PowerPoint Presentation

Mortality ReviewMedical Dept 2016Hospital MiriID and BiodataAge: 69Sex: FemaleAddress: LOT 458, pujut, padang kerbauDate of Admission: 28/1/2016Date of Death: 29/1/2016Cause of Death: sepsis secondary to CAP( ? PTB)Clinical Presentation69 years old lady, underlying hypertension, hyperthyroidism, IHD and SVT Presented with SOB for 1 dayCough for 3 daysDifficult to expectorate sputum.Fever for 3 daysNo chills or rigorsNo vomiting, no diarrhea, no UTI symptomsHistory of PTB contact (husband)3Examination on admissionConcious, restless, mild pallorBP:140/64mmHgPR:170T:39.2cSpo2: 100% on high flow maskHEART: DRNMLUNGS: bibasal crepitationABDOMEN: Soft and non tenderNo pedal oedema4Investigations on admissionABG (on high flow mask)pH7.47pCO232.9pO289.3HCO325.7BE0.4SO296.5%FBCWCC 9.8Hb12.0Plt403Hct37.2 RPurea24.3creat93Na133K3.1Cl71CXR: perihilar haziness

ECG: AFInitial managementIVD 2.5l/day all NSIV augmentin 1.2g TDSIV azithromycin 500mg ODIV ranitidine 50mg TDST carbimazole 20mg ODT rocalcitriol 0.25mg ODT caspirin 100mg ODT calcium lactate 600mg OD s/c clexane 60mg ODT simvastatin 20mg ONIV hydrocortisone 50mg TDSIvi amiodarone 360mg for 6 hour, then 600mg over 18 houri/o chartingSPo2 monitoring

Sent blood C+S, sputum AFB, sputum C+S, urine C+S, urine FEME, T4/TSH

Noted patient unresponsive at 6.30 am.Pulse not palpableCPR commenced.DXT stat 1.1 mmol/l. 50cc D50 givenHowever after 50 minutes, no chest rise, no heart sound, no pulse palpable, cardiac monitor show asystole and pronounced death at 0712h

Progress in ward FBC28/1/201629/1/2016WCC 9.812.3Hb12.011.5Plt403348Hct37.235.8 RP28/1/201629/1/2016urea24.320.6creat9376Na133142K3.13.3Cl71103LFT (29/1/2016)TB19DB8AST67ALT29ALP88TP59Alb25Glo34TFT (29/1/2016)T444.9TSH