KES IN PATIENT DEATH

(V2)
HOSPITAL : Hospital Pakar Sultanah Fatimah Muar
Name: SUBOH BIN SULAIMAN

IC :590227-05-5341
Telah diedarkan pada 28 November 2020
In Patient-Death
DEATH TYPE (DEATH DUE TO COVID/
WITH COVID):
PATIENT DETAIL
NAME SUBOH BIN SULAIMAN

AGE 63

IC/ PASSPORT 590227-05-5341

RACE MALAY

NATIONALITY MALAYSIAN

COMORBID DM, HPT, COPD, IHD

ADDRESS NO 90 JALAN KOTA 2 TAMAN MAHKOTA 84900 TANGKAK JOHOR

 DEATH SUMMARY
DATE ONSET OF ILLNESS 10/11/2022

DATE OF COVID-19 TEST DONE 16/11/2022

RESULT OF TEST (RTK-AG/ RT- POSITIVE

PCR)

CT VALUE (RT PCR) -

EPID LINK Nil

 DEATH SUMMARY
SUMMARY OF HISTORY
Date and Time of Admission: 16/11/22@ 11:40am

Diagnosis on Admission:
1. Life Threatening AECOAD secondary to Covid Pneumonia stage 5B

Max. Oxygen Requirement during Admission: Intubation

Date and Time of Death: 16/11/2022 @ 1712H

Cause of Death: Life Threatening AECOAD secondary to Covid Pneumonia stage 5B

 DEATH SUMMARY
Chronology of event, medication given, lab results, CXR:

16/11/22

63/M/M
UL DM, HPT,
COPD (h/o intubation in 2019)
IHD - stented in IJN in 2014 (2VD)
Secondary polycythemia JAK 2 negative

p/w:
SOB x1/52 – worsening in 2/7
Not improving despite getting neb

Upon arrival at ED, GCS full , tachypnoeic,

BP : 114/66
PR:101
SPO2: 93% under Neb
Lungs: reduced air entry with ronchi
 DEATH SUMMARY
Given IV Hydrocortisone 200mg stat
Neb Combivent x3
Subsequently put on BiPAP, SPO2 100%
Given IV Dexamethasone 8mg stat
s/c heparin 5000u stat
Subsequently wean down to VM60% (SPO2 96-97%)
Admitted to ward 11. Brought in wheelchair, GCS full

Blood Ix:
Hb 19.8/ TWC 23.52/PLT 250/ HCT 60.6/ ALC 1.01
Cr 247/Urea 20.3/ Na 131/ K4.2/ Cl 93/ EGFR 23
TP 72/Alb 34/ Glo 38/ AG 0.91/ Bil 24/ ALP 260/ ALT 53
Ca 2.21/ Cca 2.33/ Po4 1.7/ Mg 1.03
ABG
Under Neb: pH 7.23/ PCO2 59/ PO2 72/ HCO3 24.7/ BE -3.7/ SaO2 91
Under VM60: pH 7.23/ PCO2 52/ PO2 79/ HCO3 21.8/ BE -6.6/ SaO2 93
Under BiPAP: pH 7.21/ PCO2 66/ PO2 64/ HCO3 28.4/ BE -2.7/ SaO2 87
CXR: chronic lung disease changes
ECG: AF HR90
 DEATH SUMMARY
Upon arrival at ward, GCS full
Restless, tachypneic.
Lungs: tight air entry
1220H
Subsequently patient become unresponsive. GCS E1V1M1
BP: 87/11
PR: 150
SPO2:50% under VM60

CPR commenced as patient become pulseless,

CPR for 30mins,
Given:
IV MgSO4 1 ampoule in 20ccNS/20mins
IV adrenaline given x7
Proceeded with intubation
ROSC after 30mins
ABG under bagging: pH 7.23/ PCO2 59/ PO2 72/ HCO3 24.7/ BE -3.7/ SaO2 91
Given IV Sodium bicarbonate 100cc
IVI noradrenaline 8mg in 50cc NS -1mcg/kg/min(run 33.8cc/hr)
IVI Dobutamine 500mg in 50ccNS – 6cg/kg/min (run 3.2cc/hr)
 DEATH SUMMARY
BP 102/68
PR:86
SPO2: 98% under bagging

Patient suddenly become asystole x2, SPO2 unrecordable

CPR commenced for 2 mins each –ROSC
Noted at cardiac monitor Fast AF (HR 176-190)
Synchronised cardiovert 150J given
Post cardiovert: AF rate controlled HR 110
ABG:pH 7.23/ PCO2 59/ PO2 72/ HCO3 24.7/ BE -3.7/ SaO2 91

Post cardiovert
BP: 108/64
PR: 101
SPO2: 98% under ventilator

Started IVI midafentanyl 3cc/hr

DIL to family member
 DEATH SUMMARY
At 1640 noted by staff nurse patient asystole, vital signs unrecordable
Attended stat
CPR commenced for 30mins
Given 1V adrenaline x3
No ROSC

E1V1M1, Pupils 4/4 fixed.

No spontaneous breathing, no pulse palpable
BP, PR, Spo2 unrecordable
Cardiac monitor: asystole

Time of death: 1712H

Cause of death: Life threatening AECOAD secondary to covid 19 pneumonia stage 5B
 DEATH SUMMARY
DATE OF HOSPITAL ADMISSION 16/11/2022

STAGING OF COVID-19 ON ARRIVAL Stage 5B

DIAGNOSIS UPON ADMISSION 1. Life threatening AECOAD secondary to covid 19 pneumonia stage 5B

STATUS (INTUBATED/ OXYGEN REQUIREMENT) intubation

DATE INTUBATED 16/11/2022

DATE OF ICU ADMISSION -

DATE EXTUBATED

TREATMENT IV MgSo4 1 ampoule in 20cc NS/20mins

IV sodium bicarbonate 100cc
IVI noradrenaline 8mg in 50cc NS -1mcg/kg/min(run 33.8cc/hr)
IVI Dobutamine 500mg in 50ccNS – 6cg/kg/min (run 3.2cc/hr)
IVI midafentanyl 3cc/hr

INOTROPES (YES/ NO) YES

DIALYSIS (YES/ NO) MENTION TYPE NO

 DEATH SUMMARY
IMAGING FINDING CHRONIC LUNG DISEASE CHANGES

PM FINDING (IF DONE)

VACCINATION STATUS VACCINATED X3

DATE AND TIME OF DEATH 16/11/2022 @ 1712H

/CAUSE OF DEATH / Direct cause of death: Life threatening AECOAD secondary to covid 19
pneumonia stage 5B
Contributing factor: COAD, IHD, HPT
NAME OF SPECIALIST IN CHARGE DR HOH
RADIOLOGICAL IMAGE AND REPORT
(ATTACH CXR/ CT IMAGE AND
REPORT)

16/11/22