Mortality Report 2

Patients Particulars
Mrs. S,
78 years old, Malay lady
K/C/O: HPT, BA
( follow up at Hosp K.Kangsar)

Summary of History

Presented with:
- Epigastric pain, radiating to the back.
- SOB
- Lethargy x 2/52.
- Not ambulating due to weak x 1/52
- Fever , cough x 3/7
- LOA 1/52

Physical Examination
On Examination
Weak, dehydrated, mild tachypnoiec
BP: 124/80, PR:76, Temp: 36.3, SpO2: 100%
GCS 15/15, orientated to time/place/people
Per Abdomen:
soft, tender at epigastric,
Lungs: minimal crepts bibasal
CVS: DRNM

Investigations
Noted: Se amylase 632
Urine diastase 2834
Ca 3.43
RP: Urea 11.3; Na 129; K 2.1; Creat 141
LFT: AST 27; ALT 12; Alb 28; LDH 242;
se amylase 632, Ca 3.43
ABG: pH 7.47; pCO2 42; pO2 86;
sO2 97%; HCO2 30; BE 6




IMRIES SCORING:

Management

Treat as 1) Acute Pancreatitis
2) ARDS
3) ARF secondary to dehydration.
- K fast correction.
- IVD 8 pints NS/24H; Strict I/O charting
- Refer medical for AEBA 2 CAP, ARF
- Refer anest for ARDS and ICU care.
* Pt was transferred to ICU D2.
Progression In ICU
and ward

Day 1 (ICU)
Patients condition On HFMO2 10L/min
Not on inotropes
Examination GCS E2V4M5
BP 127/64; PR 77; CVP 9
SpO2 100%
Lungs: Bibasal crepts. A/E reduced B/L.
U/O: 300cc/H

Investigations K 2.0, Ca 3.24
Management KNBM
Cont IVD, keep CVP 8-10
Start IV Rocephine
For U/S HBS Urgent
U/S HBS Urgent (12.05.2012)
No sonographic evidence of cholelithiasis
Gallbladder is distended with regular outline.
There is sludge within the gall bladder.
Gallbladder wall not thickened.
Intrahepatic ducts, CBD and portal vein not dilated.
Pancreas not swollen.
Spleen normal.
Minimal ascites and right pleural effusion.
Imp: 1) No sonographic evidence of cholelithiasis
2) Fatty liver.
Day 2-10 (ICU)
Noted pt fitting, uprolling eyeballs,
hypersalivation and unresponsive to call; GCS
E1M4V1. Then was intubated and sedated.
Treat as pneumonia in septic shock
Was start inotropes and change to IV Cefepime 2g
BD.
Anest team request for CT Abdomen for
comfirmation of diagnosis; to look for pseudocyst
/ abscess / calcification of pancreas.
CECT Abdomen 18/5/2012
The pancreas not enlarged and homogenously
enhanced. No air pocket within to suggest
abscess collection. No calcification within and
the pancreatic duct is not dilated.
Minimal peropancreatic fluid collection and
streakiness noted at the body and tail of
pancreas.
Imp: 1) Features are of acute pancreatitis.
2) Fatty liver.

Day 11 Day 22 (ICU)
Tracheostomy done for prolonged ventilation, still
ventilated, not sedated, on inotropes.
Completed IV Cefepime 2g BD x 1/52.
Then has temp spike again, anest start back IV Unasyn 4.5g
QID.
Sputum C+S (21/5/12): Acinobacter species
Blood C+S: No Growth Obtain.
Urine C+S: No Growth Obtain.
Pt not responding to antibiotic (Given Unasyn for 9/7),
temp still spiking. Then anest change to IV Sulperazone.
Then was change to tachymask and transfer out to ward 17.
Day 23 (In Ward 17).
Sepsis controlled; BP 136/78, PR 97, T 37.
Tolerating RT feeding. Resolved pancreatitis.
On day 3 in ward 17; noted Pt tachypnoeic
and ill, reviewed by anest team, treat as
Ventilated Acquired Pneumonia.
Cont IV Sulperazone.
Blood C+S (in ward): So far no growth.
CXR: pneumonic changes, left pleural effusion.

Day 4 inn ward: patient collapse at 2.50am,
CPR commenced, adrenaline and atropine
given. CPR for 30 minutes, unable to revived
patient.
Asystole on cardiac monitor, B/L pupil fixed
and dilated. Peripheral and central pulse not
felt.
Pronounced death at 3.30am
Cause of death: Ventilated acquired
pneumonia.