WELCOME

to
Monthly Mortality Meeting
(August-2023)
Presented by:
Dr. Monirul Islam Shohan
MS phase-A resident (Otolaryngology-Head neck surgery)
Currently working : Surgery Unit- 5
Dhaka Medical College and Hospital
Total number of admitted patients in August
158 2023
180
160
140
120
100 97
80
60
40
20
0
255
Male Female
Total number of deaths in August 2023
Total: 07

Male; 3
Female; 4
Particulars Date and Date and Diagnosis Operation Cause of death
of the time of time of with ICD status
patient admission death code

Jibon Nahar 26.07.2023 05.08.2023 acute Not Done Immediate Cause Multiple organ
65years at at Intestinal dysfunction
Female 8.00 am 03.10 am Obstruction Syndrome
with AKI on
CKD with
Cauda equina
syndrome
Intermediate Cause Sepsis
ICD- K76.60,
G83.4, N18
Underlying Cause Acute intestinal
obstruction

Co-morbidities CKD
Particulars Date and Date and Diagnosis Operation Cause of death
of the time of time of with ICD code status
patient admission death
Nasima, 02.08.2023 06.08.2023 Acute Not done Immediate Cause Multi organ failure
50years, at at Pancreatitis
Female 11.10 pm 9.41 am
Intermediate Cause Septic shock
ICD K85.0

Underlying Cause Acute necrotizing

pancreatitis

Co-morbidities
Particulars Date and Date and Diagnosis with Operation Cause of death
of the time of time of ICD code status
patient admission death

Fatima, 09.08.2023 11.08.2023 Cellulitis of left Debridement Immediate Cause Multiorgan failure
45years, at at lower limb with under SAB
Female 11.00 pm 03.03 am uncontrolled
Diabetes
Mellitus
Intermediate DIC
Cause
ICD- L03.90, E11
Underlying Cause Septic Shock

Co-morbidities DM
Particulars Date and Date and Diagnosis with Operation Cause of death
of the time of time of ICD code status
patient admission death

Karthik Das, 10.08.2023 11.08.2023 Perforation of Gas Primary Immediate Cause Multiorgan failure
50years, at at Containing Hollow repair of
male 1.30 pm 04.45 am Viscous with shock duodenal
perforation
with Intermediate Cause Septic shock
omental
ICD- K 26.2 patch &
thorough Underlying Cause Duodenal
peritoneal perforation
toileting
Co-morbidities None
Particulars Date and Date and Diagnosis with Operation Cause of death
of the time of time of ICD code status
patient admission death

09.08.2023 17.08.2023 at SOL in left lobe of Not Done Immediate Cause Hepatic
Md Akkaj at 1.15pm 11.05 am liver encephalopathy
Ali,75 years,
Male
ICD-K76.82 Intermediate Cause

Underlying Cause SOL in left lobe of

liver

Co-morbidities
Particulars Date and Date and Diagnosis with Operation Cause of death
of the time of time of ICD code status
patient admission death

Sunit Saha, 09.08.2023 19.08.2023 at Carcinoma of Right Immediate Cause Acute Myocardial
60years, at 3.10pm 6.40pm ascending colon hemicolect Infarction
Male omy under
G/A
ICD-C70A.022 Intermediate Cause

Underlying Cause Carcinoma of

ascending colon

Co-morbidities IHD
Particulars Date and Date and Diagnosis with Operation Cause of death
of the time of time of ICD code status
patient admission death

Rahima, 09.08.2023 25.08.2023 Cellulitis of Right Debrideme Immediate Cause Multi organ
60years, At 6.20pm At 12.30am lower limb with nt under failure
female uncontrolled DM SAB

Intermediate Cause sepsis

ICD- L03.90, E11

Underlying Cause Cellulitis of right

foot

Co-morbidities DM
 A
Death
Review
Salient Features
Mrs jibon nahar, 65-years-old, non diabetic, Muslim female hailing from
Bera, Pabna got admitted at DMCH under SU-5 on 26.07.2023 with the
complaints of absolute constipation for 16 days, diffuse abdominal pain and
distension for 12 days. Pain was continuous & dull in nature. It was non
radiating, no aggravating factor and did not relieve on taking medications.
She also complained of nausea and vomiting for the last 4 days. Vomiting
was non-projectile, foul smelling, bilious, containing partially digested food
particles.
Salient Feature cont…
She underwent fixation and stabilization of Spine for PLID on
10.07.2023. Her bowel did not move since then.

On general examination, the patient was, disoriented, ill looking,

anaemic & moderately dehydrated. She had bilateral pitting pedal
oedema. HR was 86b/min, BP- 130/80mm of Hg, temp- 99°F, SPO2-97%
in room air, respiratory rate- 24b/min. Her GCS was 9/15

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Abdominal Examination:
Inspection- Distended, flank was full, umbilicus was centrally placed and inverted,
there was no visible scar mark present
palpation- Tender and distended, muscle guarding was present
auscultation- Bowel sound absent
percussion- Tympanic on percussion
DRE- Anal tone was reduced
- Rectum was empty
-Finger was not stained with any blood or stool
there was a linear scar mark of about 4cm on the back, in the lumbar region and
the wound was healthy
Our provisional diagnosis: Acute intestinal obstruction

Treatment given on admission:

•NPO TFO
•Continuous NG drainage
•IV fluid
•Injectable antibiotics
•Anti-ulcerant
•Antiemetic
•Analgesic
•Catheterization
Investigations on 27/07/2023
Name of investigation Value

CBC Hb% :9.2 gm/dL,

TC :21.17x103 /cmm,
N : 86%,
HCT : 37%
Platelet : 225x103 /cmm

Plain X-ray abdomen in E/P distended large bowel loops

Electrolyte Na- 122mmol/L, K-4.6mmol/l, Cl-110

mmol/L

S. Creatinine 4.15 mg/dL

RBS 4.8 mmol/L

 Investigation cont.
Name of investigation Value

Echocardiography Normal

HBsAg Negative
Anti-HCV

Blood grouping & Rh Typing O+ve

17
 Investigations on 30/07/2023

Name of the investigation Result

CBC Hb% - 9.0gm/dl

TC- 26 .34 x 103 /cmm
N: 83%
HCT- 27%
Platelet- 344 x 103/cmm
Serum Creatinine 5.3gm/dl

Serum Electrolyte Na+ - 117 mmol/l,K+- 5.1mmol/l,Cl—115mmol/l

Serum albumin 2.01gm/dl

18
 Investigations on 02/08/2023
Name of the investigation Results

CBC Hb%-8.3gm/dl
TC:31.17x103 /cmm
N: 88%,
HCT : 23%
Platelet: 425x103 /cmm

Serum creatinine 6.7mg/dl

Serum electrolyte Na-115mmol/l, K+ 5.6 mmol/L,Cl 113mmol/L

Serum albumin 1.45gm/dl

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KEY EVENTS:
on 27/07/2023, A referral call was made to Dept. of Neurosurgery regarding
her Previous PLID operation
Comments: Post operative cauda equina syndrome with toxic
encephalopathy
they suggested to continue the treatments for intestinal obstruction and to
send the patient after relief of obstruction.
KEY EVENTS CONT…

a referral was made to the dept. of nephrology

comments: AKI on CKD

fluid restriction
Daily monitoring of Serum creatinine & electrolyte

21
KEY EVENTS CONT…

The patient developed respiratory distress, hypotension and fever from

30/07/2023.

A referral was made to dept. of intensive care for further management

Her GCS was then 7/15

22
KEY EVENTS CONT….

Since the serum creatinine was 6.7mg/dl & urine output was <100ml in 24 hours,
another referral to dept of nephrology was made and they suggested for
hemodialysis on 04/08/2023.

The patients condition further deteriorated.

Her GCS was then 4/15

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Follow up on 05.08.2023
Time 2.00am 2.15am 2.35am 2.50am 3.00am
traits
complaints Respiratory Respiratory ---- ---- ----
distress distress

Pulse Feeble Feeble Not palpable Not palpable Not palpable

BP 80/50mmhg 70/30mmhg Not recordable Not recordable Not recordable

Pupil B/L dilated, B/L Dilated , non B/L Dilated ,fixed, B/L Dilated, fixed, B/L Dilated, fixed,
reacting to light reacting to light non reacting to non reacting to non reacting to
light light light

Heart sound Not audible Not audible Not audible Not audible Not audible

Respiraion Laboured Gasping Ceased Ceased Ceased

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 Declaration

After three successive follow up she was declared

dead on 05.08.2023 at 03.10 am.

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Analysis of the cause of death

Patient factor

System factor

Human factor

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THANK YOU

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