Beyond salvage

Today, I see only around 20 pple. A combination of low attendance rate and busy resuscitation.

1 60 odd years old man comes in with shock and leg pain. The pain is very severe. He has alcoholic liver cirrhosis, DM, HTn, CHF, He was only discharged 10 days ago from our unit for heart failure and pneumonia, and he come back againt. The leg pain, the shock and the fever made up a "classical" picture of necrotising fasciitis. After running a litre of saline, Dopamine, he was still in shock and has gone into fast AF with chest pain. At this point, I let the orthopaedics surgeon take him to the theatre for urgent debridement and the anaesthetist to stablise him. He may need an amputation eventually...

Just think about it, even if we can save him this time, how long can he live more? His condition is so poor, he cannot walk, he need to be bathed. He can only feed himself, but he cannot eat all the tasty food because he has DM, HTn, liver failure and heart failure. Life is a torture for him now, and death would be his savior.

For those who want to learn more: Flesh eating bugs