Sugar cane juice....

I had this case 2 weeks ago....

I was having a chat with Han(Nephrologist, Malaysian) about the Anwar Ibrahim case in the ICU. The ED informed us that they were sending a patient up. In our hospital, sending a patient is an urgent matter : no matter how busy the ICU are, the patient is sent up STAT. Due to lack of nurses in the ward and ED, it had become a non-written proctocol.  Pro and cons with such practice but the ICU nurses had gotten used to it...

the patient is a middle-aged female who look ill. The admission indication is Shock. Indeed, the SBP was 60+ in ED. I took a glanced at the CXR and the right side of the lung is WHITE !. That means it is either fluid or consolidation. The lady was found laying on the roadside and heavy alcohol scent was noted. The patient was admitted to Han's service and both of us was thinking either a traumatic hemothorax or massive pleural effusion. A bed-side sono was done and pleural effusion was confirmed. Han did a tap with a needle and the fluid look greenish... Well, empyema . Pig tail might not be suitable to drain it so we decided to place a chest tube.

I had a bad experience in the past, there was this empyema and the pus was pouring out like a spring when I inserted the chest tube. So this time I told the nurse what I expect and she concurred as she had met such situation before(she was a senior nurse...). We were lucky not to create a mass.... within minutes the bottle was full...but strangely unlike those pus that I had encountered it was odorless...

Both of us felt strange about the findings...the smear had revealed a G+ bacilli....She was started on Clindamycin and Ceftazidime. Later she was shifted to Imipenem.

1 wks later - the culture came back:
   The pleural effussion - Streptococcus Viridins
   Blood culture x II - Bacillus sp.

Well - she survived the shock and currently stable - there was still 20-30 cc of pus daily drain from the tube....

She was cirrhotic (alcohol related) and definitely immune compromised (afebrile on admission with WBC of 40000+)... I wandered if the she had mixed infection and the bacteria had degraded the smelly component and making the pus odorless ?

oh, was that sugar cane juice... I almost drool...but just like Lem said, " I am going back for dinner don't show me those appetite spoiling picture..."(of coz I showed it to him - he was the one who admitted the patient from ED...)	full and yet still pouring out....