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

 Patientmet 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
VITALS
 Temperature- 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

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

 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 :
 Neurosurgery
 Respiratory Medicine
 Physician
 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

 Centralvenous 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

 Inspiteof 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 DEATH
 Immediate cause : cardiogenic shock

 Antecedent
cause : fracture distal
humerus and left clavicle.