MORTALITY MEET

PRESENTER- Dr. Saumya Agarwal

Junior resident Dept of Orthopaedics J.N.Medical College and Dr. Prabhakar Kore Hospital and MRC, Belgaum

Name- ABC

Age- 64 yrs

Sex- Male

IP No. – 123456

PARTICULARS

Occupation- Farmer

Address- Hukkeri, Belagavi

DOA- 24/11/14

Pain over right hip since 8 days

CHIEF COMPLAINTS

Patient was apparently alright 8 days back, when he sustained a fall due to skid at his home

After fall he complains of pain over right hip

Pain was dull aching in nature and continuous throughout the day

History of presenting illness

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 conciousness ENT bleed seizures vomiting fever

Patient is a known case of right side hemiplegia since 16 years and is on phenobarbitone 60mg twice daily

Patient is a known case of hypertension since 16 years and is on amlodipine 25 mg twice daily

No history of DM/TB/Asthma

Past history

Diet – mixed

Appetite – not decreased

Sleep - Not disturbed

Bowel & Bladder - regular

No addictive habits

Personal history

Not Significant

FAMILY HISTORY

Patient is moderately built and nourished

Conscious and oriented to time, place and person

Pallor present No Icterus Clubbing Lympadenopathy Edema Cyanosis.

General physical examination

Temperature- Afebrile

Pulse – 80 /min

Blood pressure- 130/80 mmhg

Respiratory rate – 22 /min

Vitals

CVS - S1 and S2 heard, No murmurs

RS - Air entry equal on both the sides

P/A - Soft, no organomegaly, bowel sounds heard

CNS – right side hemiplegic

Systemic examination

Glasgow Coma Scale E4V5M6 15/15

Revised Trauma Score GCS4 SBP4 RR4 12/12

Pupils reactive to light

Patient was lying in supine position

Attitude of the right lower limb was externally rotated and abducted

Cannot walk

INSPECTION

Swelling was present over hip

Patient was not able to move his right side of the body

No engorged veins or sinuses

No visible pulsations

Inspectory findings are confirmed

No local rise of temperature

Tenderness present over right hip

ROM of right hip – not possible

Palpation

Pelvic compression test positive

Chest compression test negative

No limb length discrepancy

B/L Peripheral pulses well felt

Toe movements were absent

Patient was admitted in ortho free ward on 24/11/2014 at 3 pm

Vital signs were stable

Skin traction given

Investigations send

Treatment started

MANAGEMENT

Hb - 7.1 gm%

WBC - 3000/cmm

Differential count – N58, L37, E02, M03, B00

ESR – 76 mm

PCV – 21 %

Platelet Count - 1.50 lakhs/cmm

RBC - 1.60 millions/cmm

INVESTIGATIONS

Blood Urea – 28 mg/dl

S. Creatinine - 1.1mg/dl

S. Sodium - 142meq/l

S. Potassium - 3.9meq/l

S. Uric acid - 4.5mg/dl

Blood group – A +

Intra venous fluids NS/RL @50ml/hr

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

Treatment

Patient was posted for surgery on 26/11/14

Surgical fitness was obtained by physician on 25/11/14 in the afternoon

Chest x-ray was advised

On 25/11/2014 at 2 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

On 26/11/2014 at 2 am :

Patient complaint of chest pain and difficulty in breathing

BP was 100/60 mmhg

SpO2 was 90%

Pulse was 90 /min, Resp. rate was 30 /min Patient was given propped up position

Salbutamol nebulisation given

O2 started at 3 lit/min

On duty physician was informed

He advised to shift the patient to ICU

Patient attenders refused

Meanwhile, patient was on oxygen at 3 lit/min

Arterial blood gas analysis was sent

Patient was maintaining saturation at 90%

Pulse, BP , RR monitoring was going on half hourly

Patient was feeling better again.

At 7 am :

Pulse was 92 /min

BP was 100/70 mmhg Respiratory rate was 31/min

SpO2 85%

Salbutamol nebulisation repeated

with O2 continuing at 3 lit/min

At 8 am :

Patient started gasping

Pulse was not recordable

BP not recordable

CPR started

Inj.Atropine 2cc iv given

Inj. Adrenaline 1mg iv given

Patient intubated with endotracheal tube

At 8:15 am :

Pulse was not recordable

BP not recordable

CPR continued

Inj.Atropine 2cc iv given

Inj. Adrenaline 2cc iv given

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

Inspite of all resuscitation measures patient could not be revived & patient declared dead at 8:30 am on 26/11/14 at KLE Hospital, Belgaum

Post mortem was advised but patient attenders refused.

Immediate cause : Cardio – pulmonary arrest secondary to pulmonary thromboembolism ??

Antecedent cause : fracture neck of femur right hip / right side hemiplegia

Cause of death

THANK YOU