mortality meet presentation 3 by dr. saumya agarwal
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TRANSCRIPT
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
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