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
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