber sandals. He could barely look up. 

I simply decided that he could be a ‘he’. That leaves me with another question: Who dresses their child like that?

In my opinion, I do not have a clue of what this child’s background is but I can tell that he would be much valued and treated as a person if he were to be living with his own parent(s). 

Dear parents, I know we live in a hard economy; where things and times are hard but please try and look after the kids your bring into this world. No child should be allowed to suffer. When you send them out as maids to people; be it relatives, bear in mind that they are not theirs and can hardly be treated as theirs. If they end up with people that have some conscience, good for them. 

Dear guardians or Madams, you all need help with chores and staying without maid is inevitable. Please treat your maids as humans. They deserve your love, care and affection just like you would do if they were to be your own. Remember, that they are living with you does not make them less human. In fact,they have come to help you why don’t you help them too or make life easy for them?

I intentionally mentioned Madams because in most homes it is the woman that normally see to the affairs of the maid. That a maid is happy or treated well where he/she lives boils down to the madam of the house. Sometimes, I wonder why the men give a cold shoulder to these kind of issues at home whereas they could tell that something is not right and can make an effort to fix it.
No child deserves to suffer. 
P.S Hope your May has been going well? May the remainder of the month bring you good news.

Liver Diseases

Last Updated on 12/11/2017 by Vivien Ayinotu

I have come across lots of articles and case studies on liver diseases and the rapid health decline of most sufferers. So, I will like to share some of my knowledge of the liver and liver diseases. I will tell it like a story and cite where necessary. 
Before I start, what melted my heart the other day was when I met a very young girl who has undergone two liver transplants. In this girl’s case, her former transplant failed because her body system rejected the organ. The later transplant is pretty new and she complained of so much pain and discomfort. As I write this, my heart reaches to her, I wish her a speedy recovery and hope this is her last organ transplant. 
The liver is the second largest organ in the body and the biggest reservoir for blood. It serves as the body factory and plays lots of significant roles that are vital to life. The liver is located in the upper right side of the abdomen, beneath the diaphragm and on the top of the right kidney.
The main functions of the liver include;

  • Filtration and cleansing of the blood 
  • Fights against infections and diseases
  • Production of proteins that makes blood clot( i.e when you bleed)
  • Aids in digestion
  • Destroys and deals with poisons and drugs
  • Excretion of wastes.
There are lots of other roles the liver play in the body. It is a very powerful organ than we think. 

Onset of liver disease:- Acute- Whereby it happens over a short period of time

                                   -Chronic- Here, the disease manifests after couple of years e.g 5-8 years

Main causes: -Heavy alcohol consumption or alcohol misuse (the commonest)
                      -Undiagnosed hepatitis
                      -Obesity
Types of Liver diseases
-Alcohol related liver diseases- Liver damage occurs due to years of heavy alcohol consumption.
-Non-alcoholic fatty liver diseases-  
-Hepatitis- Inflammation of the liver
-Haemochromatosis i.e an inherited disorder whereby there is iron overload in the body
-Primary biliary cirrhosis
All these types of  liver diseases can cause scarring of the liver, which is called Cirrhosis (www.nhs.uk)

Pathophysiology
Photo credit: Youtube images
The liver responds to injury by becoming inflamed. Any form of inflammation of the liver is known as hepatitis. This can happen suddenly (acute) or over a long period of time (chronic). Repeated injuries cause the liver cell not to regenerate any more, fibrosis gradually forms.
When the fibrosis spreads out due to persistent harm not been addressed, the liver shape and function is disrupted.and is known as compensated cirrhosis. As damage progresses, the liver is unable to function effectively (decompensated) and begins to fail. This stage is termed end stage liver disease this allows toxic chemicals and wastes to build up in the body causing  jaundice, ascites and hepatic encephalopathy (i.e. a brain disorder due to toxins in the brain). Further deterioration may lead to multiple organ failure and death. 
Signs and Symptoms:
It is important to know that liver diseases can go on for a long time before the clinical manifestations sets in. They include:

  • Loss of appetite
  • Weight loss or sudden weight gain 
  • Jaundice i.e yellowing of the skin
  • Itchy skin and bruises
  • Fluid retention (oedema)
  • Brownish or orange tint in the urine
  • Light coloured stools
  • Confusion, disorientation, personality changes
Treatment and Management  
This can achieved mainly the use of drugs or surgery
Diet control; Avoiding too much or little protein.
Drugs:-Lactulose;This works by changing the stool acidity which prevents bacterial growth and reduces                    ammonia production.
            -Neomycin; An antibiotic which kills intestinal bacteria and minimises ammonia production.
            -Rifaxiimin; An antibiotic used in reducing the recurrence of hepatic encephalopathy.
SurgeryParacentesis: This is the removal of fluid that has accumulated in the liver due to ascites
                 –Liver transplant: This occurs in cases where liver transplant is inevitable.

Prevention
The commonest type of liver diseases is the Alcohol liver disease, which means we can make liver diseases unpopular.
  • Avoidance or minimal alcohol intake (you need to know your limit: Ask)
  • Diet: reduced protein intake is advised to minimise ammonia(waste) production
  • Exercise- This is good for you to stay fit. Being overweight or obese can affect the progress or treatment your liver condition. Thus, avoid sendatary lifestyles.
  • Get vaccinated against hepatitis B.
  • Health education about liver and causes of liver disease: Equip yourself by reading or watching videos or discussing with health professional about the liver.
References: 
British Liver Trust, 2014
http://stemcellfoundation.ca/en/diseases/liver-failure
www.nhs.uk, 2014

Disclaimer: This cannot substitute for a professional medical advice and treatment. Research further and seek help when need be.

P.S. It’s quite a lengthy post. Thanks for your time😄

Sorry Sir

Last Updated on 12/11/2017 by Vivien Ayinotu

A friend of mine was attending to a gentleman.

Halfway, the man interrupted.

“How many legs do you have?” He asked her.

“Two”, she answered.

She then looked down to her feet…

The man said “Can you please stand on your own legs”

It turned out to be that my friend’s left foot was actually comfortably resting on top of his, unbeknown to her.

I couldn’t stop laughing when my friend told me about this.

However, I would like to assume he wasn’t in much discomfort.

P.S. I will like to mention that March is my month and March 2016 is very special to me. 

Have a beautiful month Pals.

Do You Think People Around You Know Truly Who You Are?

Last Updated on 12/11/2017 by Vivien Ayinotu

I enjoyed this lovely sermon from my priest; one of his interesting lenten season preachings. I would like to call this, my favorite.

He talked about the marvelous works of Jesus and how he did masked himself most of times as his power would be too much for anyone he comes in contact with to contend.

Photo Credit: www.taskforce-gaea.com

Applying the same masking formulae to humans, the reverse is the case. He told us that some individuals are living in pretense just to fit into the society.

He went further and said that such false way of living can momentarily be beneficial to us but most of the time it has an adverse effect on us.

He went on to tell us all to imagine what our lives would be like, if we truly show inner selves to people around us.
Take for instance:
     -A situation where we do not have to cover up to look accepted amongst our peers or colleagues.
     -A situation where we say something in honesty and people take our word for it.
     -A situation where we express ourselves freely without being afraid of being called names.
The list goes on…

It actually occurred to me that we live in a world where we most times find ourselves doing what is expected of us by the society irrespective of what we actually want or how we feel about them..

Do you think people around you know truly who you are?

P.S. It’s my first post for the year.
Have a beautiful 2016.