ARE GADGETS SAVIOURS IN SALVAGING SICK CASES – ULTRASOUND FOR BOTH NERVE BLOCKS AND VASCULAR ACCESS IN A CASE OF SEPTIC SHOCK
Keywords:Diabetes, Sepsis, Nerve block, Vascular access, Ultrasound
Diabetes mellitus and diabetic foot syndrome presents to us with varying degrees of sepsis. We present a 52-year-old male with chronic diabetes with fore foot sepsis in shock. His blood sugar was controlled with insulin and the other parameters were normal. The blood pressure was around 90/50 mm Hg with noradrenaline support of 0.5 mic/kg/min. We secured a right internal jugular venous access with ultrasound (USG). The volume status as assessed by USG of the IVC was satisfactory. We administered popliteal sciatic nerve block along with saphenous nerve block visualizing the nerves with USG. The amputation of forefoot went on for 1 h where the hemodynamics remained stable at 100/70 mmHg. After the surgery was over, the patient was shifted to sick cubicle and in the next 6 h, the inotrope support was weaned off. The control of sugars was continuously monitored and kept under control. Any other form of neuraxial block could have been detrimental to him in the presence of hemodynamic imbalance. Such precise deposition of local anesthetics in the sciatic nerve is very difficult without the use of USG. We conclude that advanced gadgets may bring back hope in salvaging sick patients.
Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Ann Med 2017;49:106-16.
Parthasarathy S, Manohar R. Combined mandibular nerve block and superficial cervical plexus block for parotid gland surgery. Br J Pharm Med Res 2017;2:394-6.
Kumar TS, Indu K, Parthasarathy S. Successful management of above knee amputation with combined and modified nerve blocks. Anesth Essays Res 2017;11:520-1.
Pourmand A, Pyle M, Yamane D, Sumon K, Frasure SE. The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients. World J Emerg Med 2019;10:232-8.
Parthasarathy S, Indu K. Excision of right nasolabial cyst under intra oral infra orbital nerve block-a case report and a short review. Indian J Clin Anaesth 2017;4:147-9.
Arjun BK, Prijith RS, Sreeraghu GM, Narendrababu MC. Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients. Indian J Anaesth 2019;63:635-9.
Bond DM, Champion LK, Nolan R. Real-time ultrasound imaging aids jugular venipuncture. Anesth Analg 1989;68:700-1.
Eissa D, Carton EG, Buggy DJ. Anaesthetic management of patients with severe sepsis. Br J Anaesth 2010;105:734-43.
How to Cite
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.