The department of Ruby Critical Care consists of 91 ICU beds. During the peak of the Covid crisis we increasd it to 102 beds. The team comprises of Consultant Intensivists, Pain physicians, Senior & Junior Doctors and highly efficient, experienced and well trained nursing & paramedical staff.
World class Infrastructure along with modern medical technology which made this department one of our centres of excellence.
Venepuncture / Central vein cannulation, Peripherally inserted Central venous Cannula
Peripheral artery cannulation – Blind and Ultrasound guided.
Pulmonary Artery catheterization
Trans esophageal Echocardiography
Basic and Advanced non invasive and invasive monitoring including ABG.
Nasotracheal and endotracheal intubations (Adult, Paediatric and Neonatal)
Management of difficult airway
Management of Ventilators and its accessories, High-frequency Oscillatory Ventilation (HFOV)
Transportation of critically ill patients
Trauma patient resuscitation
Peripheral ICU assessment, airway management, central venous cannula insertion.
Management of the critically ill, medical, surgical and trauma patients and intensive care
Septic shock, hypovolemic shock management
Antibiotics & antifungal prescriptions,
Heart–Lung interaction
Dyselectrolytemia & acid base management
RRT( PD, HD & CCRT)
Coagulopathy Management
Nutrition in ICU (Enteral & Perenteral)
Management of tetanus Patients
Obstertic critical care and analgesia
Basic acute and chronic pain management.
Bedside ultrasonography in orbit, neck, airway, chest, abdomen, extremity and vascular
Transthoracic echocardiography
Percutaneous tracheostomy
Intra Aortic Balloon Pump (IABP) & cardiopulmonary bypass
Epidural catheterization (Lumbar and Thoracic).
Critically ill medical patients proper assessment, diagnosis and managements such as septic shock with multi organ involvement, patients with severe antibiotic resistant infection.
Manage life threatening multiple organ problems appropriately.
Using Ultrasound as an assessment tool for critically ill patients with multi organ involvement.
Manage patients with respiratory failure like ventilation management, Prone ventilation
Post operative ICU Care after complicated surgery
Managing patients with acute kidney failure in ICU
Life saving bedside procedure like chest drain, tracheostomy etc.
All types of complicated trauma patient management in ICU
A 22 year old young man from Bangladesh had been presented in the Emergency department of Ruby General Hospital with complaints of severe respiratory distress and altered sensorium. He was immediately intubated and put on mechanical ventilator support due to gasping. Relevant investigations were carried out which revealed that too much acid had been produced in the body. He had a very high blood pressure and had been diagnosed with acute kidney injury and imbalance in the required amount of electrolytes along with bleeding disorder. The gentleman required multiple haemodialysis as per his clinical condition. Ryle’s Tube and Foley’s catheter had been inserted for nutrition and hygiene, AV fistula had been done for requirement of maintenance haemodialysis. The young man had no family members in Kolkata as he was an employee of Alamgir Navigation Company and being a designated Lasker in a foreign vessel plying to and from Bangladesh and India, he was not authorized to leave the vessel and also had no passport and visa. Since, all of a sudden he fell ill, he had to be taken to the hospital and did not have adequate documents to fulfill the required legal formalities of being a foreign patient. Inspite of these limitations, the hospital did not deny nor delay medical aid as care delayed is care denied. The gentleman could not be sent home by water as he requires dialysis every alternate day so he had to be transported by road or air. Tirupati Vessel Pvt Ltd, the authorized agency, in coordination with the Foreigner Regional Registration Office (FRRO), Bangladesh High Commission and Ruby Hospital, helped the young man cross the border and go to his family in his homeland.
A 57 year old lady had been presented in the Emergency of Ruby General Hospital in a gasping condition after a sudden fall at home with a head injury. She had a history of a sudden onset of vomiting followed by unconsciousness post dinner a couple of days back. She had been immediately intubated and ventilated but she suffered 5 episodes of cardiac arrest at the Emergency where she had been resuscitated and invasively ventilated, then shifted to Intensive Care Unit (ICU) with 100% oxygen, double vasopressor heart rate of 35/min. Temporary Pacemaker (TPM) had been inserted through left femoral vein, but, she suffered from another 5 episodes of cardiac arrest on the way to the Catheterization Laboratory (Cath Lab) and had been resuscitated. In a couple of days time the lady developed pneumonia, septic shock, Acute Kidney Injury (AKI), coagulopathy, and Acute Ischaemic Hepatitis. Gradually, she was weaned off ventilator and extubated keeping the Temporary Pacemaker (TPM) in situ. She had Hypotension and further investigations were advised which revealed altered Renal function and Liver Function levels along with a drop in HB% (7.4) for which one unit of Packed red Blood Cells (PRBC) had been transfused. Her hypoxia (An absence of adequate oxygen in the tissues to sustain bodily functions) worsened, was put on Lasik infusion and gradually, the oxygen demand reduced and she was weaned off to nasal cannula. A Permanent Pacemaker (PPM) had been inserted and Temporary Pacemaker (TPM) had been removed. The post procedure period had been uneventful and the lady had been mobilized. On discharge, the lady went home walking, without any organ dysfunction and she thanked the Critical Care team, sisters, the team of technicians, Dieticians and the Floor PROs for their relentless effort and care.
A 16 year old girl had been admitted in Ruby General Hospital under the care of Dr. Prashant Verma (Consultant Critical Care) with complaints of fever, loss of appetite, diarrhea and recurrent seizure episodes. She was drowsy in the emergency department so she was intubated and mechanically ventilated. Relevant investigations were sent for which revealed pancytopenia (Low counts of all three types of blood cells : red blood cells, white blood cells and platelets), direct hyperbilirubinemia (Hepatobiliary disorder) and coagulopathy (Impaired blood clotting). Since, she had very low haemoglobin (2g/dl) and platelet count, she received 5 units of Packed Red Blood Cells (PRBC), 12 units of platelet and 4 units of fresh Frozen Plasma (FFP). Bone marrow biopsy had been done which was normal and she was started on steroids and the IgG covid antibody was very high. After further improvement, the girl had been extubated and shifted to the ward with BiPAP oxygen support. She had persistent tachypnoea (Abnormally rapid breathing) due to which echocardiogram had been advised and it revealed Right Atrium (RA), Right Ventricle (RV) dilatation. Anticoagulant could not be started as platelet count was below 50,000 and the girl was improving when, she suddenly developed seizures following which she had been intubated and mechanically ventilated. MRI brain had been advised which revealed bilateral pontine and frontoparietal (Frontal and parietal bones) ischaemic (restricted blood supply to any tissue, muscle group or organ of the body causing a shortage of oxygen needed for cellular metabolism) changes. In two days she was taken out of ventilator support and was alert, conscious, oriented and haemodynamically stable. An endocrinology opinion had been taken due to persistent hypoglycaemia (low blood sugar level). As a result of pancytopenia the girl had been diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C). The parents were very happy taking their daughter home and planning her future ahead.
A 32 year old lady had been admitted in Ruby General Hospital under the care of Dr. Dibyadip Mukhopadhyay (Consultant Intensivist and Pain Physician) with complaints of shortness of breath and chest discomfort post Lower Uterine Caesarean Section (LUCS) a couple of days back. On arrival in the Emergency department, the lady had been hypoxic (A condition in which the body / a region of the body is deprived of adequate oxygen supply at the tissue level) and tachypnoic (Excessively rapid breathing) and was immediately shifted to the Intensive Care Unit (ICU) and put on High Flow Nasal Cannula (HFNC) support. After a thorough evaluation relevant investigations were done which revealed a failing heart and a damaged pair of lungs. The lady had been diagnosed with Amniotic Fluid Embolism (A rare but serious condition with a very high mortality and occurs when amniotic fluid i.e., the fluid that surrounds a baby in the uterus during pregnancy, or foetal material, such as foetal cells enters the mother’s bloodstream.), and Lower Respiratory Tract Infection. The lady was ventilated in prone position due to severe Acute Respiratory Distress Syndrome (ARDS). The blood reports revealed increased inflammatory markers such as D-Dimer, C-Reactine Protein (CRP) and N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) was almost equal to 8 thousand. Further, sputum investigations were done which revealed gram positive Cocci, so BioFire Panel had been done which showed infection with Pseudomonas Acinetobacter and she was treated accordingly. There was a remarkable improvement and the sepsis markers had gone down along with the shortness of breath. The lady was weaned out of the ventilator within 48 hours. The lady and her family had been very grateful to Ruby Critical Care that she could go back to her newborn child in a few days time.
A 21 year old pregnant lady had been admitted in Ruby General Hospital under the care of Dr. Sujay Samanta (Consultant Critical Care) and Dr. Bikash Banerjee (Consultant Gynaecologist) with complaints of fever and shortness of breath. The lady had been in her 32nd week of pregnancy (8 months) and fortunately, the Covid 19 test had been negative. On thorough evaluation she was diagnosed with anaemia, dengue fever with hepatic transamnitis (High levels of certain liver enzymes called transaminases) and noncardiogenic pulmonary edema (A specific form of pulmonary edema i.e. excess fluid in the lungs that results from an increase in permeability of the normal alveolarcapillary barrier) with bilateral pleural effusion (A build-up of fluid between the tissues that line the lungs and the chest). The lady had been managed with judicious titration (It is a technique where a solution of known concentration is used to determine the concentration of an unknown solution) of fluid therapy, non invasive ventilation support along with intense foetal well being monitoring. The lady was also detected to be scrub typhus positive (It is a disease caused by a bacteria called Orientia tsutsugamushi and is spread to people through bites of infected chiggers / larval mites). Appropriate antibiotics had been given and with a judicious team decision, blood transfusion had been postponed considering the pulmonary status. She was kept on close monitoring in the Intensive Care Unit (ICU) including foetal monitoring. Gradually, the lady improved with organ supportive care and subsequently had been discharged. She was very grateful to Ruby Hospital and the whole team involved in her speedy recovery as well as the well being of her child.
Sk Mehabub Ali, a 64 year old senior citizen had been admitted under the care of Dr. Dibyadip Mukhopadyay (Consultant Intensivist and Pain Physician) with complaints of acute respiratory difficulty. He also had a history of heart and kidney diseases along with an obstructive upper airway mass which was causing the respiratory trouble. The gentleman had been running from pillar to post but, he faced only denial from many renowned institutes including some cancer centres of Kolkata as the burden of risks for surgical intervention was very high and the gentleman was gradually succumbing to his breathing difficulty when he decided to come to Ruby General Hospital. After evaluation it was found that there were chances of an on table death on administering anaesthesia and this outweighed the chances of attempting to relieve the obstruction. Inspite of the above risks a tunnel needed to be secured to relieve the breathing difficulty. After detailed discussion with the family members about the pros and cons and the high risk involved, the treating consultant decided to do what had nearly never been done (only two cases in the whole world as per records). Tracheostomy (A medical procedure that involves creating an opening in the neck in order to place a tube into a person’s windpipe allowing air to enter the lungs), the life saving procedure was done without any form of intravenous anaesthesia and more importantly without any backup airway in place. This procedure is called ‘Awake Bedside Tracheostomy’ was done by Dr. Dbyadip Mukhopadyay (Consultant Intensivist and Pain Physician) and assisted by Dr. Arindam Mukherjee (Consultant Pulmonologist) and Dr. Debarshi Roy (Consultant ENT). The slightest of error or not taking the risk of performing the procedure, both would have been fatal for Sk Mehabub Ali. The post procedure period was uneventful. The gentleman has been discharged and he went home ever grateful that Ruby Hospital helped him take a breath of fresh air without any difficulty.
A gentleman of over 50 years had been presented in the Emergency department of Ruby General Hospital with complaints of severe weakness for the last seven days along with fever and was admitted under the expert care of Dr. Raktim Guha (Consultant Critical Care). The gentleman was febrile initially and had dengue fever with uncomplicated course previously. On presentation he had severe bodyache and rashes over the anterior part of the body and both upper limbs. Considering the pandemic scenario keeping in mind all the probabilities, a thorough evaluation had been done which revealed dengue fever and SARS-CoV-2 infection. The platelet count had been very low (22,000) with increased haemoglobin and P.C.V., so a close watch was kept on two parameters, hydration which was maintained properly with IV fluids and coagulation profile as the liver function was deranged, which is very common in repeat dengue infection. The patient had a bleeding tendency as he tested positive for tourniquet test and it was due to dengue together with piles which could be a potential source of bleeding. Thus, it was hard for the treating consultant to decide whether to use heparin or not. It was decided to wait till the platelet count increased and then they started low molecular weight heparin (which is essential in SARS-CoV-2 infection due to increased blood clotting tendency), also keeping an eye on D dimer level along with taking care of stool consistency so that the piles do not bleed. Keeping in mind both the disease condition, the fluid balance was adjusted so that all the organs get perfused adequately and at the same time the lung should not get flooded. The other organ functions were also monitored closely. The patient got stable, oxygen was no longer required, D dimer had also decreased and the liver function was improving slowly. The key steps were not to get indulged in the wave of SARS-CoV-2 only, but, to keep in mind the endemic diseases like malaria or dengue. Secondly, a thorough workup for fever was required. Thirdly, a fine balance in treatment protocol should be maintained.
There are numerous times when things happen unintentionally and they are undesirable in nature. These, we call accidents, which are often very severe and sometimes even fatal. Such was the case of a 27 year old youth, who had a sudden fall from the roof of a one storied building due to an accidental slipping. He was presented in the emergency with trauma to the head, right upper limb, right side of chest, right lateral portion of abdomen and right thigh and was unable to move due to severe pain. There was a history of bleeding from the nose and ears. After evaluation, he was shifted to the ICU, radiological and haematological investigations were done. Intercostal Drainage (ICD) had been done in view of hemothorax (Collection of blood in the space between the chest wall and the lung) and he was kept on Bipap support. Blood had also been transfused, but, suddenly, the patient developed tachypnoea, progressive desaturation, tachycardia, respiratory failure. He was put into mechanical ventilation and after he was stable, the operations for fractures had been done. He had been operated for a displaced fracture of shaft right femur, displaced intra‐articular fracture right radius (distal). Post operation he developed high fever (sepsis) and respiratory failure which were managed successfully in the ICU. Gradually, the patient improved and he returned to his family, who always say that Ruby Critical Care and Trauma Unit is the best in the city.
A 54 year old gentleman had been admitted in Ruby General Hospital under the expert care of Dr. Dibyadip Mukhopadhyay (Consultant Intensivist and Pain Physician) with complaints of fever for the last ten days and severe respiratory distress for four days. He had been transferred to Ruby Hospital from a district hospital and was on ventilation when the medical team there had nearly given up all hopes of his survival. The gentleman also had a history of Type II Diabetes Mellitus and Hypertension. On arrival at the Emergency Department, the gentleman had been intubated (Placement of a flexible plastic tube into the trachea / windpipe to maintain an open airway and help a person breathe) and ventilated for severe hypoxia (An absence of enough oxygen / reduced amount of oxygen in the tissues to sustain bodily function). All relevant investigations were done and he tested positive for Covid-19 RT-PCR. All relevant medications were given for Covid-19 pneumonia. He had been ventilated in prone position (Body lying face down) intermittently for ten days. Tracheostomy (A medical procedure that involves creating an opening in the neck below the vocal cords inorder to place a tube into a person’s windpipe/ trachea allowing air to enter the lungs and assist in breathing) had also been done. The gentleman developed secondary sepsis (A life threatening condition in which the body causes injury to its own tissues and organs in response to infection) which was managed with culture specific antibiotics. Gradually, he improved and was weaned off from ventilator. Decannulation (A process where the tracheostomy tube is removed once the patient no longer needs it) had been done and the gentleman had been able to go home to his family after more than a month. His family and he had been very grateful to Ruby Critical Care team as he has been able to go back to his family when others had given up on him.
A 23 year old young mother had been presented at the Emergency department of Ruby General Hospital with complaints of shortness of breath, abdomen distension, bleeding from Ryle’s Tube and nasal cannula and post operative anaemia. She had a history of Lower Uterine segment Caesarean Section (LUCS) a week ago and was presented with post operative anaemia, preeclamsia (A condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria) and was admitted in a local hospital in the Burdwan district for abdominal distension. Relevant investigations were done there and the USG abdomen revealed hemoperitoneum (Intra – abdominal haemorrhage, a type of internal bleeding in which the blood gathers in the peritoneal cavity which is the space between the organs and the inner lining of the abdominal wall) and bilateral mild pleural effusion. An emergency laparotomy had been performed for rectus sheath haematoma (An uncommon cause of acute abdominal pain caused by accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear), post which the lady developed progressive shortness of breath and she had been transferred to Ruby General Hospital under the expert care of Dr. Raktim Guha (Consultant Critical Care Medicine). The young lady had been clinically assessed and relevant investigations were advised. She had been intubated and given ventilator support while, continuing giving suction as per requirement through face and mouth. She had been transfused with Packed Red Blood Cells (PRBC), Fresh Frozen Plasma (FFP) and Platelet. Urgent haemodialysis had to be done due to Acute Kidney Injury (AKI). She also developed metabolic acidosis (Presence of too much acid in the body fluids) and it was corrected. During this period, she also had uncontrolled Hypertension and bleeding from mouth. Merocel pack had been given for controlling bleeding and later removed. Gradually, the lady improved and was weaned off from ventilator, the Ryles’s Tube was clamped and started on liquid diet which was later shifted to soft diet. Antibiotic therapy was de-escalated and shifted to oral medications followed by removal of permcath (Placement of a special IV line into the blood vessel on the neck or upper chest just under the collarbone) which had been done to facilitate dialysis treatment. The young mother was ready to go back to her family and more eager to be by her newborn.
