case conference intern 陳姝蓉. patient profile name: 鍾高 o 錦 79 year-old female occupation:...
TRANSCRIPT
Case Conference
Intern 陳姝蓉
Patient profile
Name: 鍾高 O 錦 79 year-old female Occupation: unknown Chart number: 15790607 Arrival time: 2007.04.05 AM08:38 Arrival method: EMT from 小港 hospital
Injury mechanism
The patient ingested unknown amount of hydrochloric acid at 6AM of April 5th
She was brought to 小港 hospital ER for help
Pre-hospital evaluation and management
Sent to 小港 hospital ER Consciousness: drowsy, GCS: E2V2M4-5
Head : ILOC(-), dizziness(-), headache(-), nausea/vomiting(-), amnesia(-), vertigo(-)
Mouth: oral ulcers (+) Neck: pain(-), stiff(-), soreness(-) Chest: pain(-), tachycardia(+) Abdomen: distension(+), tenderness(+) Extremities : edema(+)
Initial evaluation ( 小港 hospital)A (airway) / B (breathing):
Speech: incomprehensible sound Respiration: SaO2: 88% Lips: cyanotic and pale Respiratory rate: 10~24/min
C (circulation): Pulse: palpable over all major peripheral arteries Cuff BP : 122/80 mmHg Skin condition:
Appearance: pale and cyanotic over lips and mouth Temperature: 35.7 C Humidity: unknown
D (disability): GCS: E2V2M4-5
Pupil response:
od: 3mm, +/+ os: 3mm, +/+
E (exposure) : nil
Initial evaluation ( 小港 hospital)
Progression at 小港 hospital Air hunger was noted with deterioration in GCS
(E1V1M1) Intubation with size 7.5 endotracheal tube fixed at 21
cm On ventilator (TV: 500mL, RR: 16/min, FiO2: 100%) On neck CVC and give N/S 1 bottle
Blood pressure dropped to 81/57 mmHg IV full-run Consult surgeon
Due to peritonism, the patient was transferred to KMUH by ambulance
Initial evaluation (KMUH)A (airway) / B (breathing): Collar fixation: (-) Breathing:
Respiratory rate: on endo Airway:
Speech: incapableRespiration: ambu-baggingAirway obstruction sign: presentForeign body in the mouth: absentTrachea: midline
C (circulation): Pulse: impalpable on carotid artery Cuff BP : unmeasurable Skin condition:
Appearance: pale-looking Temperature: cold (34.8C)Humidity: unknown
Initial evaluation (KMUH)
D (disability): GCS: E1VtM1 Pupil response: absent bilaterally
E (exposure) : nil
Initial evaluation (KMUH)
Current medication Unknown
Past history DM: (-), HTN: (+), Hepatitis: (-) Major depressive disorder? Smoking(-), alcohol(-), betal nut(-) Operation history: unknown Allergy history(-) Travel history(-), contact history(-)
Family history Not contributory
Secondary evaluation (KMUH ER)
ECG monitor Lab data Pulse oximeter
Initial management Start CPR Fluid and drugs during resuscitation
NaHCO3 Atropine Adrenaline Gelofusine
Lab CBC, WBC classification, ABG, image
Special management DC shock Ventilator
Lab data
Blood 96/04/05
WBC 12.62 x 103/uL
RBC 1.09 x 106/uL
Hgb 3.5 g/dL
Hct 10.5 %
MCV 96.3 fL
PLT 45 x 103/uL
Neu 66.9 %
Eosin 0.5 %
Baso 0.2 %
Lymph 30.7 %
Mono 1.7 %
Arterial Blood Gas 96/04/05
Temperature 37.0 ℃
pH 7.207
pCO2 24.5 mmHg
pO2 390.8 mmHg
HCO3- 9.5 mmol/L
Total CO2 8.6 mmol/L
Base excess -16.5 mmol/L
SBC 11.9 mmol/L
BEecf -18.4 mmol/L
%sO2c 99.9 %
Image study
Impression Pulseless electrical activity (PEA) on arrival Corrosive esophagogastritis
Plans ACLS
Thanks for your attention !!!
Indication of surgical intervention for corrosive esophagogastritis Clinical signs of perforation, mediastinitis,
or peritonitis