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Critical Care

Critical Care

We are what we repeatedly do.

 Excellence in healthcare and service is a habit not an act.  

CIMS Critical Care is dedicated to the emergency and urgent healthcare needs of critically ill or emergency patients. The 24-hour Critical Care Unit at CIMS Hospital in Ahmedabad is headed by specialized internationally trained Intensivists who provide dedicated, continuous, specialized care to critically ill patients with a variety of medical or surgical conditions who require complex multi-organ support.

It ensures best possible care and outcome of all the complex medical and surgical cases. Critical Care mainly aims at intensive care with analyzing, discussing and understanding the patient problem. It helps people from life-threatening injuries and illness.

CIMS is well equipped to cater to all needs with well-planned specialty ICU’s for Cardiac, medical, Surgical and trauma patients. We also host the distinction of having Gujarat’s First ECMO (Extra Corporeal Membrane Oxygenation) facility.

CASE 2: Diagnosis, Severe Mechonium aspiration Syndrome with PAH (Pulmonary Arterial Hypertension)

Diagnosis, Severe Mechonium aspiration Syndrome with PAH (Pulmonary Arterial Hypertension)

38 wk, Term, Male child was presented to us at 1st hour of life

With H/O thick MSL, with severe birth asphyxia, with Severe RD and impending respiratory failure. CMV was commenced and he required very high settings on CMV (MAP14, Fio2 of 0.8 giving result to spo2 of 94%). At 26 hour of life he developed massive pneumothorax on CMV. At night 03:00 am Lt. intercostal drain was inserted by using 8 Fr. IC Drainage catheter and pneumothorax was drained successfully.

To avoid further leak and in view of providing lung protective ventilation, child was shifted to HFOV. Insertion femoral arterial line was performed for repeated ABG sampling required. Air leak resolved after 24 hours (Shown in x-rays wide infra) and weaning of ventilation was possible quite faster than expected. On day 3, child was switched on SIMV and child was successfully extubated on day 5 of admission.

CASE 1 (CIMS Neonatal & Paediatric Critical Care Services)

CIMS Neonatal & Paediatric Critical Care Services

We are sharing our use of SLE5000 (HFOV) with one of the most recommended technology which has unique feature of combining conventional mode with HFOV-providing ability to switch over to CMS to HFOV and vise versa.

Case 1 :

Diagnosis – Severe RDS (HMD) 26 weaker/900gms/male/aga with severe grunting presented at 32 hours of life with 60% Oxygen saturation and gasping respiration. Intubation was performed and ventilation was commenced (CMV).Child had extremely non compliant lungs with severe acidosis with Ph of 6.7 and Pco2 of 72 with Pao2 of 46.Rescue surfactant was given immediately but very transient response was achieved being late presentation. Commenced on HFOV with MAP of 18, Delta P of 40 and fio2 of 90 %. Gradually, child started improving lung recruitment was better on X-ray on day 3 of ventilation. Weaning was soon started with ABG analysis at 2,8,14 and 20 hours of starting HFOV and henceforth 8-12 hourly once ABG as per need clinically. On day (4) settings were minimal on HFOV with MAP of 10,Delta P of 25 and

Fi02 of 0.45.We switched over to CMV mode and continued weaning on traditional SIMV+PC mode for 3 days, sooner child was prepared for extubation which was successful.

Discussion –disease with Homogenous lung damage like HMD, ARDS can have best result with HFOV if used early in the setting how it was used in these patients. Newer Modalities and mode of HFOV like HFOV+CPAP is getting a wide acceptance during weaning of such patient and same was used in above patient for approximately 26 hours before extubation by Naso pharyngeal tube in situ. Recent data says that early and protocol based use of HFOV is not associated with any adverse outcome rather neurodevelopment is unaffected at all (1).

References:-

> Neuromotor outcome at 2 years of very preterm infants who were treated with high-frequency oscillatory ventilation or conventional ventilation for neonatal respiratory distress syndrome. Truffert P – Pediatrics – 01-APR-2007; 119(4): e860-5 (1)

> Soll R.F.: Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2. 2000; CD000511 (4)

 

 

 

 

 

How to perform CPR

How to perform CPR

The victim should lie on a flat, hard surface. The place should not be crowded.

 

Follow the Chain of survival

One thing to remember is, assuming that you are alone, when you find someone down, first establish if they really need CPR: are they breathing? do you see any signs of movement?

Remember to look, listen and feel, for any signs of movement, for breath sounds and for air movement by placing your ear over their mouth.

 

Fifteen Facts Every Family Should Know about CPR

Fifteen Facts Every Family Should Know about CPR

  1. No family can rely on 108 or emergency doctors alone. When someone stops breathing, or the heart stops beating, he or she can typically survive for only 4 to 6 minutes before lack of oxygen can result in brain damage or death. CPR can buy extra time until advanced help arrives by artificially circulating oxygen to the brain.
  2. Sudden cardiac arrest is the leading cause of death in adults. Most arrests occur outside the hospital. Immediate CPR doubles a person’s chance of survival from sudden cardiac arrest. Over 1.5 million heart attacks occur each year and approximately 350,000 of these people die before ever reaching a hospital.
  3. About 80 percent of all out-of-hospital cardiac arrests occur in private residential settings. So being trained to perform cardiopulmonary resuscitation (CPR) can mean the difference between life and death of your patient.
  4. The commonest heart rhythm in sudden cardiac arrest is ventricular fibrillation-the heartbeat becomes very fast and is arrhythmic. The only treatment for it is immediate shock (defibrillation), but CPR can provide trickle of blood to brain and heart and increase the chances of survival after normal rhythm is established.
  5. If CPR is started within 4 minutes of collapse and defibrillation provided within 10 minutes, a person has a 40% chance of survival. Over 70% of all cardiac and breathing emergencies occur at home when a family member is present and available to help a victim.
  6. Approximately, 95 % of sudden cardiac arrest victims die before reaching the hospital.
  7. CPR saves lives. Statistics show that the earlier CPR is initiated, the greater the chances of survival. In fact, it is estimated that 100,000 to 200,000 lives of adults and children could be saved each year if CPR were performed early enough.
  8. CPR is not just for heart attacks! Approximately 10 million adults and children suffer disabling injuries at home each year, resulting from accidents which may require CPR.
  9. Some of the common causes of “sudden death” that may require CPR include:
    • Electric Shock
    • Heart Attacks
    • Drowning
    • Severe Allergic Reactions
    • Choking
    • Drug Overdose
    • Suffocation
  10. The number 1 killers — a combination of heart attacks and accidents — claim a life every 10 seconds in India.
  11. One in five men and women aged 45 and above (20 % of adults) have had a heart attack or stroke. Approximately, 50% of all heart attacks occur in people under age 65.
  12. One in ten people have the opportunity to use CPR in their lifetime.
  13. One thing you need to remember is, in case of an adult he or she always needs a shock to the heart as soon as possible, because they have most likely suffered from a heart attack.
  14. In case of infants and children, it is rarely a heart attack. They mostly need air, because as we all know, the young ones tend to put anything and everything into their mouths and proceed to choke on it.
  15. After sudden cardiac arrest Brain Damage Time Table….

     

    0 Minutes Breathing stops. Heart will soon stop
    beating
    0-4 Minutes Clinical Death
    4-6 Minutes Brain Damage Possible
    4+ Minutes Biological Death
    6-10 Minutes Brain Damage Likely
    10 + Minutes Brain Damage
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CIMS Hospital has been awarded the Certificate of Excellence as the Best Multispecialty Hospital in Gujarat

August 31, 2018
We proudly announce that CIMS Hospital has been awarded the Certificate of Excellence as the Best Multispecialty Hospital in Gujarat at the International Healthcare Awards, 2018 held in Delhi. The Award is a testimony to the hard work and dedication of the entire CIMS Family which has inspired trust in us leading to rising patient volumes.

Certificate course in EMG & NCV Technology

May 15, 2018

Renal Transplant (CIMS/RIC/2018/09) on 15/05/2018

May 15, 2018
Renal Transplant is done on 15/05/2018, which was approved by Hospital based Ethical committee and Government Authorization committee. Relationship between Donor and Recipient : Wife - Husband

We are proud to announce that CIMS Hospital has been recognized as the Times Health Icon 2018 in 2 categories

March 19, 2018
We are proud to announce that CIMS Hospital has been recognized as the Times Health Icon 2018 in 2 categories Multispecialty Hospital- Oncology and Multispecialty Hospital-Critical Care.

CIMS Heart Transplant Team completes another successful Heart Transplant on 06-02-2018, 5th row in a short term.

February 8, 2018

Felicitation Ceremony of Heart Transplant Donors and Recipients held in the presence of Honorable Chief Minister of Gujarat, Shri Vijay Rupani, CIMS cardiac and heart tranplantation doctors by CIMS Hospital.

January 12, 2018
Felicitation Ceremony of Heart Transplant Donors and Recipients held in the presence of Honorable Chief Minister of Gujarat, Shri Vijay Rupani, CIMS cardiac and heart tranplantation doctors by CIMS Hospital.