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  • Surgery M&M 1

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    Uhuebor David
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    A 53-year-old African male presented with gastroenteritis, difficulty breathing, and a hemoglobin level of 3.1g/dl. He had a history of hypertension, chronic kidney disease, prostate cancer, and previous upper GI bleeding. On examination he was pale with bibasal lung crepitations and tachycardia. Investigations showed a low hemoglobin and elevated urea and creatinine. He was admitted and transfused but became febrile, dyspneic, and acidotic. He was diagnosed with hospital-acquired pneumonia but became unresponsive and died. He had a history of non-compliance with treatment and follow-up appointments.

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    A 53-year-old African male presented with gastroenteritis, difficulty breathing, and a hemoglobin level of 3.1g/dl. He had a history of hypertension, chronic kidney disease, prostate cancer, and previous upper GI bleeding. On examination he was pale with bibasal lung crepitations and tachycardia. Investigations showed a low hemoglobin and elevated urea and creatinine. He was admitted and transfused but became febrile, dyspneic, and acidotic. He was diagnosed with hospital-acquired pneumonia but became unresponsive and died. He had a history of non-compliance with treatment and follow-up appointments.

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    34 views9 pages

    Surgery M&M 1

    Uploaded by

    Uhuebor David
    A 53-year-old African male presented with gastroenteritis, difficulty breathing, and a hemoglobin level of 3.1g/dl. He had a history of hypertension, chronic kidney disease, prostate cancer, and previous upper GI bleeding. On examination he was pale with bibasal lung crepitations and tachycardia. Investigations showed a low hemoglobin and elevated urea and creatinine. He was admitted and transfused but became febrile, dyspneic, and acidotic. He was diagnosed with hospital-acquired pneumonia but became unresponsive and died. He had a history of non-compliance with treatment and follow-up appointments.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 9

    M&M : Mr. S.

    Biodata
    .53 year old Employed African Male.

    Immediate Hx&Co-morbidities
    HPT defaulting treament
    Chronic Kidney Disease with probable end-

    stage renal failure


    Previous upper GI bleeding end of March
    2013
    Prostate Ca diagnosed clinically in Nov 2012
    with histopathology diagnosis of
    adenocarcinoma, Gleasons 4, 4 in Feb 2013.

    Presented to the casualty 3/52 ago @ 21h55,

    triaged Red with a 2/7 history of


    gastroenteritis and 1/7 history of difficulty in
    breathing. Vitals were RR of 40 cpm, PR 115
    bpm, BP of 86/42 and a Sats of 70% and a
    ward HB of 3.1g/dl.

    Examination Findings
    Gen: pale.
    Chest: GAEB. Bibasal creps
    CVS: Tachycardia
    Abd: Soft. Not tender. No palpable organ

    enlargement. Normo-active BS. PR not done

    Investigations
    FBC :Hb 4.1, WCC 10.93. Platelets 61
    UKE: Urea 26.5. Creatinine 228 Na 135 K 3.5
    CXR findings not documented
    Dipstix on stool : 4+ blood
    Stool sent for mcs: report not available

    Intervention
    Transfused in the casualty with 2 units of RCC
    Admitted to Ward 6

    -Day 1: On the ward patient was transfused with


    an additional 2 units of RCC following a posttransfusion Hb of 5.6g/dl
    -Day 2: Febrile with rigours and dyspnoeic with
    flaring alae nasae, increased RR and intercostal
    recession. Sats on RA was 84% and improved to
    94% on face mask oxygen.
    ABG: Metabolic acidosis

    Ass: Probable Hosp Acquired Pneumonia was

    made.
    Consult to the medical department.
    Plan: to commence px on Augmentin and
    Erythromycin
    @ 21h00 of day 2 on admission: px became
    unresponsive and was certified dead.

    Added Points
    Patient was reportedly uncooperative.
    Declined biopsy when clinical diagnosis was

    made @ the end of Nov 2012. Opted to


    followup in January 2013 as against the
    immediate appoinment of 1st week in Dec
    2012 secured for him.
    Signed RHT on one of the admissions inspite
    of social workers intervention while being
    managed for Upper GI bleeding in March 2013
    Whilst on admission patient could not make
    his KSD oncology appointment because he

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