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MORTALITY MEET
PRESENTER- Dr. Saumya Agarwal
Junior resident Dept of Orthopaedics J.N.Medical College and Dr. Prabhakar
Kore Hospital and MRC, Belgaum
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PARTICULARS
Name- ABC
Age- 48 yrs
Sex- Male
IP No. – 123456
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Occupation- farmer
Address- Mallur, Belagavi
DOA - 11/02/15
DOE - 12/02/15
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CHIEF COMPLAINTS
Pain and swelling over right thigh
unable to walk
since 10 days
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History of presenting illness
Patient was apparently alright 10 days back, when he sustained a fall while boarding the bus.
After fall he complains of pain and swelling over right thigh
Pain was dull aching in nature and continuous throughout the day and swelling was localized to the right thigh
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After the accident he was taken to a local hospital where x-rays were taken and was referred to KLE for further management
No history of loss of consciousness ENT bleed seizures vomiting fever
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Past history Patient is a known case of
diabetes mellitus since 16 years and is on glimipiride twice daily
Patient is a known case of hypertension since 16 years and is on amlodipine 25 mg twice daily
No history of IHD/TB/Asthma
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Personal history
Diet – mixed
Appetite – not decreased
Sleep - Disturbed due to pain
Bowel & Bladder - regular
No addictive habits
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FAMILY HISTORY
Not Significant
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General physical examination
Patient is moderately built and nourished
Conscious and oriented to time, place and person
Pallor present No Icterus Clubbing Lymphadenopathy Edema Cyanosis.
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Vitals
Temperature- Afebrile
Pulse – 88/min
Blood pressure- 126/80 mmhg
Respiratory rate – 24/min
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Systemic examination
CVS - S1 and S2 heard, No murmurs
RS - Air entry equal on both the sides
P/A - Soft, no organomegaly, bowel sounds heard
CNS – conscious, oriented
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Glasgow Coma Scale E4V5M6 15/15
Revised Trauma Score GCS4 SBP4 RR4 12/12
Pupils reactive to light
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INSPECTION
Patient was lying in supine position
Attitude of the right lower limb was externally rotated and abducted
Cannot walk
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Swelling was present over right thigh
No engorged veins or sinuses
No visible pulsations
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Palpation Inspectory findings are confirmed
No local rise of temperature
Tenderness present over right thigh
ROM of right hip and knee – restricted and painful
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Pelvic compression test positive
Chest compression test negative
No limb length discrepancy
B/L Peripheral pulses well felt
Toe movements were present
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MANAGEMENT Patient was admitted in general
ward on 11/02/2015 at 10 am
Vital signs were stable
Skin traction given
Investigations send
Treatment started
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INVESTIGATIONS Hb - 9.1 gm%
WBC - 5000/cmm
Differential count – N68, L27, E02, M03, B00
ESR – 56 mm
PCV – 25 %
Platelet Count - 2.50 lakhs/cmm
RBC - 2.70 millions/cmm
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Blood Urea – 32 mg/dl
S. Creatinine - 1.0mg/dl
S. Sodium - 144meq/l
S.Potassium - 4.0meq/l
S.Uric acid -5.5mg/dl
Blood group – B +
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Treatment
Inj Rantac 2cc iv 1-0-1
Inj Inac im 1-0-1
Tab Calcium 500 mg 1-0-0
Cap Becosules 0-0-1
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Patient was posted for surgery on 13/02/2015
Surgical fitness was obtained by physician on 11/02/15 in the afternoon
Chest x-ray was advised
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On 11/02/2015 at 5 pm :
Patient started complaining of mild discomfort in breathing
Respiratory rate was 29 /min
Salbutamol nebulisation was started
Patient was given O2 at 3 lit/min
Patient felt better and relieved
No fresh complaints
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On 11/02/2015 at 8 pm :
Patient complaint of chest pain and difficulty in breathing
BP was 100/70 mmhg
SpO2 was 92%
Pulse was 88 /min, Resp. rate was 32 /min Patient was given propped up position
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Salbutamol nebulisation given
O2 started at 3 lit/min
On duty physician was informed
He advised to shift the patient to ICU
Patient was immediately shifted to ICU
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Meanwhile, patient was on oxygen at 3 lit/min
Arterial blood gas analysis and serum electrolytes were sent
Patient was maintaining saturation at 90%
Pulse, BP , RR monitoring was going on half hourly
Chest x-ray was done
ECG was done
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ABG showed metabolic acidosis with compensatory respiratory alkalosis
pH 7.17 pCO2 26.8 pO2 83.8 HCO3 14.8
S. Sodium - 142meq/l
S. Potassium – 4.1meq/l
S. Chloride 110meq/l
ECG showed tachycardia with ST segment elevation
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At 12 am :
Pulse was 94 /min
BP was 100/74 mmhg Respiratory rate was 33/min
SpO2 86%
Salbutamol nebulisation repeated
with O2 continuing at 3 lit/min
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At 2 am :
Patient started gasping
Pulse was not recordable
BP not recordable
CPR started
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Inj.Atropine 2cc iv given
Inj. Adrenaline 1mg iv given
Patient intubated with endotracheal tube
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At 2:15 am :
Pulse was not recordable
BP not recordable
CPR continued
Inj.Atropine 2cc iv given
Inj. Adrenaline 2cc iv given
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Pupils became dilated, fixed and non reactive to light
CVS – S1 S2 absent
RS – breath sounds absent
ECG – no voltage
Defibrillation attempted but patient did not revived
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Inspite of all resuscitation measures patient could not be revived & patient declared dead at 2:30 am on 12/02/15 at KLE Hospital, Belgaum
Post mortem was advised but patient attenders refused.
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Cause of death Immediate cause : Cardio –
pulmonary arrest secondary to pulmonary thromboembolism ??, diabetes mellitus and hypertension
Antecedent cause : fracture shaft femur right side
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THANK YOU