202311494

 

 

Case History and Clinical Findings

DEATH SUMMARY

50 YEAR OLD MALE CAME WITH CHIEF COMPLAINTS OF SOB SINCE 10 DAYS AND EDEMA OF UPPER LIMB AND LOWER LIMB SINCE 6 DAYS. HE WAS MANAGED BY GIVING INJ LASIX 40 MG AND RATE CONTROLLING T. MET XL 25 MG GIVEN. HE WAS SHIFTED TO AMC. IN VIEW OF GLOBAL HYPOKINESIA HE WAS STARTED ON ANTI PLATELET.

IN VIEW OF HIGH CREATININE LEVELS NEPHRO OPINION WAS TAKEN AND THEY SUGGESTED CONSERVATIVE MANAGEMENT

 

ON 16/03/2023 PATIENT SUDDENLY DEVELOPED SINUS TACHYCARDIA AND SHIFTED TO ICU AND GIVEN RATE CONTROLLING AGENTS WERE GIVEN.

SINCE YESTERDAY MORNING HE IS COMPLAINING OF GIDDINESS AND CEREBELLAR SIGNS WERE NEGATIVE AND RULED OUT CENTRAL CAUSE.

IN VIEW OF INCREASED CREATININE PATIENT IS ADVISED FOR DIALYSIS BUT PATIENT ATTENDERS WERE NOT WILLING FOR DIALYSIS.

YESTERDAY NIGHT [18/03/2023] PATIENT WAS DROWSY BUT AROUSABLE. TO RULE OUT ANY INFARCT MRI WAS SUGGESTED BUT PATIENT WAS NOT COOPERATIVE FOR MRI AT NIGHT PATIENT WAS DROWSY AND SUGGESTED DIALYSIS IN VIEW OF ? UREMIC

ENCEPHALOPATHY. BUT PATIENT ATTENDERS WERE NOT WILLING FOR DIALYSIS

ON 19/03/2023 MORNING PATIENT WAS DROWSY AND ACCEPTED FOR DIALYSIS. AT 9AM PATIENT WAS DROWSY AND AROUSABLE TO DEEP PAIN AND WAS BRADYCARDIAC.

AT 10 AM CENTRAL AND PERIPHERAL PULSES WERE NOT FELT AND EMERGENCY CPR WAS DONE AND EMERGENCY INTUBATION WAS DONE. 4 CYCLES OF CPR WAS DONE AND ROSC OBTAINED.

BP WAS NOT RECORDABLE AND IONOTROPE [NORADRENALINE] WAS STARTED

AT 11:15 CENTRAL AND PERIPHERAL PULSES WERE NOT RECORDABLE AND CPR WAS DONE. 2 CYCLES OF CPR WAS DONE AND ROSC ACHIEVED

BP WAS NOT RECORDABLE AND STARTED ON TRIPLE IONOTROPES [NORADRENALINE, VASOPRESSIN, DOBUTAMINE]

AT 01.15 AGAIN CENTRAL PULSES WERE NOT RECORDABLE AND 30 MINS OF CPR WAS DONE AND INSPITE OF THIS PATIENT WAS NOT REVIVED AND DECLARED DEATH AT 1.48PM

 

IMMEDIATE CAUSE- METABOLIC ACIDOSIS, CARDIOGENIC SHOCK

ANTECEDENT CAUSE- CARDIOGENIC SHOCK SECONDARY TO HEART FAILURE WITH MID RANGE EJECTION FRACTION SECONDARY TO CAD

METABOLIC ACIDOSIS SECONDARY TO CKD ACUTE KIDNEY INJURY ON CKD

B/L PLEURAL EFFUSION ? TRANSUDATIVE [R>L] MODERATE ASCITIS

K/C/O PULMONARY TB K/C/O DM II

COPD

UREMIC ENCEPHALOPATHY

 

Treatment Given(Enter only Generic Name)

FLUID RESTRICTION <1.5L / DAY SALT RESTRICTION <12GM/DAY T.MET XL 25 MG PO/BD

INJ PAN 40 MG IV/OD INJ ZOFER 4 MG / IV/ BD INJ HAI/ SC/TID

T. ECOSPRIN 75/10 MG/PO/HS

T. VERTIN 8MG/ PO/ BD

T. LASIX 20 MG/PO/OD

T. ALDACTONE 50 MG /PO/OD

T. LUBONFORTE/PO/BD

T. FIDOTOX 1 GM POWDER WITH 1 GLASS OF WATER/PO/OD

T. NEPHROADD/PO/OD

INJ ERYTHROPOIETIN 4000 IU/SC/ ONCE WEEKLY OXYGEN INHALATION TO MAINTAIN SPO2 >94% SYP. CREAMFFIN 5ML/PO/HS