Monday, September 19, 2005

DIVC (Disseminated intravascular coagulopathy)

Lately there are so many patients with Disseminated Intravascular Coagulopathy/DIVC inside ICU...
  • 2 SLE patients with septic shock & acute on chronic renal failure in DIVC
  • 2 DHF patients in DIVC
  • Leptospirosis patient with liver impairment, renal impairment & septic shock in DIVC
  • post lymphoma excision with recovering DIVC, but still having thrombocytopaenia.
Sounds like almost everyone is in DIVC :(

Was busy with one of the septic patient with very severe DIVC.. despite transfusing so many courses of DIVC regimes & blood products, her counts were still derranged and we still unable to correct her DIVC status.. She continued bleeding & oozing from many cavities and organs..

She had severe Adult Respiratory Distress Syndrome (ARDS) with pleural effusion with lung collapse as well and was on maximal ventilatory support (PCV 30, PEEP 15, FiO2 1.0 PS 20) but having very poor gas exchange and very severe metabolic acidosis. Blood pressure was low despite on high inotropic support. She also went into Acute Renal Failure (ARF). We attempted inserting femoral catheter for her for dialysis purpose but failed.. Unable to insert the guide wire further (resistance around 10 cm insertion depth) despite very good blood back flow.. We attempted several times at different sites but unsuccessful as well. .. likely due to her very distended and tense abdomen (with likely intra abdominal bleed as well from what we see from ultrasound abdomen).. However, she was not stable for dialysis as well since her BP becoming lower & lower despite on increasing inotropic support and she was not stable for any surgical intervention as well...

She also passed out massive blood clots per vaginally. We suspected she might had intra cranial bleed (ICB) as well since pupils are unequal.. She later went into arrythymia several times as well with unstable SVT (with heart rate 220 to 250 beats per minutes) which was unresponsive to iv adenosine. BP drop further later on and synchronised cardioversion done, but she was unresponsive as well. She remained critically ill despite the maximum medical supports given and her condition went downhill and finally we lost her :(

11 comments:

glutton rabbit said...

Doc, really pity the patient. It must be tough being a doctor. I think I'll cry everyday if I was a doctor...

Chen said...

glutton rabbit,
yeap.. especially those unexpected death.. So I always say, treasure every moment we have cos we never know what might happen the next minute. Life is short ...

Imagine this patient is still healthy, and very well at home last week except mild fever and suddenly her condition deteriorates, very fast to the extend that she succumbed within few days :(

letti said...

ugh..one of the messiest things around..divc..

Jellyfish said...

aiyak.... loctor toks
completely dun understand
*blur*

Chen said...

Letti,
yep, imagine bleeding everywhere.. from the nose, oral cavity, stomach, urinary tract etc etc...

jellyfish,
I don't believe u "completely" don't understand lah.. :)

cooknengr said...

what's up Doc, this sounded like 金庸's description of 七孔流血.

Chen said...

cookengr,
yeah.. Sometimes I used this phrase 七孔流血 to describe this sort of condition as well...

glutton rabbit said...

Chen, yes it's really scary if someone who looks okay suddenly pass away...

Don't know how you can tahan being a doctor... really honourable...

Chen said...

Glutton Rabbit,
I even have patient who talked & joked with me in the ward, & few hours later he just collapsed & died, unresponsive to resuscitation...

azlandaud said...

doc.. i just wondering what is the differences btwn DIC and DIVC?? are they the same??

Chen said...

azlandaud,

Yes, DIC is the same as DIVC