Death Report Malignant Round Cell Tumor dd Ewing Sarcoma + Anemia + AKI St.

Injury (improved)
N/♀/14y/29kg + Paraplegi Inferior UMN Type + s. Intracranial Metastase
22/10/2019 Patient was referred from Sidoarjo Hospital with Malignant Round Cell Tumor. Patient complaint pain in her legs
since 4 days before admitted in hospital. GCS 456, BP 100/70 mmHg, HR 92 bpm, RR 22 tpm, T 36,8oC, SpO2
98%, pain scale 1. WBC 1680/Hb 10.9/Plt 180.000/ANC 900  Analgetic, consult to paliative, chemoteraphy.
25/10/2019 Pain sometimes appeared. GCS 456, BP 90/70 mmHg, HR 90 bpm, RR 20 tpm, T 36,8oC, SpO2 97%. Pain scale 3.
Lab: WBC 2620/Hb 8.6/Plt 370.000 PRC transfusion, palliative medicine (paracetamol,morphin, amitriptilline).
28/10/2019 Pain increased. Pain scale 6. GCS 456, BP 110/70 mmHg. HR 116 bpm, RR 20 tpm, T 36.8oC, Sp02 98%. WBC
8.790/Hb 11.4/Hct 32.6/Plt 527.000/PPT 10.9/APTT 32.1/AST 46/ALT 13/Alb 3.3/Cr 2.2/BUN 33/UA 7,4/Na 133/K
4.8/Cl 100/GFR 36/pH 7.3/pCO2 36/pO2 46/HCO3 18.5/Beecf -7.6/SO2 78  plan to Chest X-Ray, lumbosacral X-
ray, USG abdomen, open biopsy, consult to Nephrology div.
29/10/2019 Abdominal USG : Bilateral Mild hydronephrosis, Thorax: No metastatic procces, Lumbosacral: Blastic lesion at
right iliac wing with bulging soft tissue mass.
30/10/2019 Patient was done open biopsy with general anesthesia.
1/11/2019 Pain increased (pain scale 9), pale, fever, bleeding from wound post open biopsy. GCS 456, BP 110/60 mmHg, HR
124 bpm, RR 20 tpm, T 38,1oC, SpO2 98%. Lab : WBC 11.920/Hb 8,6/Plt 534.000  RC Transfusion, nabic po.
4/11/2019 Pain decreased (pain scale 5), flaccid in lower extremities. GCS 456, BP 100/70mmHg, HR 90 bpm, RR 20 tpm, T
36,8oC, SpO2 97%. Lab: WBC 8790/Hb 11,4/Plt 527.000/pH 7.35/pCO2 24/pO2 124/HCO3 13.2/BE -12/SO2 99 
Plan to EMG, Brain MRI, Paliatif medicine, consult to neurology  perspiration test.
8/11/2019 Patient did perspiration test  Anhidrosis at myelum Th 6-7 lower, immunohistochemistry.
10/11/2019
07.00 Pain at right hand, GCS 456, BP 100/70 mmHg, HR 98 bpm, RR 24 tpm, SpO2 96% Paliative drugs continued.
10.00 Dyspnea, clammy extremities. GCS 356, BP 60/Palp, HR 64 bpm, RR 26 tpm, SpO2 89%  Fluid resuscitation, O2
tight mask 10 lpm, consulted to ERIA Division.
11.00 Agitated, clammy extremities. GCS 345, BP 70/Palp, HR 60 bpm, RR 24 tpm, SpO2 80%  fluid resuscitation,
active PPV, family education.
12.00 Agitated >>. GCS 235, BP 40/palp, HR 56 bpm, SpO2 76%  Active PPV, Family education, Resuscitation.
12.30 Inadequate breathing. GCS 223, BP unmeasurable, HR 50 bpm, SpO2 unmeasurable  resuscitation.
13.00 Apneu, BP unmeasurable, pulseless, SpO2 unmeasurable  resuscitation.
13.30 Pulseless, SpO2 unmeasurable  resuscitation.
13.45 HR 0 RR 0 pupil dilated maximal  Patient died.