MORTALITY APRIL

2019
DR FAIZAN /DR IQRA
PATIENT #1

• Name :zubaida bibi

• Age :60/fe
• Resident of jallo morr
• Doa:24-3-19
• Dod:8-4-19
• Duration of stay :16 days
• Diabetic hypertensive female presented in er with c/o generalized abd pain +vomiting for
2 days at her 10th pod after exploratory laprotomy +right hemicolectomy +covering
ileostomy o/a acute Intestinal obstruction ,hemicolectomy specimen showed well
differentiated adenocarcinoma of intestine pt3,pn1,pmx.
• o/e :viltally stable
• Abd soft ,distended with generarlized tenderbess.
• Xray erect abd normal
• Usg:minimal free fluid in pelvis with few adynamic gut loops,mild spleenomegaly .
• Lipase :78,amylase:58
• Cpk:30,ckmb:19,ldh:458
• Cea:4.1,cue:8-10 pus cells,15-20rbscs yeasts cells +++.
• hba1c 8.6
date hb Tlc plt Na/k Urea creat Alt pt inr
24-3-19 9.5 15 829 125/5.5 1.5 28 14 1.1
26-3-19 9.3 16.4 776 132/5.4 78 0.9 21 15 1.2
28-3-19 8.5 11.7 460 128/4.5 3.3 0.7 29 15 1.2
31-3-19 12.7 13.4 248 134/3.5 27 0.6 20 14 1.1
1-4-19 9.3 17.6 349 127/2.9 30 0.6 25 15 1.1
3-4-19 10.8 15 335 143/3.4 28 0.6 24 15 1.1
5-4-19 9.3 6.3 236 137/2.2 35 0.7 41 1.9
7-4-19 10.1 3.7 124 137/2.4 22 0.7 40
• Pt was managed conservatively in ward ,remained vitally stable then after 3 days pus
started coming out of stoma site and wound ,pt developed abdominal pain and
vomiting,foul smelling discharge from previous drain site ,

• Pt was re-explored on 2nd april .closure of stump of transverse colon,peritoneal

lavage,end ileostomy and debridement of wound at previous drain site was done.
• IOF:multiple interloop adhesions and gut adherent to ant abd wall ,300 ml pus in
pelvis,right paracolic gutter+subhepatic space,100 ml pus from subcutaneoud plane of
previous laprotomy site and leakage of anastomosis.
• 0n 3rd aprilPt was irritable with deranged bsr levels ,mutilple calls from.dmc have already
been attended.Ketones were ++.calls to med ,ccu and pulmonogy were attended and pt
was managed on tripple supports.
• Bnp and ddimers were also raised.
• By 5th april pt started maintaining bp w/o supports and ketones were nil.
• Pt collapased on 8th,bp less pulseless,pt was intubated and cpr started,cardiac activity
restored after 5 mins of cpr ,pt put in manual ambu bagging with tripple supports as no
bed was available in icu.
• Pt again collapsed on 11pm ,cpr starte acc to protocol ,continued for 20 mins .ecg done
.straight line.Death declared.
PATIENT #2

Name:khursheed
Age:60/male
Resident of lhr cantt
Doa:24-3-19
Dod:2-4-19
Duration of stay:10 days
Non diabetic non hypertensive male referred from ghurki in er with c/o mild to moderate
epigastrium for 2 months with increased severity for more than 12 hours .there was also
h/o abd distension with lower grade fever for 2 months.
o/e .pulse 140/min.100/60 bp.
Abd distended ,genealized tenderness .
Labs :hb 14 tlc 6,plt 212
Urea:32,creat 0.8
Xray chest :air under right hemi diaphragm
Exploratory laprotomy was performed within 3 hours @7 pm .along with graham’repair d/t
prepyloric gastric perforation..There was 500 ml ascitic fluid peroperatively.
Pt remained on ventilator for 12 hours ,no bed was available in med /surgical icu.(resp
acidosis)
date hb tlc plt Na/k creat alt inr
28-3-19 12.5 8.8 119 138/3.0 1.0 109 1.1
29-3-19 11.8 7.2 49 136/3.7 1.1 77 1.1
2-4-19 12.3 2.5 114 139/2.5 2.0 90 1.1
• Pt remained vitally stable except raised bp for which call to med was attemded and pt was
managed accordingly with open wound until 31st .
• Started complaining of blurring of vision for which call to eye was attended .Pseudophakic
lens was mentioned with no other signifucant pathology.
• At 10 pm pt ‘gcs started deteriorating to 13/15 with high grade fever and shivering.at 1
am.was k/o dcld so kleen enema given and pt was managed accordingly.
• Then at 8:40am on 2nd pt was attended moaning with resp distress and drowsy
• Bsr was lo,4 amp 25%dw given and shifted t hdu at 9:15 am.bp was on lower side and was
oliguric.was resuscitated with i/v fluids andtripple supports were started
• Chest had b/l coarse crepts in all zones,o2 attached at 4l/min
• Pt again deteriorated at 5:20 pm sat dropped to 50%,ett passed,ambubagging done .no beds
were available in med /surgical icu.pt became pulseless ,cpr started ,continued for 30 mins ,pt
couldn’t be revived .death declared after confirmation.
PATIENT #3

• Name :Ritta
• Age :32y
• Gender:fe /married
• Resident of lahore cantt
• Doa:14-3-19
• Dod:11-4-19
• Duration of stay:29 days
• Non diabetic non hypertensive ,rheumatic heart disease pt (for 25 years ,on warfarin injection once a month) presented with
acute ischemia of left lower limb .
• She was vitally stable .o/e gangrenous lefr leg with well defined margins ,with femoral pulses not palpable.
• After getting ct angio done ,above knee amputation was performed.after getting high risk consent.Iof:clot in femoral artery.
• Patient remained vitally stable in ward in post op period ,echo was planned on 18 th which showed rheumatic heart disease with
severe mitral stenosis,moderate TR with severe pulmonary HTN ,milldy dilated LV with good systolic function.EF:60%.
• Patient was shifted to CCU on 21st for specific management.And shifted back to us on 1st april.patient remained vitally stable in
ward ,ecg used to be done twice a day and multiple calls were attended from PIC and ccu for long term managemnet plan of
RHD for pt.
date hb tlc plt Na/k creat alt pt aptt inr
15/3 10.9 11 344 138/4. 0.6 61 13 33 1
18/3 10.4 15.2 330 134/4 0.6 17 35 1.4
21/3 10.7 15 382 132/4 0.8 15 33 1.2
22/3 8.8 14.4 315 131/5. 0.7 14 34 1.2
1/4 8.6 11.2 453 128/3.6 1.0 32 14 35 1.3
3/4 8.8 13.6 473 122/3.8 0.8 53
5/4 10.5 11.4 423 128/3.1 1.0 38 13 34 1.0
8/4 9.5 14.9 219 137/3. 0.9 32 13 33 3.9
• Debridement of wound under LA was done on 5th april.
• Although pt remained vitally stable throughout the stay however pulse was irregularly
irregular with no symptoms for which multiple calls were attended from ccu nd PIC.
• Duplex of right lower limb was planned on 9tj which was to be done on 11th .
It showed multiple enlarged lymph nodes with preserved fatty hilum .bisphasic flow in sup and
deep femoral artery.thining and narrowing of popliteal ,ant post tibial and dosralis pedis artery
for which CT angio was advised.
On 11th april at 3pm pt was received from NOT after debridement with no bp and pulse
recordable.pt was tachypnic Nd tachycardic amd wasn’t maintaining sat at RA.pt was resucitated
and double supports started.call sent to med/surgical icu but no bed available.
Pt shifted to hdu at 4:50 pm with tripple supports and bp still unrecordable.call was attended
from ccu,bicarv was replaced.at 5:30pm elective intubation was advisd by sr on call ,call again
sent to ccu,no senior was available.r/r :60/min .bp :80/60 pulse (carotid) 140/min spo2:84 @high
flow.
• Pt again collapsed at 6:50pm with no respiratory activity and heart activity,cpr
started,boluses of fluid given ,supports increased to maximum,pt revivied with irregular
rhythm and bradycardia ,.ambo bagging cintinured at 10 breaths /min.call to nephro was
attended for nil uop in last 5 hours even after boluses.
• Cpr again started at 7:45pm .ecg showed iregular rhythm.atropine repeated.
• Ecg became straight at 8:40pm .death declared.
PATIENT #4

• Name :Nazir
• Age :50y
• Sex :male
• Unattended pt so no adress available.
• Doa:21-4-19
• Dod:22-4-19
• Duration of stay:2 days
• Hep c +ve pt (for year) presented with c/o on /off PR bleeding for 1 year and urinary retention for 3 days.Also
h/o hematemsis +malena for 1 year .
• o/e vitally stable.abd distended tender in RHC .perianal swelling 2×2cm 1 cm from.anal verge @7’o clock
position.
• DRE:normal anal tone no blood stained /feacal matter stainrd finger..
• Investigations :hb 6.5 tlc:8.9 plt:242.Na/k 140/4.1 urea :67 Alt:39 pt:14 INR 1.1
• On next day ,gcs started deteriorating ,it was 11/15 .abd was tense ,distended with absent bowel sounds .
• Call to med was also attended for DCLD.
• Dms was also informrd about pt’s status.
• At 9pm pt gcs further deteriorated had rapid shallow breathing .shifted to hdu.o2 attached ,boluses given.ng
passed .abgs sent which showed metabolic acidosis.
• Xray abd and usg were planned but pt wasnot stable to get it done.at9:30 pt became bpless pulseless,cpr
started acc to protcol n continued for 30 mins .pt didn’t revive ,ecg done ,showed staright line .death declared
• Body handed over to policemen.
PATIENT #5

• Name :maryam bibi

• Age :48/fe
• Marital status:married
• Resident of narowal
• Doa:24-4-19
• Dod:30-4-19
• Duration of stay:7 days
• nondibetic hypertensive pt presented in s2 ‘er with c/o urinary retention +constipation +abd
distension for 7 days.
• Pt was fuco ileostomy reversal +mesh hernioplasty -2 years back and hystrectomy +ileostomy
3 years back.
• o/e :abd distended ,tender ,bs negative ..with midline palpable abd mass.she was vitally stable.
• She was started to be managed on line of subactue intestinal obstruction.
• Call to urology and nephrology was attended d/t b/l hydronephrosis and deranged creat
respectively.
• Pt started passing flatus on 2nd day and loose stoo in small amount on 4th doa.
• Ct abd pelvis was done ,PCN nd dialysis was planned on 29th.
• When pt was sent for pcn they said its not needed at moment and anaesthesia dept took 5
hours to pass cvp so slot for dialysis was missed.
date hb tlc plt urea creat alt inr Na/k
23-4-19 7.8 15.4 398 56 4.1 26 1.1 129/4.6
24-4-19 5.7 13.2 336 69 4.8 26 1.3 130/3.6
25-4-19 5.2 13 319 102 6.6 25 1.2 131/3.4
26-4-19 5.1 12.8 305 99 7.3 21 1.1 132/3.4
28-4-19 9 10.8 461 136 9.2 25 1.1 132/3.5
29-4-19 8.9 12.1 429 138 10.2 22 1.1 133/3.6
• Pt was dyspnic and irritable most of tims during stay .spo2 started dropping on 30th 2am
high flow oxygen was givenbut was improving with oxygen and nebulization .3 am pulse
was 110/min bp 100/60 sp2 90% at high flow.no urine output in last 7_8 hours even after
lasix and dopa infusion.
• At 6 am.pulse 60/min bp 50/nil.
• Spo2 60%.meanwhile she became bp less pulseless ,cpr started acc to protocol.continued
for 30 mins.pt didn’t revive amd ecg showed staright line.pupils fixed dilated.death
declared at 6:45am.
PATIENT #6

• Pt name:Amir
• Age :23/m
• Marital status :married
• Resident of kasur
• Doa:28-3-19
• Dod:30th -4-19
• Duration of stay :33 days (pt was absent from ward for 12 days
• Non diabetif non hyoertensive pt presented in er with c/o dyspahgia (from solids to
liquids) for 5 months with h/o weight loss.No h/o trauma /corrosove intake .
• o/e vitally stable.think lean pt with unremarkable abd examination but coarse crepts on
right side.
• Investigations :barium (14-3-19) leakage of dye from esophagus into mediastinum also
dye reaching distal to esophagus.
• Usg abd: (1-4-19) .mild hepatomegaly with right sided pleural effusion )
• Ct scan abd+chest+pelvis: (26 -3-19) .esophagial growth in 2nd part with right lung
abscess .with few paraortic lymph nodes.
• Endoscopy: (2-4-19) :polypoidal growth at 30cm from incisor.
• Bronchoscopy:no tracheoesphageal fistulae.
• Biopsy showed :sqaumous cA
date hb tlc plt Na/k+ creat alt Aptt/inr
31-3-19 12.6 7.9 273 133/5.1 0.7 15 33/1.0
4-4-19 9 16.2 571 138/3.7 0.6 22 34/1.1
7-4-19 10.5 12.8 593 136/5.0 0.8 24 34/1.0
9-4-19 10.7 13.3 580 135/4.8 0.7 17 33/1.0
10-4-19 10.7 11 352 134/4.6 0.8 19 33/1.0
12-4-19 11.4 8.1 557 126/4.1 0.7 17 34/1.1
13-4-19 11 8.4 498 122/5.3 0.6 12 33/1.1
14-4-19 10 8 490 138/4.4 0.6 12 33/1.0
• Feeding jejunostomy was done on 11-4-19.
• Pt remained vitally stable in ward Nd left ward along with file on 14th -4-19.
• Came back along with file pn 26th.

• Pt had complain of pus coming from feeding jej site .and was fully emaciated.
• At 3am pt suddenly went into apnea and bradycardia with spo2 65% .on chest
examination there were b/l coarse crepts ,50 ml aspirate was drained by active
suctioning,pt went into arrest again .DNR was signed .pt did not revive .death declared
after confirmation at 3:30am.
PATIENT # 7
• Pt name :Masood ul hassan
• Age :71 y /m
• Marital status :married
• Resident of sadiqabad
• Doa:15-3-19
• Dod:29-4-19
• Duration of stay :45 days
• Non diabetic hypertensive male presented with c/o absolute constipation Nd multiple
episodes of vominting for 1 day.h/o open appendectomy in 1971..
• o/e :abd soft ,tender in epigastrium and bs +ve .
• Dre: collapsed rectum
• Pt was managed on line of subacute intestinal obstruction ,conservatively..
• Usg : mild to moderate dilated bowel loops with sluggish bowel movements.
• Ct abd :sigmoidal thickening with right colon mass
• Pt started passing stool /flatus after 2 days .
• but abd was distended and mildly tender.
• Colonoscopy was planned which was on 25th march.
• Exploratory laprotomy +right hemicolectomy +tumor debulking and covering ileostomy
was done on 26th.
• Iof:mass involving caecum and ascending colon of almost 10×15cm with tumor metastasis
to root of mesentry.multiple enlarged mesenteric and paraortic lymph nodes .tumor
seedling in peritoneum.multiple adhesions of omentum with mass.
• Pt remained vitally stable in post op period with stoma working ,orally free ,
• Usg abd on 7th pod showed mild abdominopelvic ascites wth exophytic mass at right
lower pole.
• Biopsy showed poorly differentiated adenocarcinoma
• Ct scan abd/pelvis iv oral contrast was planned.
• On 10th pod pt developed abd pain with spikes of fever.
• Pt was re-explored on 6th april,peritoneal lavage was done.
• IOF :200 ml serosanguinous fluid in rif with Interloop infected fluid drained.
• Pt remained vitally stable ,developed partially dehiscent wound after 4 days.developed
weakness of lower limbs after few days of reexploration.deveopled electrolytes
imbalance which was managed acc.
• Pt ‘s gcs started deteriorating ,fluctuated b/w 8-9 /15.
• Became irrtitable,tachypnic on 28th.
• 4am on 29th pt wasn’t maintaining spo2,went in apnea ,pulse 30/min ,dopa dobuta with
high flow oxygen started.
• 5am ,spo2 wasn’t improving on high flow and bp was on lower side ater supports and
adrenaline shots and boluses.attendents were counselled ,dnr was signed.
• Pt went Into cardiac arrest ,did not revive death declared after confirmation.