Tag Archives: DIC

the ounce of prevention

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A code that came in this weekend brought me back in time about a decade.

He came in dead, and he left that way too, as these things are sometimes wont to go. Later, after the post-mortem, the infection control officer did her customary chasing down of the staff members who were at the code. Seems the patient had meningococcal meningitis, a severe infection of the brain linings caused by a bacterium which spreads in the droplets of respiratory secretions. The infection control officer was there with a stack of prescriptions for antibiotics, a dose of which we all had to take to ensure that we who were exposed would not succumb to this infection.

The scariest part about meningococcus isn’t antibiotic resistance (MRSA) or disease mutations in animal hosts making the pathogen more dangerous to humans (H1N1), but rather how fast the disease progresses from an asymptomatic incubation stage to causing severe brain damage or death. Vaccination is available against the infection but vaccination campaigns in Canada haven’t been part of the routine immunization series, so herd immunity is nonexistent. The last time a number of teenagers died of this vaccine-preventable disease was when I received my immunizations against it.

About ten years ago, several high-school aged kids where I lived contracted meningococcal infection. Some of them got treated early enough on for meningitis, but the unlucky ones ended up like this kid. The infection overwhelmed their bodies, resulting in a the typical meningitis-type rash growing and growing into purpura, a sign the infection had caused DIC. At that point, the sepsis had progressed so far that the likelihood of a good outcome was extremely poor, and as a result, two very healthy kids died very suddenly.

Meningococcal disease is downright frightening, and is one of the few examples of infections you shouldn’t wait to get antibiotics for. It’s one of relatively few infections that, even in industrialized nations, still kills people fast enough that a matter of hours can make the difference between alive and dead. It’s one infection where the best treatment is that ounce of prevention: vaccination for those who are at risk. It’s one infection that emphasizes how important vaccination can be in avoiding preventable deaths. It’s one infection that really lays bare how little the medical community can do if we don’t catch you in time. And it makes it very starkly clear how dangerous it can be to not pay attention to your body.

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even when it’s different, it’s always the same

It’s funny how reading news stories bring back memories.

It’s always awful when a new mum dies. It’s usually such an awful death, too.

I remember the first time I ever was at a birth like that. An emergency section, an abrupted placenta. Baby’s heart rate frighteningly low, respiratory came for baby, and ended up with front row seats at the show. Enough bleeding for a horror movie. More bags of PRBCs and FFP than I had ever seen before. Fluids, fluids, fluids. I’d been at many c-sections before and they were all elective, scheduled, methodical things. The most tension in the room was an obstetrician demanding a student justify their presence or an anaesthetist calling someone out for making a mess of the OR with gloves covered in baby cheese. None of this wide-eyed adrenaline, the obstetrician and his assistant scrambling to get the baby out as fast as possible, the air thick with the sense of urgency. The jokes about us making him feel like a “real obstetrician” lighten the mood only the tiniest of margins. There’s a little person in there, and it’s not exactly scheduled to come out.

This story, however, is about the mum. When mum gets sick, or something horrifyingly bad happens. These scenes stick in my mind forever, not only because of the family, the husband, the tiny baby. The father and tiny baby aren’t there to see those last five, ten, thirty-five minutes. Just me, and the code team, there to witness what will later be described in one sentence.

Pick your pathology, really; there’s no shortage of pathologies that can cause this type of thing. The one that crosses my mind when thinking about these events is the amniotic fluid embolus. A seemingly normal birth, a happy fresh baby, an elated family. The endings of birth didn’t stop the bleeding. It continued and continued, and what began as a mild worry quickly escalated into a high-strung fear. The bleeding wasn’t stopping.

The infusions of blood products are really only a stopgap measure. By the time her heart stops, it’s already too late. We can only infuse so much. I have, arguably, the easiest job: stand at the head of the bed and watch, while I make her limp body breathe. Everyone else is scrambling and using their brain. I, I am standing there with one hand on the bagger and one hand on the yankauer, suctioning blood that flows freely from her lips, nose, eyes. It seems wrong, these young people coding in our ICU. As if the codes should all involve 90 year olds who were ready to let go. All I can think of, while watching this person die of DIC, is their husband, their family members, their brand new baby.

It’s been a long time since women routinely died in childbirth. These events are admittedly quite rare. But they happen. And when they happen, everything inside me twigs about how abnormal it is for a new mother to die in this place of western medicine and modern cures, of nothing other than having a baby.

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