MORTALITY MEET

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

PARTICULARS

Name- ABC

Age- 75 yrs

Sex- Female

IP No. – 123456

Occupation- housewife

Address- Khanagaon, Gokak

DOA - 05/11/16

DOE - 26/11/16

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

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

PAST HISTORY Known case of Diabetes Mellitus

and Hypertension since 20 years

Known case of Ischaemic Heart Disease

No history of Tuberculosis/Asthma

PERSONAL HISTORY

No addictive habits

FAMILY HISTORY

Not Significant

GENERAL PHYSICAL EXAMINATION

Patient is well built and nourished

semiconscious

Pallor present No Icterus Clubbing Lymphadenopathy Edema Cyanosis

VITALSTemperature- Afebrile

Pulse – 100/min

Blood pressure- 80/50 mmHg with inotropes

Respiratory rate – 34/min

SPO2 – 95%

SYSTEMIC EXAMINATION

CVS – tachycardia, S1 and S2 heard, No murmurs

RS – Tachypnea

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

CNS – semiconscious

Glasgow Coma Scale E2V1M4 7/15

Pupils sluggish reacting to light

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

PALPATION

Inspectory findings are confirmed

Local rise of temperature present

Crepitus present

Abnormal mobility present

Diffuse swelling present

Pelvic compression test and chest compression test negative

B/L Peripheral pulses feeble

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

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

CT BRAIN

CHEST X-RAY

X-RAY PELVIS WITH B/L HIP AP VIEW

X-RAY RIGHT FEMUR AP VIEW

X-RAY CERVICAL SPINE

HRCT THORAX – THIN RIM OF PLEURAL EFFUSION

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

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 +

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

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

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

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

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

REFERENCES WERE GIVEN TO :NeurosurgeryRespiratory MedicinePhysician Intensivist

NEUROSURGERY REFERENCE

FINDINGS :

GCS : E2M4VT

Pupils sluggish reacting

ADVISED :

No neurosurgery intervention

RESPIRATORY MEDICINE REFERENCE

FINDINGS : RS clear HRCT – thin rim of pleural infusion

ADVISED :

No active intervention

PHYSICIAN REFERENCE FINDINGS :

Semiconscious

Not responding to deep pain stimulus

ADVISED :

Inotropic support

INTENSIVIST FINDINGS :

Pt with polytrauma GCS – E2M4VT SpO2 – 98% with oxygen

ADVISED :

RBS 6 hrly Noradrenaline @ 4ml hrly

Treatment was continued

Central venous line was inserted at right internal jugular vein

Patient vitals were stable on ventilator, GCS remained same

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

ECG was taken

Chest x-ray advised stat

Arterial blood gas analysis was done

At 7:30 pm :

CPR continued

BP, Pulse and SPO2 were not recordable

Atropine 2ml and 2ml adrenaline given

At 7: 45 pm :

CPR continued

BP, Pulse and SPO2 were not recordable

Atropine 2ml and 2ml adrenaline given

Pupils dilated and fixed

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

CAUSE OF DEATHImmediate cause : cardiogenic

shock

Antecedent cause : fracture distal humerus and left clavicle.