St. Clair Hospital HouseCall Vol VII Issue 1

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St. Clair Hospital's community newsletter sharing new medical technologies, patient stories and health tips.

Transcript of St. Clair Hospital HouseCall Vol VII Issue 1


    Primary Care Physicians Play Leading Role In Regions And U.S.s Healthcare SystemsAsk The Doctor I Awards And Recognition I Foundation Updatesinside



  • 2 I HouseCall I Volume VII Issue 1

    Michele Weatherly was at work when she receivedthe phone call that every parent dreads. Thecaller identified himself as a physician in the Intensive Care Unit (ICU) at St. Clair Hospital, and told her

    that her 26-year-old daughter, Alison, had been admitted

    through the Emergency Room with pneumonia. She had been

    intubated and placed on a ventilator. Her condition, the doctor

    explained that day last fall, was very serious and he

    urged Michele and her husband, Reg, to come to the Hospital


    That was the beginning of a long ordeal for the Weatherly

    family of Upper St. Clair. Alison, a University of Miami (Fla.)

    senior majoring in anthropology, was a bright, healthy, viva-

    cious young woman who had dreams of graduate school and

    a career in forensics. Living in an apartment in Mt. Lebanon,

    she had taken a semester off and was looking forward to

    returning to school to finish the final four classes that would

    lead to her degree. Michele and Reg, who are attorneys in

    downtown Pittsburgh, had taken Alison out for dinner just a

    few days earlier. Alison seemed fine then, except for a cold.

    I kept getting sicker instead of getting better, Alison recalls.

    I didnt go to the doctor because I thought it was just a bad cold.

    But I developed a fever, and my breathing became difficult.

    I asked a friend to take me to St. Clairs Emergency Room.

    By the time I got there, I was very sick, in extreme pain, unable to

    breathe and feverish. I learned later that the doctors intubated

    me right away and put me on oxygen and a ventilator; they

    sedated me, started antibiotics and admitted me to the ICU.





    ABOUT THE COVERMichele Weatherly reaches out to her daughter, Alison Weatherly, during a recent visit to the ICU to thank

    the physicians and nurses there who cared for Alison during her hospitalization. Pictured with Michele

    and Alison are, left to right, Greg Thompson, R.N., Kristen Cardimen, R.N. and Gregory J. Fino, M.D.

    Continued on page 4

  • Volume VII Issue 1 I HouseCall I 3

    Former ICU patient Alison Weatherly, left, and hermother, Michele Weatherly, share a laugh with St. ClairHospital ICU registered nurses, Greg Thompson, rear,and Mike Sembrat, during Alisons and Micheles recentvisit with some of the clinicians who cared for Alison during her battle to overcome severe sepsis.

  • 4 I HouseCall I Volume VII Issue 1

    Continued from page 3


    A very serious diagnosisAs bad as things were for Alison at that point, they would quickly

    become far, far worse. Alison had pneumococcal pneumonia, which had

    developed into severe sepsis, a raging, whole-body complication of infection

    that leads to multiple organ failure, shock, abnormal coagulation (the bodys

    blood clotting process), and sometimes, to a condition known as ARDS

    acute respiratory distress syndrome. ARDS results in respiratory failure,

    with poor ventilation, perfusion and low oxygen levels throughout the

    body. It is about as sick as a person can get.

    Sepsis is a medical emergency, a life threatening condition

    that begins with a localized infection such as pneumonia, a

    urinary tract infection or a surgical wound infection. Sepsis can

    happen to anyone, but those at highest risk are usually the elderly

    and people who are immunosuppressed due to chemotherapy

    or transplant medication. Those who are hospitalized are at risk,

    too, as they often have incisions and breaks in the skin. Sepsis

    has one of the highest mortality rates of any medical condition; it carries a

    far greater risk than heart attack or stroke. It is a major cause of morbidity

    and mortality in hospitals throughout the world. Sepsis mortality is as high

    as 80 percent for elderly or immunocompromised patients; in general, the

    mortality rate is 40 percent. Fully one-third of those who develop severe

    sepsis with ARDS will die.

    Sepsis is triggered when some of the pathogenic organisms usually

    bacterial, but sometimes viral or fungal get into the bloodstream, which

    carries the infection beyond the site of origin to various organs. The body

    goes into shock, cells are not perfused with the oxygen they require, and

    they die. Organ damage, and eventually organ failure, is the result. The

    signs of early sepsis are subtle: changes in body temperature, above or

    below normal range; tachycardia (an abnormally fast heart rate); abnormally

    rapid breathing; and low blood pressure.

    In patients with sepsis, their bodies respond to infection with a tremendous,

    all-out counterattack that

    wreaks physiologic havoc

    throughout their

    systems. Gregory J.

    Fino, M.D., a pulmo-

    nologist and Co-Director of Critical Care at St. Clair,

    who played a primary role in managing Alisons care in

    the ICU, says the bodys immune system mounts a systemic inflammatory

    response that sets off a cascade of events which lead to organ failure and,

    all too often, death. The medical term for this response to infection is SIRS

    systemic inflammatory response syndrome. The body reacts so vigorously

    to the invading microbes that it overshoots a bit, Dr. Fino explains. We can

    treat the infection with appropriate antibiotics, but theres no way to stop

    Sepsis is a severe medical emergency,

    a life threatening condition that can

    happen to anyone.

    Posing for a group photo in the ICU at St. Clair Hospital are, left toright, Greg Thompson, R.N., Kristen Cardimen, R.N., Michele andAlison Weatherly, Gregory Fino, M.D., and Mike Sembrat, R.N.

  • Volume VII Issue 1 I HouseCall I 5

    the bodys attack mode. It will carry on for a week

    or so. Once we have the infection under control,

    we more or less wait for the body to heal itself,

    as we provide support to the patient and do every-

    thing we can to optimize the outcome.

    Severe sepsis is a diagnostic challenge, but

    identification of those at risk, recognition of the

    early signs, and the prompt initiation of diagnostic

    testing and treatment is critically important to good

    outcomes. Early recognition and treatment of sepsis

    greatly improve chances for survival. (Please see

    sidebar on detecting sepsis in patients, page 8.)

    A team is assembledThe situation in the ICU was dynamic and dramatic.

    Alison was extremely unstable, in critical condition,

    with regular fluctuations in her vital signs and

    oxygen saturation levels. In constant attendance

    was St. Clairs team of critical care experts

    doctors, nurses, respiratory therapists and other

    clinicians who worked to save Alison with a

    robust response that matched the ferocity of her

    illness. The team included Pulmonologist Dr. Fino,

    a 30-year veteran of the ICU, and his colleagues:

    Patrick Reilly, M.D.; Andrew Perez, M.D.; Laurie

    Kilkenny, M.D.; and Zachary Young, M.D., all

    pulmonologists and critical care specialists.

    Also involved in Alisons care: nocturnist critical

    care physicians Yvonne R. Chan, M.D. and

    Maxim V. Bocharov, M.D.

    Alison was deathly ill, Dr. Fino recalls.

    She had a common, community-acquired form

    of pneumonia, with inflammation throughout

    her lungs. We provided fluid resuscitation and

    tailored her antibiotic therapy specifically to the

    pneumococcus. She was put into a medically-

    induced coma to help us to better manage her

    ventilation and for her own comfort. Alisons

    lungs collapsed, requiring the placement of

    chest tubes to re-expand them. We performed

    a tracheotomy. She had respiratory failure, liver

    failure, severe slowing of her heart rate and

    arrhythmias. We utilized prone therapy, which

    can improve ventilation.

    Prone therapy with a Rotaprone bed is an

    innovative intervention for severely ill patients

    in the ICU who cannot be adequately ventilated

    with the usual approaches. Alisons pneumonia

    was so extensive, Dr. Fino explains, that we

    could not provide oxygen via the ventilator to

    keep her oxygen levels adequate. She was receiving

    100 percent oxygen what we breathe normally

    in room air is 21 percent. We were giving her

    maximum levels of extra pressure on expiration

    to push oxygen through the lung to the blood-

    stream. But it reached a point where we could

    not oxygenate her.

    With pneumonia and ARDS there is a severe

    mismatch in the lungs of oxygen and blood so

    oxygen is not transferred into the blood stream

    effectively. The Rotaprone bed literally rotates the

    patient from side to side and prone allowing a

    better mixing of the oxygen and the blood. Using

    this bed allowed us to deliver intervals of prone

    therapy over extended periods of time to help

    improve Alisons oxygenation.

    Alison spent nine days in the Rotaprone bed,