Polymyxin B and Doxycycline for Treatment of Multidrug Resistant Klebsiella Pneumoniae and Staphylococcus Aureus Pneumonia in Intensive Care Unit

Doxycycline is a broad spectrum antibiotic. We hereby report a case report of patients that developed multidrug resistant hospital acquired pneumonia. Patients were treated with Polymyxin B and Doxycycline. From this we want to emphasize that Doxycycline can be used as alternative agent in combination with Polymyxin B for treatment of multidrug resistant pneumonia although there are no large scale studies on combination of Polymyxin B and Doxycycline.

Human Albumin and N-Acetylcysteine for Treatment of Fat Embolism: A Case Report

Fat embolism is a life-threatening condition that mostly occurs after long bones and pelvis fractures and treatment is controversial with many available drugs. We hereby present a case of 53 years male who developed shortness of breath, tachycardia, fever, anemia, distended jugular vein, thrombocytopenia, hypoalbuminemia and was diagnosed to have fat embolism after fracture of femur, tibia, fibula and pubic rami following road traffic accident. Patient was treated with 20 percent human albumin, N-acetylcysteine, other supportive treatment and discharged after fourteen days. From this we want to emphasize role of human albumin and N-acetylcysteine in treatment of fat.  

Human Albumin and N-Acetylcysteine for Treatment of Fat Embolism: A Case Report

Fat embolism is a life-threatening condition that mostly occurs after long bones and pelvis fractures and treatment is controversial with many available drugs. We hereby present a case of 53 years male who developed shortness of breath, tachycardia, fever, anemia, distended jugular vein, thrombocytopenia, hypoalbuminemia and was diagnosed to have fat embolism after fracture of femur, tibia, fibula and pubic rami following road traffic accident. Patient was treated with 20 percent human albumin, N-acetylcysteine, other supportive treatment and discharged after fourteen days. From this we want to emphasize role of human albumin and N-acetylcysteine in treatment of fat. Keywords: fat embolism; human albumin; N-Acetylcysteine.

Need of Improvement in Emergency Medical Service in Urban Cities

Introduction: An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied. Methods: Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis.Results: Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area. Conclusions: Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu.Key Words: ambulance, emergency medical service, para-medics, triage Need of Improvement in Emergency Medical Service in Urban Cities Gongal R,1Dhungana B,1Regmi S,1Nakarmi M,2Yadav B11Patan Hospital, Lalitpur, Nepal, 2Health Care Foundation, Kathmandu, NepalCorrespondence:Dr. Rajesh GongalDepartment of SurgeryPatan Hospital, Patan, Nepal.Email: rajgongal@yahoo.comORIGINAL ARTICLE J Nepal Med Assoc 2009;48(174):139-43INTRODUCTIONThe sophisticated Emergency Medical Service (EMS) is limited to developed country only. Many developing countries are now slowly developing such system although most services are localized to the urban areas.1-5 Although inadquate ambulance services are available in the capital city of Nepa

Need of improvement in emergency medical service in urban cities

INTRODUCTION

An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied.

METHODS

Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis.

RESULTS

Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area.

CONCLUSIONS

Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu.