The other day I was doing a routine Critical Care ward round and came to a patient who was on a mechanical ventilator, having been admitted 3 days earlier from theatres following surgery for a perforated bowel. They had been ventilated since admission. However overnight the patients ventilatory requirements had increased a bit (slightly higher ventilation pressures and a bit more oxygen), their white blood cells had gone up as had their CRP and the nurses were getting a bit more “muck” up off their chest. The Critical Care Consultant looked at that mornings chest x-ray and identified some patchy infiltrates (shadowing).
 
“So the patient has ventilator-associated pneumonia!” the junior doctor declared reaching for the drug chart. The Critical Care Consultant and I exchanged a glance… 

​A 37 year old lady was brought in to the Emergency Department having fallen off her horse, which had then accidentally stepped on her. The patient had severe left upper quadrant abdominal pain and marked hypotension. A probable splenic injury was diagnosed and she was taken to theatre. Her spleen had been badly damaged and had to be removed (splenectomy) in order to control the bleeding. After she was back on the ward and stable the doctors called the Microbiologists to ask whether she should be immunised and what antibiotics she should be on.