mortality meet presentation 9 nov 2016
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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, Belagavi
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PARTICULARS
Name- ABC
Age- 75 yrs
Sex- Female
IP No. – 123456
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Occupation- housewife
Address- Khanagaon, Gokak
DOA - 05/11/16
DOE - 26/11/16
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CHIEF COMPLAINTS
Patient came to the casualty semiconscious following road traffic accident- 2 wheeler was hit by a 4 wheeler.
She was first taken to a primary health centre and after that she was referred to our hospital
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HISTORY OF PRESENTING ILLNESS
Patient met with a road traffic accident and sustained injuries over right elbow and left shoulder as told by the attender
Patient was semiconscious, no external injuries
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PAST HISTORY Known case of Diabetes Mellitus
and Hypertension since 20 years
Known case of Ischaemic Heart Disease
No history of Tuberculosis/Asthma
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PERSONAL HISTORY
No addictive habits
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FAMILY HISTORY
Not Significant
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GENERAL PHYSICAL EXAMINATION
Patient is well built and nourished
semiconscious
Pallor present No Icterus Clubbing Lymphadenopathy Edema Cyanosis
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VITALSTemperature- Afebrile
Pulse – 100/min
Blood pressure- 80/50 mmHg with inotropes
Respiratory rate – 34/min
SPO2 – 95%
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SYSTEMIC EXAMINATION
CVS – tachycardia, S1 and S2 heard, No murmurs
RS – Tachypnea
P/A - Soft, no organomegaly, bowel sounds heard
CNS – semiconscious
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Glasgow Coma Scale E2V1M4 7/15
Pupils sluggish reacting to light
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INSPECTION Patient was lying in supine position semiconscious
Intubated with C-spine inline immobilization
Deformity seen at right elbow and left shoulder
Diffuse swelling present
No engorged veins or sinuses
No visible pulsations
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PALPATION
Inspectory findings are confirmed
Local rise of temperature present
Crepitus present
Abnormal mobility present
Diffuse swelling present
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Pelvic compression test and chest compression test negative
B/L Peripheral pulses feeble
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MANAGEMENTPatient was intubated in resuscitation
room with c-spine inline immobilization
O2 started at 11 lit/min and the patient was put on ventilator
Crystalloids RL @ 100 ml/hr were given Xray chest AP view done, ECG taken
Investigations sent and catheterised
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Patient was shifted to ICU
CT-Brain was performed
CT-Brain showed no major abnormality
Few streaks of subarachnoid hemorrhage in right frontal and temporal regions
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CT BRAIN
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CHEST X-RAY
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X-RAY PELVIS WITH B/L HIP AP VIEW
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X-RAY RIGHT FEMUR AP VIEW
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X-RAY CERVICAL SPINE
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HRCT THORAX – THIN RIM OF PLEURAL EFFUSION
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INVESTIGATIONS Hb – 7 gm% 5/11/16
WBC - 21400/cmm
Differential count – N79, L17, E00, M04, B00
ESR – 90 mm
Platelet Count - 1.30 lakhs/cmm
RBC - 2.51 millions/cmm
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Blood Urea – 59 mg/dl
S. Creatinine – 0.84mg/dl
S. Sodium - 151meq/l
S.Potassium - 4.24meq/l
S.Uric acid -5.5mg/dl
Blood group – A +
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Total bilirubin – 0.52
Direct bilirubin – 0.12
SGOT – 70
SGPT – 59
Total proteins – 6.2
S. albumin – 3.3
S. calcium – 8.9
S. PCT – 0.82 mg/ml
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Osmolality – 270 mOsm/kg
PT – 14.1 sec
APTT – 28 sec
INR – 1.26
HIV 1 and 2 non reactive
HBsAg non reactive
HCV non reactive
ECG showed ST segment elevation
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ARTERIAL BLOOD GAS ANALYSIS pH 7.45 pCO2 25.8 pO2 356.5 HCO3 17.8
Hct – 19.7 %
S lactate – 3.5 mmol/lit
RBS – 169 mg/dl
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TREATMENT
Intra venous fluids at 100 ml/hr 1pint RL
Inj Tazorid-P 2.25gm iv 1-1-1-1
Inj Pantocid 40 mg iv 1-0-1
Inj Tramadol in 100 ml NS 1-0-1
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Inj Emeset 4mg iv 1-0-1
Pt was put on O2 at 11 lit/min
1 pint whole blood was transfused on 2nd day
TPR-BP charting was performed hourly
Input output charting was done on daily basis
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REFERENCES WERE GIVEN TO :NeurosurgeryRespiratory MedicinePhysician Intensivist
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NEUROSURGERY REFERENCE
FINDINGS :
GCS : E2M4VT
Pupils sluggish reacting
ADVISED :
No neurosurgery intervention
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RESPIRATORY MEDICINE REFERENCE
FINDINGS : RS clear HRCT – thin rim of pleural infusion
ADVISED :
No active intervention
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PHYSICIAN REFERENCE FINDINGS :
Semiconscious
Not responding to deep pain stimulus
ADVISED :
Inotropic support
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INTENSIVIST FINDINGS :
Pt with polytrauma GCS – E2M4VT SpO2 – 98% with oxygen
ADVISED :
RBS 6 hrly Noradrenaline @ 4ml hrly
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Treatment was continued
Central venous line was inserted at right internal jugular vein
Patient vitals were stable on ventilator, GCS remained same
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On 06/11/2016 at 7:15 pm :
Patient started gasping on ventilator and went into sudden cardiac arrest
Respiratory rate was 44 /min
BP – not recordable
Started on atropine 2ml and 2ml adrenaline
SpO2 – not recordable
CPCR started
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ECG was taken
Chest x-ray advised stat
Arterial blood gas analysis was done
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At 7:30 pm :
CPR continued
BP, Pulse and SPO2 were not recordable
Atropine 2ml and 2ml adrenaline given
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At 7: 45 pm :
CPR continued
BP, Pulse and SPO2 were not recordable
Atropine 2ml and 2ml adrenaline given
Pupils dilated and fixed
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Inspite of all resuscitation measures patient could not be revived & patient declared dead at 8:00 pm on 06/11/16 at KLE Hospital, Belagavi
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CAUSE OF DEATHImmediate cause : cardiogenic
shock
Antecedent cause : fracture distal humerus and left clavicle.
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