MORTALITY

REPORT- MAY, 2022

INTERNAL MEDICINE
DR. F.O.N. ARTHUR
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SUMMARY OF OPD ATTENDANCE
C. ROOMS INSURED NON-INSURED TOTAL

MALE FEMALE S.TOTAL MALE FEMALE S.TOTAL G.TOTAL

CR1 509 1621 2,103 209 201 410 2513

CR2 422 1438 1860 137 165 302 2162

CR3 210 780 990 66 72 138 1128

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OPD ATTENDANCE
MONTHS NO. OF ATTENDANCE
JANUARY 5028
FEBRUARY 4721
MARCH 5646
APRIL 4774
MAY 5803

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 SUMMARY OF WARD ADMISSIONS
WARDS MALES FEMALES TOTAL
ADMSSIONS MMW 0 51
62+51+36=
FMW 0 62
146
ANNEX 36 BOTH F&M 0
ICU/PR 0 2
NO. OF DEATHS MMW 3 0
FMW 0 2
ANNEX 0 2 7
ICU/PR 0

NO. OF 48 51 +29 86
DISCHARGES (ANNEX)

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 TABULAR REPRESENTATION
MONTH NO. OF ADMISSIONS NO. OF DEATHS MORTALITY RATE

JANUARY 72 11 15.3%
FEBRUARY 66 8 12.1%
MARCH 115 7 6.1%
APRIL 116 8 6.9%
MAY 149 7 4.6%

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GRAPHICAL PRESENTATION
MORTALITY RATE

MAY
10%

APRIL JANUARY
15% 34%

MARCH
14%

FEBRUARY
27%

JANUARY FEBRUARY MARCH APRIL MAY

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SUMMARY OF MORTALITIES IN MAY

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 MORTALITY RATE

16

14

12

10

0
Jan feb mar apr may

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NO INITIALS AGE SEX WARD DOA DOD DIAGNOSIS CAUSE OF DEATH
1 J.K 53YS F ANNEX 1/05/22 09/05/22 KNOWN RVI 1.SEPTIC SHOCK
COMPLICATED BY
1.HYPOVOLEMIC SHOCK
SEC INFECTIVE DIARRHEA
WITH SOME
DEHYDRATION AND
ELECTROLYTE IMBALANCE

2.SEIZURE ?CAUSE
CNS TOXOPLASMOSIS

2 KOFI M. 43YRS M MMW 04/05/22 11/05/22 1.DECOMPENSATED MULTIPLE ORGAN

TWUMASI CHRONIC LIVER DISEASE DYSFUNCTION
SEC TO CHRONIC HEP B
INFECTION COMPLICATED
BY
ESOPHAGEAL VARICES SEC
PORTAL HYPERTENSION
-MASSIVE ASCITES
-HEPATORENAL
SYNDROME
-HEPATIC
ENCEPHALOPATHY STAGE
2

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NO INITIALS AGE SEX WARD DOA DOD DIAGNOSIS CAUSE OF
DEATH

3 E.D 60YRS F FMW 13/05/22 15/05/22 1.SEPTIC SHOCK SEC TO RESPIRATORY

INFECTED LEG ULCER FAILURE
SURGICAL
2.OLD STROKE WITH
EXPRESIVE APHASIA AND
TETRAPARESIS
3.PNEUMONIA
4?LEFT LEG DVT
5.UPPER AND LOWER LIMB
CONTRACTURES

4 A.B 63YRS F FMW 13/05/22 17/05/22 ACUTE UNTYPED STROKE SEPSIC SHOCK
WITH EXPRESSIVE APHASIA
AND RIGHT HEMIPARESIS
WITH RISK FACTORS
HPT/DM .
SEPTIC SHOCK SEC
UROSEPSIS AND
BIVENTRICULAR FAILURE
PRECIPITATED BY
PNEUMONIA

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NO INITIALS AGE SEX WARD DOA DOD DIAGNOSIS CAUSE OF DEATH

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SUMMARY OF MORTALITIES
C.T 41YRS F ANNEX 16/05/22 18/05/22 SEPTIC SHOCK IN NEWLY SEPTIC SHOCK
DIAGNOSED RVI WITH
SEVERE ANAEMIA
PNEUMONIA R/O PTB
ACUTE GASTROENTERITIS
ACUTE SUPURATIVE
OTITIS MEDIA

6 A.K 80YRS M MALE 09/05/22 18/05/22 SEVERE ANEMIA SEC MESTASTIC

MEDIC PROSTATE CA PROSTATE CA
AL
WARD BILATERAL PNEUMONIA
R/O PTB
PARAPARESIS SEC TO RTA
THE (SPINAL INJURY )
HPT
CLD

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 SUMMARY OF MORTALITIES
NO INITIALS AGE SEX WARD DOA DOD DX CAUSE OF DEATH

7 J.A 63YRS M MMW 24/05/22 27/05/22 1. RECURRENT CVA SEPTIC SHOCK

WITH DEFICIT OF
RIGHTHEMIPLEGI
A WITH RISK
FACTORS OF OLD
AGE, ATRIAL
FIBRILLATION

2. 2. MALARIA WITH
MODERATE
ANAEMIA
3. 3. SEPSIS(WBC
21.88)

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INDEX CASES
VITALS ON ARRIVAL @2:36 PM DOA-1

T-35.8

BP-113/98 MMHG

PR-106BPM

RR-20CPM

RBS-9.4MMOL/L

SP02-98% ORA

PC: ABDOMINAL PAIN AND ABDOMINAL SWELLING 2/7

HPC:CLIENT IS KNOWN TO ABUSE ALCOHOL,HE WAS IN THIS STATE OF HEALTH UNTIL A 2 MONTHS PRIOR TO PRESENTATION WHEN HE STARTED HAVING THE SUDDEN
ONSET,EPIGASTRIC PAIN,STABBING CHARACTER,NON RADIATING,EXACERBATED BY FOOD INTAKE,ASSOCIATED WITH VOMITING(YESTERDAY,2 EPISODES,DARK),EARLY
SATIETY AND PROGESSIVELY INCREASING IN ABDOMINAL SWELLING.HE RATED THE OAIN 5/10,REPORTED TO THE OPD A WEEK AGO WITH THE ABOVE COMPLIANS
DIAGNOSIS OF CLD SEC HEP B INFECTION WAS MADE AND DISCHARGE HOME TAB CIPROFLOXACIN,METRONIDAZOLE,LASIX,SPIROLACTONE.SYMPTOMS STILL PERSISTED
SO REPORTED HERE FOR FURTHER MANAGEMENT

ODQ:JAUNDICE+,FEVER+,CHILL-,PROFUSE SWEATING+,HEADACHE-,DIZZINESS-,GBW+,PALPITATION-,SLEEP
DISTURBANCE+,CONFUSION-,HEMATEMESIS+,MELENA+,DYSURIA+,FREQUENCY-,URGENCY-

PMHX: ADMITTED ON ACCOUNT OF AN RTA, SURGERIES-, HEMOTRANSFUSION-

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DHX:TAB CIPROFLOXACIN,METRONIDAZOLE,LASIX,SPIROLACTONE,
HX OF HERBAL PREPARATION INTAKE .

FHX:NIL

SHX:HE IS A FARMER,LIVES IN AGOGO,HAS A WIFE AND 5 CHILDREN,

HX OF ALCOHOL INTAKE(2 TOT A DAY ) BUT ACCORDING TO HIME HE STOPPED
4 MONTHS AGO,HAS NO SMOKINING HISTORY.

O/E:A MIDDLE-AGED MAN,LOOKS CHRONICALLY ILL,CACHECTIC, NOT PALE,SEVERELY JAUNDICED,WARM TO TOUCH(6.3),NOT

IN OBVIOUS RESPIRATORY DISTRESS,HS IS FAIR.

CHEST-RR-22CPM
SP02 97%ORA
AIR ENTRY IS REDUCED BILATERALLY,BRONCHIAL BREATH SOUNDS

CVS-S1+S2+M0 P-96 BPM RGV

BP-127/103 CRT <3 SEC BILATERAL BIPEDAL EDEMA UP TO THE KNEE

ABDOMEN- DISTENDED,NON TENDER,FLIUD THRILL+,LIVER,SPLEEN,2K COULDNT BE ASSESSED BECAUSE OF THE MASSIVE

ASCITES,LIVER BOWEL SOUND PRESENT AND NORMAL

CNS- CONSCIOUS AND ALERT, GCS- 15/15.NO PEDAL SWELLING,FLAPPING TREMORS+

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HEP B-REACTIVE
HEP C-NON-REACTIVE
LFT:GLOBULINS- 42.5
TOTAL PROTEINS-87.1
AST-261
ALT-149
ALP-715
DIRECT BIL- 80.8
TOTAL BIL-88.1
GGT-1397.7
RFT:CREATININE -175.5
UREA-16.4
ABDOMINAL ULTRASOUND-THE LIVER IS INCREASED IN ECHOGENICITY WITH A COARSE ECHOTEXTURE AND AN IRREGULAR LIVER CONTOUR
NOTED. THE PORTAL VEINS ARE DECREASED IN ECHOGENICITY. NO INTRAHEPATIC MASS SEEN. MASSIVE FLUID AROUND THE LIVER.
GALLBLADDER- DISTENDED WITH AN ECHOGENIC COLLECTION ( SLUDGE) NOTED WITHIN IT. NORMAL WALL SEEN
IMP:1.DECOMPENSATED CHRONIC LIVER DISEASE SEC TO CHRONIC HEP B INFECTION COMPLICATED BY UPPER G.I BLEEDING
1. -MASSIVE ASCITES
2. -HEPATORENAL SYNDROME
3. -HEPATIC ENCEPHALOPATHY STAGE 2
DDX:ALCOHOLIC LIVER DISEASE 15
PLAN@ 2:45 PM 4/05/22

ADMIT TO THE CD
TO DO FBC,BF FOR MPS,HEP B PROFILE, VIRAL LOAD,RETRO,URINE DIPSTICK,CHEST XRAY
IV CEFTRIAXONE 2G DLY X 48HRS
ORAL METRONIDAZOLE 400MG TDS X 48HRS
TAB LIVOMYN 1 TAB DAILY X 30
IV LASIX 40MG BD X 48HRS
TAB SPIRONOLACTONE 25MG DAILY X 30
SYRUP LACTULOSE 15MLS TDS X 14/7
SYRUP AMINOPEP 15MLS TDS X 14/7
TAB PROPRANOLOL 40MG BD X 7/7
TAB TRANEXAMIC ACID 500MG TDS X 24/7
TAB OMEPRAZOLE 20MG DLY X 14/7
SYRUP NUGEL 15MLS TDS X 14/7
IV PABRINEX 1&2 IN 500MLS DNS
TAB THIAMINE 100MG DLY X 30/7
ORAL GLUCOSE 50G TDS X 30/7

ADDENDUM + DR REXFORD@8;45 PM
TO DO ABDOMINAL PARACENTESIS

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5/05/22 @1:02 AM
PROCEDURE :ABDOMINAL PARACENTESIS

PATIENT WAS PLACE IN A SUPINE POSTION ,UNDER ASEPTIC CONDITIONS ABDOMEN WAS CLEANED WITH SPIRIT AND THEN
SALVON A 16G CANNULA WAS INSERTED WAS INSERTED @THE Mc BURNEYS POINT CONNETED TO A GIVEN SET AND URINE
BAG CONNECTED TO A GIVEN SET AND URINE BAG AND 3L OF SEROUS FLUID DRAINED

VITALS
BP:129/87
PR:66bpm
RR: 20cpm
SpO2:100% ORA

TOTAL AMOUNT DRAINED-: 3L

POST PROCEDURE CONDITION-SATISFACTORY

FULL BLOOD COUNT

HB-14.2
WBC-10.79
PLT-432

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DOA-2

REVIEW@MWR

VITALS
BP-95/70
P-53
T- 36.3
FBS: 5.3MMOL/L
BODY WEIGHT- 60KG
ABD CIRCUM- 92CM

PLAN:
1.MODIFY ORAL GLUCOSE TO 100MG QID
2.ABDOMINAL TAP AND DRIAN 2L DLY
3.EGG THERAPY
4CONT OTHER TREATMENT

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REVIEW @ MWR
DOA:3
C/O- INABILITY TO SLEEP AND DIARHOEA(HAS PASSED STOOLS ABOUT 6TIMES)
ODQ: ABDOMINAL PAIN+, ABDOMINAL DISTENSION+, ASCITIC DRAIN REMOVED SPONTANEOUSLY, FEVER-
O/E:LOOKS CHRONICALLY ILL BUT BETTER THAN PREVIOUS DAY,NOT PALE,SEVERELY JAUNDICED,

VITALS:
BP-96/69
P-54
T- 36.4
SPO2-96?% ON RA
FBS: 6.1MMOL/L

CHEST-AIR ENTRY IS REDUCED BILATERALLY,

VESICULAR BREATH SOUNDS WITH NO ADDED SOUNDS

CVS-S1+S2+M0
ABDOMEN- DISTENDED,NON TENDER,LIVER, SPLEEN AND KIDNEYS NOT BALLOTABLE, BS PRESENT AND NORMAL
ASCITIC DRAINED ABOUT 2000MMLS OF ASCITIC FLUID
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HEPATITIS B PROFILE SHOWS:
HBsAG- POSITIVE
HBsAB- NEGATIVE
HBeAG- NEGATIVE
HBeAB- NEGATIVE
HBcAB- POSITIVE
IMP: CHRONIC INACTIVE HEPATITIS B INFECTION
ABD USG FINDINGS-LIVER IS INCREASE IN ECHOGENCITY WITH A COARSE ECHOTEXTURE AND AN IRREGULAR LIVER CONTOUR NOTED .THE PORTAL
VEINS ARE DECREASE IN ECHOGENECITY NO INTRAHEPATIC MASS SEEN .MASSIVE FLUILD NOTED AROUNG THE LIVER .
KIDNEY-NORMAL
ABDOMINAL CAVITY –THE LOOPS APPEAR NORMAL WITH NORMAL PERISTALSIS ,APPENDIX WAS NOT PROPERLY VISUALISED .MASSIVE FLUID
COLLECTION NOTED IN THE PERITONEUM .
DOA-4
-TB AMYTRYPTYLLINE 25MG NOCTE X 5/7
HOLD ON SYRUP LACTULOSE FOR TODAY
-TO DO FBC, AFP,
-TO TRANSFUSE WITH FFP
-TO TAKE 2EGGS BD
-TO CT ORAL GLUCOSE
-MONITOR RBS 20
DOA:4
VITALS:
BP-95/70
P-53
T- 36.3
FBS: 5.3MMOL/L
BODY WEIGHT- 60KG
ABD CIRCUM- 92CM
PLAN
CT MANAGEMENT

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 DOA-5

C/O- NIL

VITALS:
BP-95/53
P-54
T- 36.4
FBS: 6.3MMOL/L
BODY WEIGHT- 60KG

PLAN
-CT MEDICATIONS
-EXTEND IV CEFTRIAZONE AND IV METRONIDAZOLE FOR 48HRS
-TB TRAMDOL 50MG TDS X 7/7
-SYRUP LACTULOSDE 10MLS TDS X7/7
-MONITOR RBS
-TB AMYTRYPTYLLINE 25MG NOCTE X 5/7
-MONITOR VITALS

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DOA-6

ADDENDUM
-COUNSEL WIFE ON PROGNOSIS
-TO DO AN ASCITIC TAP
-CT MANAGEMENT
-TB METRONIDAZO;E 400MG TDS X 7/7
-ORAL GLUCOSE 100MG TDS

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DOA-7
VITALS
TEMP-BP-79/58
P-46
T- 36.5
RBS: 6.4MMOL/L

PLAN + SNR COLLEGUE

-MONITOR RBS
-CT MEDICATIONS
-MONITOR VITALS
-TB METRONIDAZOLE 400MG TDS X 7/7
-ORAL GLUCOSE 100MG TDS

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TIME: 11-MAY-2022 @12:36 PM
ADDENDUM
CALLED TO SEE PATIENT WHO WAS UNRESPONSIVE AND WITH NO CARDIPULMONARY ACTIVITY CPR WAS
DONE FOR ABOUT 10MINUTES. PUPILS WERE FIXED AND DILATED, NO CARDIOPULMOARY ACTIVITY.PATIENT
DECALRED CLINICALLY DEAD AT 11: 42AM
PLAN
INFORM RELATIVES
INFORM MORGUE
PERFORM LAST OFFICES

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CHALLENGES
1. -POOR AWARENESS ON HEPATITIS B AND C PREVENTION,TREATMENT ,MODE TRANSMISSION
IN THE GENERAL PUBLIC AND THE RURAL AREA .

2. FINANCIAL DIFFICULTIES IN OBTAINING ALL 3 DOSE OF VACCINATION

3. MISSING THE TIMING OF THE DOSES OF VACCINATION
4. LATE REPORTING OF HEPATASIS B INFECTED PATIENTS (MAY HAVE DEVELOPED
COMPLICATIONS)

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RECOMMEDATION
1. POOR PUBLIC AWARENESS ON MEDIA PLATFORMS ESPECIALLY RADIO STATIONS

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THANK YOU FOR YOUR
ATTENSION
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