case 11 .50 M with sob and fever since 5-7 days

Date of admission 3/5/24

Expired on 5/5/24

Diagnosis

TYPE 1 RESPIRATORY FAILURE WITH RIGHT MIDDLE AND LOWER ZONE CONSOLIDATION ?

CAP K/C/O CAD , K/C/O CKD ON MHD ,K/C/O DM TYPE 2 AND HTN

Case History and Clinical Findings

CHIEF COMPLAINTS

C/O BREATHLESSNESS AND CHEST PAIN SINCE 1 WEEK

HOPI

PATIENT WAS APPARENTLY ASYMPTOMATIC 1 WEEK BACK,AFTER WHICH SHE DEVELOPED

BREATHLESSNESS ALONG WITH RIGHT SIDED CHEST PAIN ,SHARP,PRICKING TYPE NOT

RELIEVED ON MEDICATION

C/O BREATHLESSNESS PROGRESSED TO GRADE 4(AT REST)

NO H/O COUGH

H/O FEVER,LOW GRADE ,NOT CONTINUOUS RELIEVED ON MEDICATION.

H/O PEDAL EDEMA ON &OFF TILL KNEES,PITTING TYPE ASSOCIATED WITH DECREASED

URINE OUTPUT

PT IS K/C/O CKD ON MHD SINCE 2 YEARS

K/C/O DM2 SINCE 15 YEARS AND HTN SINCE 6 YEARS

Investigation

Name ValueAnti HCV Antibodies - RAPID 03-05-2024 03:09:PM Non Reactive

HEMOGRAM

HB 9.4 MG/DL

TLC 32000 CELLS/CUMM

HBsAg-RAPID 03-05-2024 03:09:PM Negative

LIVER FUNCTION TEST (LFT) 03-05-2024 03:09:PMTotal Bilurubin 1.76 mg/dlDirect Bilurubin 0.86

mg/dlSGOT(AST) 19 IU/LSGPT(ALT) 13 IU/LALKALINE PHOSPHATASE 1387 IU/LTOTAL

PROTEINS 7.4 gm/dlALBUMIN 3.0 gm/dlA/G RATIO 0.69

RFT 03-05-2024 03:09:PMUREA 195 mg/dlCREATININE 9.0 mg/dlURIC ACID 9.7

mmol/LCALCIUM 8.9 mg/dlPHOSPHOROUS 9.4 mg/dlSODIUM 142 mmol/LPOTASSIUM 4.2

mmol/L.CHLORIDE 101 mmol/L FBS-169 mg/dl PLBS- 338 mg/dl HBA1C-8% COMPLETE BLOOD PICTURE (CBP) 03-05-2024

03:09:PMHAEMOGLOBIN 9.5 gm/dlTOTAL COUNT 35000 cells/cummNEUTROPHILS 94

%LYMPHOCYTES 04 %EOSINOPHILS 01 %MONOCYTES 01 %BASOPHILS 00 %PLATELET

COUNT 2.34SMEAR Normocytic normochromic anemia with neutrophilic leukocytosis

ABG 03-05-2024 09:24:PMPH 7.322PCO2 22.6PO2 51.6HCO3 11.4St.HCO3 14.1BEB -13.0BEecf -

13.5TCO2 24.2O2 Sat 83.2O2 Count 11.7

Treatment Given(Enter only Generic Name)

1.INTERMITTENT NIV

2.INJ PIPTAZ 2.25 GM/IV/TTD

3.INJ CLINDAMYCIN 600 MG IV/BD

4.INJ PAN 40 MG/IV/OD/8 AM

5.INJ MIXTDRD 5U/SC/BD

6.INJ EPO 4000 IU /SC/ONCE WEEKLY

7.TAB LASIX20 MG/PO/BD

8.TAB OROFER XT/PO/OD

9.TAB NODISIS 500 MG /OD

10.TAB SHELCAL CT /OD

11.MONITOR BP,PR,RR,SPO2,TEMP 4TH HRLY

Preventive Care

SIGNATURE OF PATIENT /ATTENDER

SIGNATURE OF PG/INTERNEE

SIGNATURE OF ADMINISTRATOR

SIGNATURE OF FACULTY

Death Summary

DATE; 4/5/24

TIME 2.18 AM

50 YEAR OLD MALE WHO IS A KNOWN DIABETIC AND HYPERTENSIVE ON REGULAR

HEMODIALYSIS FOR CHRONIC KIDNEY DISEASE SINCE 2 YEARS PRESENTED WITH

COMPLAINTS OF BREATHLESSNESS AND RIGHT SIDED PRICING TYPE OF CHEST PAIN

SINCE 1 WEEK ASSOCIATED WITH FEVER ,ON AND OFF RELIEVED ON

MEDICATION.SPUTUM FOR C &S WAS SENT AND CHEST XRAY WAS DONE.WHICH RELIEVED

RIGHT LOWER ZONE OPACIFICATION.PATIENT WAS STARTED EMPERICALLY ON

ANTIBIOTICS ALONG WITH HEMODIALYSIS AND OTHER OTHER CONSERVATIVE

SUPPORTIVE TREATMENT.BUT PATIENT DIDNT IMPROVE SYMPTOMATICALLY WITH

WORSENING CHEST X RAY,PULMONOLOGY OPINION WAS TAKEN AND WAS PLANNED FOR

BRONCHOSCOPY AND WAS DONE WITH CONSENT FROM BOTH PATIENT AND

ATTENDER,PROCEDURE WAS UNEVENTFUL,SA.MPLE WAS SENT FOR TRUNAAT

AFB,C&S.TRUNAAT WAS NEGATIVE ,NO AFB FOUND ,NOFUNGAL ELEMENTS,ONLY E COLI

WAS FOUND,MEANWHILE DESPITE TREATING THE PATIENT WITH IV ANTIBIOTICS AND

CONSERVATIVE MANAGEMENT ,PATIENT CLINICALLY WORSENED WITH HYPOXIA WITH

ROOM AIR SATURATIONS OF 80 % AND ABG SHOWING PO2 OF 50 WITH MODERATE

METABOLIC ACIDOSIS ,PATIENT WAS ADVISED TO CONNECTED TO INTERMITTENT CPAP

NIV BUT PATIENT WAS NOT COOPERATIVE FOR CPAP AND DENIED TO BE ON

CPAP.TACHYPNEA WORSENED FURTHER WITH INCREASED RESPIRATORY EFOORT AND

WORSE OF BREATHING PATIENT GENERALCONDITION FURTHER WORSENED AND PT

GRADUALLY BECAME SEVERLEY TACHYPNEA AND SATURATION ON LT O2 WERE 70 % AND

ATTENDERS EXPLAINED ABOUT THE NEED FOR INTUBATION,MEANWHILE PT BECAME

UNRESPONSIVE WITH FEEBLE PULSE WAS NOT RECORDABLE,CPR WAS INITIATED AND

INTUBATED WITH ET TUBE NO.7 SIMULTANEOSLY AND ET TUBE POSITION CONFIRMED

WITH BILATERAL EQUAL CHEST RISE AND 5 POINT AUSCULTATIONB,MIST IN TUBE BUT

DESPITE 4 CYCLES OF CPR ,PATIENT COULDNT BE REVIVED AND DECLARED DEAD AT 2:18

AM ON 4/5/24 WITH ECG SHOWING FLAT LINE

IMMEDIATE CAUSE OF DEATH

TYPE 1 RESPIRATORY FAILURE

SUDDEN CARDIAC ARREST

ANTECEDENT CAUSE OF DEATH

RIGHT MIDDLE AND LOWER ZONE CONSOLIDATION?CAP

K/C/O CKD ON MHD

K/C/O DM 2 AND HTN

Expired due to Type 1 respiratory failure