Aims:This study aims to study the incidence, microbiological and antibiotic sensitivity and resistance profile and impact on intensive care units (ICUs) stay and mortality of nosocomial infections in patients admitted to surgical ICU of our hospital.Methods:A retrospective analysis of all patients admitted, over the course of 1 year, in the surgical ICU was undertaken. All patients who developed nosocomial infections were included in the study. Incidence, sites, common organisms of nosocomial infection were identified. The antibiotic sensitivity pattern of the microorganisms which were cultured was identified. This group of patients with nosocomial infections was matched with group of patients without nosocomial infections with respect to age, gender, and clinical diagnosis and the impact of nosocomial infections on ICU stay, and mortality was studied.Results:Of 1051 patients admitted to the ICU during the study, 350 patients developed nosocomial infections and were included in the study group. Of the remaining patients, 350 patients matching the patients in the study group were included in the control group. The prevalence of nosocomial infections in our study was 33.30%. Skin and soft tissue infections (36.30%), including postoperative wound infections were the most common nosocomial infection, followed by respiratory infections (24.46%) and genitourinary infections (23.40%). The most common organisms causing nosocomial infections were Escherichia coli (26.59%) and Acinetobacter species (18.08%). About 40% of all Gram-negative organisms isolated were multidrug resistant. The average length of stay in ICU was 14.4 days for patients with nosocomial infections and 5.4 days (P < 0.05) for matched patients without nosocomial infections. The mortality in patients with nosocomial infections was 25.14% while that in patients without nosocomial infections was 10.57% (P < 0.05). Overall ICU mortality was 14.27%.Conclusions:Nosocomial infections in surgical ICU patients significantly increase ICU length of stay and mortality.

Insertion of central venous catheter (CVC) is the most common procedure to be performed in Intensive Care Units. Addition of ultrasonographic guidance to this procedure, which was initially performed blindly, has improved safety of this procedure. Confirmation of endovenous placement of CVC though, is tricky, as methods for confirmation are either operator dependent, time-consuming or not available at bedside. Prospective observational study was carried out to study feasibility of use of sonobubble test to confirm the presence of CVC within central vein. After insertion of CVC in the internal jugular, subclavian or axillary vein, a 10 ml bolus of shaken saline microbubble is injected through port of CVC, and opacification of right atrium is observed in xiphoid view on ultrasonography. The Sonobubble test was helpful for dynamic confirmation of endovenous placement of CVC and prevented complications such as arterial puncture and cannulation. We recommend its use following CVC insertion.

A 21-year-old, male was admitted with high grade fever associated with chills, abdominal pain, vomiting (3 episodes/day) and yellowish discolouration of urine for 5 days. He became ill 2 days after week long trip to Mumbai. On admission, he was febrile (102 0 F), had bradycardia and hypoxia & blood pressure was 90/60 mm of Hg. He had icterus, fine bilateral respiratory crackles and right hypochondriac tenderness. Rest of physical examination was normal. With provisional diagnosis of tropical infection, symptomatic treatment was started and he was given rapid infusion of IV fluids and blood investigations were sent. The patient's initial laboratory reports revealed mild anaemia, normal leukocyte count and severe thrombocytopaenia [Table/ Fig-1]. Renal function tests were normal while liver function tests revealed mildly elevated SGOT, SGPT and moderately increased Sr.Bilirubin. Peripheral smear was positive for P. falciparum malaria parasite with parasitic index of > 40%. USG abdomen and pelvis revealed hepatomegaly with gall bladder sludge and bilateral mild pleural effusion. The patient was started on parenteral Artemisinin based treatment for severe malaria.On the 2 nd day, patient became drowsy, tachypneic and oliguric and he had 3 episodes of hypoglycaemia for which he received 25% dextrose. He was shifted to the ICU. The 3 rd day patient became severely hypoxic; Chest X-ray revealed ARDS and the patient was put on Non-invasive ventilation. The parasite index now was 70%. He was started on ionotropes for persistent hypotension and shock. On day 4 he was intubated and put on mechanical ventilation. His LFTs and RFTs gradually deteriorated [Table/ Fig-1] and he landed in multiorgan failure.On the 5 th day, decision was taken to do an exchange transfusion. Under Ultrasonographic guidance the right femoral vein was cannulated with a central venous catheter. A manual exchange transfusion was done replacing 2000 ml of patient's blood with 4 bags of whole blood, 2 bags of packed cell volume and 4 bags of Fresh frozen plasma. During the procedure patient had one episode of bradycardia (45/min) which reverted with injection atropine (0.6 mg). The total duration of procedure was 4 hours. After exchange transfusion the laboratory reports showed decrease in serum Bilirubin and renal function tests [Table/ Fig-1]. Urine output improved. On third day after exchange transfusion, patient was extubated. On ninth day after admission, patient was shifted outside the ICU and on eleventh day, patient was discharged. DiSCuSSiOnExchange transfusion removes infected red blood cells and thus decreases the parasite load. Exchange transfusion is used as an additional modality to reduce the mortality of severe Falciparum malaria. Blood viscosity is improved due to removal of infected red blood cells with reduced deformability which in turn reduces sludging in microcirculation. It also improves oxygen carrying capacity of blood [1]. Exchange transfusion not only decreases the parasite load but also removes products of inflammatory respo...

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In India the organized trauma care services are restricted only to tertiary care centres and golden hour trauma care is often delayed. We decided to create awareness among the MBBS students by teaching basic trauma management skills since they are the first responders to a trauma victim brought to any hospital setup. This would help improve primary trauma care. Aim: To assess the improvement in knowledge, attitude and practice after primary trauma care workshop in MBBS students Methods and Material: A one day primary trauma care workshop was conducted in our institute for two consecutive years during the annual academic undergraduate conference 2018 and 2019 respectively. The MBBS students enrolled were given a questionnaire to solve before and after the workshop. They received a lecture on triage and hands-on practice on Primary survey, log roll & cervical spine stabilization, Airway management, Intravenous fluids & shock management and Basic life support. Statistical analysis: The pre and post workshop questionnaires were statistically analyzed by paired t-test using software version SPSS 20.0 and a P value of < 0.05 was considered statistically significant. Results: Pre workshop 9.9% and 10.5% of the students had above average total score in 2018 and 2019 respectively which increased to 67.6% and 78.5% post workshop. The mean Knowledge, Attitude and Practice scores also improved individually. Conclusion: We should include such workshops in the undergraduate curriculum, it would improve primary trauma care and will reduce trauma related morbidity and mortality