Mortality Meet Presentation

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

2. PARTICULARS
Name- ABC
Age- 75 yrs
Sex- Female
IP No. – 123456

3. Occupation- housewife
Address- Khanagaon, Gokak
DOA - 05/11/16
DOE - 26/11/16

4. 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

5. 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

6. PAST HISTORY
 Known case of Diabetes Mellitus and
Hypertension since 20 years
Known case of Ischaemic Heart
Disease
No history of Tuberculosis/Asthma

7. PERSONAL HISTORY
No addictive habits

8. FAMILY HISTORY
Not Significant

9. GENERAL PHYSICAL EXAMINATION
 Patient is well built and nourished
 semiconscious
 Pallor present
 No Icterus
 Clubbing
 Lymphadenopathy
 Edema
 Cyanosis

10. VITALS
Temperature- Afebrile
Pulse – 100/min
Blood pressure- 80/50 mmHg with
inotropes
Respiratory rate – 34/min
SPO2 – 95%

11. SYSTEMIC EXAMINATION
 CVS – tachycardia, S1 and S2 heard,
No murmurs
 RS – Tachypnea
 P/A - Soft, no organomegaly, bowel
sounds heard
 CNS – semiconscious

12. Glasgow Coma Scale E2V1M4
7/15
Pupils sluggish reacting to light

13. 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

14. PALPATION
Inspectory findings are confirmed
 Local rise of temperature present
Crepitus present
Abnormal mobility present
Diffuse swelling present

15. Pelvic compression test and
chest compression test negative
B/L Peripheral pulses feeble

16. MANAGEMENT
Patient 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

17.  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

18. CT BRAIN

19. CHEST X-RAY

20. X-RAY PELVIS WITH B/L HIP AP VIEW

21. X-RAY RIGHT FEMUR AP VIEW

22. X-RAY CERVICAL SPINE

23. HRCT THORAX – THIN RIM OF PLEURAL EFFUSION

24. 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

25. 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 +

26.  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

27.  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

28. 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

29. 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

30.  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

31. REFERENCES WERE GIVEN TO :
Neurosurgery
Respiratory Medicine
Physician
Intensivist

32. NEUROSURGERY REFERENCE
FINDINGS :
 GCS : E2M4VT
 Pupils sluggish reacting
ADVISED :
 No neurosurgery intervention

33. RESPIRATORY MEDICINE REFERENCE
FINDINGS :
 RS clear
 HRCT – thin rim of pleural infusion
ADVISED :
 No active intervention

34. PHYSICIAN REFERENCE
FINDINGS :
 Semiconscious
 Not responding to deep pain stimulus
ADVISED :
 Inotropic support

35. INTENSIVIST
 FINDINGS :
 Pt with polytrauma
 GCS – E2M4VT
 SpO2 – 98% with oxygen
 ADVISED :
 RBS 6 hrly
 Noradrenaline @ 4ml hrly

36.  Treatment was continued
 Central venous line was inserted at right internal
jugular vein
 Patient vitals were stable on ventilator, GCS remained
same

37.  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

38. ECG was taken
Chest x-ray advised stat
Arterial blood gas analysis was done

39. At 7:30 pm :
CPR continued
BP, Pulse and SPO2 were not
recordable
 Atropine 2ml and 2ml adrenaline given

40. At 7: 45 pm :
CPR continued
BP, Pulse and SPO2 were not recordable
 Atropine 2ml and 2ml adrenaline given
Pupils dilated and fixed

41. 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

42. CAUSE OF DEATH
Immediate cause : cardiogenic shock
Antecedent cause : fracture distal
humerus and left clavicle.