mortality meet presentation 2 by dr. saumya agarwal

37
MORTALITY MEET PRESENTER- Dr. Saumya Agarwal Junior resident Dept of Orthopaedics J.N.Medical College and Dr. Prabhakar Kore Hospital and MRC, Belgaum

TRANSCRIPT

Page 1: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

MORTALITY MEET

PRESENTER- Dr. Saumya Agarwal

Junior resident Dept of Orthopaedics J.N.Medical College and Dr. Prabhakar

Kore Hospital and MRC, Belgaum

Page 2: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

PARTICULARS

Name- ABC

Age- 48 yrs

Sex- Male

IP No. – 123456

Page 3: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Occupation- farmer

Address- Mallur, Belagavi

DOA - 11/02/15

DOE - 12/02/15

Page 4: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

CHIEF COMPLAINTS

Pain and swelling over right thigh

unable to walk

since 10 days

Page 5: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 6: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 7: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 8: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Personal history

Diet – mixed

Appetite – not decreased

Sleep - Disturbed due to pain

Bowel & Bladder - regular

No addictive habits

Page 9: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

FAMILY HISTORY

Not Significant

Page 10: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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.

Page 11: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Vitals

Temperature- Afebrile

Pulse – 88/min

Blood pressure- 126/80 mmhg

Respiratory rate – 24/min

Page 12: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 13: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Glasgow Coma Scale E4V5M6 15/15

Revised Trauma Score GCS4 SBP4 RR4 12/12

Pupils reactive to light

Page 14: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

INSPECTION

Patient was lying in supine position

Attitude of the right lower limb was externally rotated and abducted

Cannot walk

Page 15: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Swelling was present over right thigh

No engorged veins or sinuses

No visible pulsations

Page 16: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Palpation Inspectory findings are confirmed

No local rise of temperature

Tenderness present over right thigh

ROM of right hip and knee – restricted and painful

Page 17: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Pelvic compression test positive

Chest compression test negative

No limb length discrepancy

B/L Peripheral pulses well felt

Toe movements were present

Page 18: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 19: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 20: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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 +

Page 21: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 22: Mortality Meet Presentation 2 by Dr. Saumya Agarwal
Page 23: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 24: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 25: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 26: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 27: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 28: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 29: Mortality Meet Presentation 2 by Dr. Saumya Agarwal
Page 30: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 31: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

At 2 am :

Patient started gasping

Pulse was not recordable

BP not recordable

CPR started

Page 32: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Inj.Atropine 2cc iv given

Inj. Adrenaline 1mg iv given

Patient intubated with endotracheal tube

Page 33: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

At 2:15 am :

Pulse was not recordable

BP not recordable

CPR continued

Inj.Atropine 2cc iv given

Inj. Adrenaline 2cc iv given

Page 34: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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

Page 35: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

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.

Page 36: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

Cause of death Immediate cause : Cardio –

pulmonary arrest secondary to pulmonary thromboembolism ??, diabetes mellitus and hypertension

Antecedent cause : fracture shaft femur right side

Page 37: Mortality Meet Presentation 2 by Dr. Saumya Agarwal

THANK YOU