Death Report 12 Th Januari 2013

8/13/2019 Death Report 12 Th Januari 2013

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DUTY TEAM

Dr. Wahyudi

Dr. Seri Amni Siregar

Dr. Yostila

Dr. Riko JumatullahDr. Fajriansyah, dr. Yanrike


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1. Muchni Luthan, M, 60 YO

A man was admitted since 47 days ago withWD/

Septic shock Cb Bronchopneumonia

Non small cell lung Carcinoma effusion bilatreral Cb malignancy

COPD acut exacerbation

Melena Cb Gastropathy Steroid Hyponatremia Cb Low intake

Post GEA


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Therapy

Rest/ flow NGT, fasting 8 hours continue gastric diet / O25 L/1

Prosogan Drip 2 amp in 500 cc NaCl 0,9 % for 10 hours

IVFD NaCl 0,9 % 12 hours/kolf

Ciprofloxacin inf. 2 x 200 mg Dopamin drip 5 microgram/KgBW/hours

Vit. K inj. 3 x 1 amp

Transamin inj. 3 x 1 amp

Sucralfat syr 3 x C1

PCT 3 x 500 mg Ambroxol syr. 3 x C1

Fluid Balanceapplay chateter


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Physical Examination

Skin : Decrease of turgor

Eyes : Anemic (+) ikteric (-)

Lung : Broncovesiculer , rales +/+ , Wh-/-

Heart : mur mur (-), reguler

Abdomen : liver and spleen unpalpable

Ext : Oedema -/-


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LAB

Hb : 7,4 gr/dl Ht : 41 %

Tr : 626000/mm Leu : 18.200 /mm3

Ur : 34 mg/dL Cr : 1 mg/dL

Na/K/Cl : 123/2,6/98 mmol/dL

RBG : 162 mg/dL

Blood gas analysis

pH : 7,34 pCO2 : 22 mmHg

pO2 : 92 mmHg HCO3- : 11,9 mmol/L

BE ecf : -13,9 mmol/L SO2 : 97 %


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Investigation

21/11/2013 : Result of Lung X-ray : Right LungTB

Result of pleural fluid analysis

Impression : Excudate, PMN 85 %, MN 15 %,Rivalta (+)

Pleural fluid cytology : impression : malignancyeffusion (metastase)

CT-Scan ThoraxSugestif Ca. Bronchogenicsegment of the right lung


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Consul of consultant hematologist

Impression :

- Non small cell Bronchogenic carcinoma

Advice :

- Prepare of chemotherapy- Chemotherapy with Sindaxel and Actoplatin

Stool cultures of E. Colli sensitive to ciprofloxacin andgentamicin

Sputum cultur : Streptococcus and Hemolyticus, sensitiveCiprofloxacin and Meropenem


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Therapy Rest /Gastric diet I/O2 3 L/

Prosogan Drip 2 amp in 500 cc NaCl 0,9 %for 10 hours

Dopamin drip 5 microgram/KgBW/hours

Correction NaCl 3 % 12 Hours/kolf (1 kolf)

Ciprofloxacin inf. 2 x 200 mg

KSR 1 x 1 tab

Sucralfat syr 3 x C1

PCT 3 x 500 mg Ambroxol syr. 3 x C1

Fluid Balanceapplay chateter

Intensive control every 15 minute


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Follow up, 10.50 AmS/ Breathlessness (+) Black stool (+)

O/ :GA : Severe Sens : cmc

BP : 70/p HR : fast and smooth

RR : 26 x/min T : 35 C

Impression : Septic shock not resolved

Attitute :

- Intensive control every 15 minute

- Dopamin drip maximal dose continue- Norepinefrin 1 amp in 50 cc NaCl 0,9 % (syringe

pump) star 0,01 microgram/KgBW/hours, up titrationevery 15 minute until Blood presure >= 100 mmHg


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At. 22.30 wib

Patient apnue, BP unmeasure, pulselessness,

pupil midriatic, ECG flat, patient state death in

front of doctor, co-ass, nurse and family with

COD septic shock


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2. Marzuki, Male, 80 yo,MW

Patient a man was admitted since 1 day

ago wd/:

Septic shock Cb BP bilateral (CAP)

Left antebrachii cellulitis

AKI rifle I Cb pre renal Cb dehidration


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Condition of the patient at

admission

S/ Fever (+) , cought (+)

Breathlessness (+)

O/

GA : severe Sens : apathy

BP : unmeasuremen HR : 104x /min

Rr : 32x/min Temp : 36,7 C


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Physical examination

Skin : Tugor back later

Eyes : anemic (+), icteric (-)

Lung : Bronchovesiculer , rales +/+

Wheezing -/-

Heart : pure heart rhythm, murmur (-),M1>M2,

A2 > P2

Abd : soepel, Liver and spleen unpalpable


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Laboratory :

Hb : 11,8 gr/dl

Ht : 38 %

Tr : 168000/mm

Leu : 3400 /mm

BG : 81 mg/dl


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Therapy that has been awarded

Rest / soft diet high calory high protein/O2 L/1

Loading NaCl 0,9 % until urine output >= 0,5 -1 cc/kgbw/hor BP > 100mmHg

Ceftriaxone inj. 1x2 gr (iv)

Ciprofloxacine 2x100 mg Methylprednisolon inj. 2x 30 mg

Ambroxol syr 3x 30 mg

Pct 3x500 mg

Liquid balanceApplay chateter

if the shock is not resolved further norepineprin drip uptitration every 15 minute, maximal 0,5 mg/kgBW/hour

NB : Syring pump is no available, patients fitted drip dopamin


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Condition when reffered to duty team

S/ Breathlessness (+), cough (+)

O/ Sens : Apathy BP : 60/palpation

HR : 120 x/min RR : 30 x/min

T : 35,4 C

Eyes : anemic (-), Icteric (-)

Neck : JVP 5-2 cmH2o

Lung : Bronchovesiculer , rales +/+ smooth wet loud,

Wheezing : -/-

Heart : Cardiomegaly (-)

Abd : Liver and spleen unpalpable

Extremitas : oedema -/+

Left Arm : selulitis(+), abses size10x5x0,5cm,pus (+), edema(+)


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Impression :

Septic shock Cb Celulitis left antebrachii

(Vascon attached 0,05 microgram/KgBW/hours) BP Bilateral (CAP)

AKI RIFLE I ec prerenal Cb dehydration Cbseptic

Action :

o Intensive controll/15 min

o Norepinefrin up titration

o Another therapy is continued

o Wound care 2x/days


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At 11.15 Am

Patient apnue, BP unmeasure, pulselessness,



COD Septic Shock


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The patient's condition at admission HCU, January 10 th

2014

S/ - Decrease of consioussness (+)

- Breathlessness (+), Fever (+)

O/

Sens : Severa Sensorium : Soupor

BP : 130/80 mmHg HR : 110 x/min

RR : 29 x/min T : 35,8 C

Eyes : anemic (+), Icteric (-)

Neck : JVP 5-2 cmH2o, stiff neck (-)


Wheezing : -/-

Heart : Cardiomegaly (-)Abd : Liver and spleen unpalpable

Extremitas : oedema +/+


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LAB Hb : 7,9 gr/dl Ht : 41 %

Tr : 126.000/mm Leu : 18.200 /m Ur : 42 mg/dL Cr : 0,7 mg/dL

Na/K/Cl : 122/4,8/97 mmol/dL

RBG : 132 mg/dLAlb/Globulin : 2,8/2,2 gr/dL

Blood gas analysis pH : 7,31 pCO2 : 42 mmHg

pO2 : 56 mmHg HCO3- : 21 mmol/L

BE ecf : -5,2 mmol/L SO2 : 86 %


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Therapy that has been awarded

Rest/ Fluid diet via NGT/DD 1700 Kcal

Correction NaCl 3 % 12 hours/kolf and three way with IVFD NaCl0,9 % 12 hours/kolf

Ceftazidin 2 x 1 gr (IV)

Levofloxacin inf. 1x500 mg

Nebulizer Ventolin : fulmicort = 1:1 (if needed) Phyllocontin 2 x tab 1

Brain act inj. 2 x 500 mg

Methyl prednisolon inj. 2 x 30 mg

Neptin tab 2 x 1

Aspilet 2 x 80 mg PCT 3 x 500 mg (if needed)

Fluid BalanceApplay Chateter

Transfusion PRC until Hb >= 10 gr/dL


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Visite of duty consultant

Impression : Septic Cb HAP

Advice :

- Applay CVP line

- Fluid balance

- Decubitus ulcer treatment

- Cultur of pus

- Passive mobilization


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Condition when reffered to duty team, January 12 th

2014, 08.10 AM

S/ Decrease of consioussnes (+)

Brethlessness (+), Cough (+)O/

Sens : Severe Sens : Souporcomatous

BP : 120/80 mmHg HR : 110 x/min

RR : 29 x/min T : 37,4 o C

Eyes : anemic (+), Icteric (-), pupils ishokor,Light reflex (+)Neck : JVP 5-2 cmH2o, stiff neck (-)


Wheezing : -/-

Heart : Cardiomegaly (-), pure rhythm

Abd : Liver and spleen unpalpableExtremitas : oedema +/+


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A/

Decrease of Conscioussness Cb hipoxia

Septic Cb HAP

Multiple infark cerebri stroke Type 2 DM controll by insulin with ulcus Right

pedis

Ulcus decubitus grade II-III Hipoalbuminemia Cb Low intake

Hiponatremia Cb Low intake


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Impression :

- Intensive control / hours

- Repeat BGA

- Therapy Continue

Planing : Apply CVP line emergency

Consult of cosultant vasculer surgery for

apply CVP lineagree for apply CVP

line


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13.00 Wib

out result BGApH : 7,21 pO2 : 49 mmHg

pCO2 : 44 mmHg HCO3- : 22,2 mmol/L

BE ecf : - 4 SO2 : 80 % mmol/LImpression :

- Type 1 Respiratory failure with respiratory Acidosis

Attitude :

- Containment NRM 10 L/1 for 6 Hours

- Check BGA 6 hours post correction


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19.00 WIB

S/ the patient still unconsciousBreathlessness (+)

O/

Sens : Severe Sens : Suporocomatus

BP : 110/70 mmHg HR : 120 x/min

RR : 24 x/min T : 37,2 o CEyes : Pupils ishokor,Light reflex (+)

Neck : stiff neck (-)


Wheezing : -/-

Laboratory :Out result BGA : pH : 7,2 pCO2 : 54 mmHg pO2 : 141 mmHg

HCO3- : 21,1 mmol/L BE ecf : -6,9 mmol/L

S O2 : 99 % Na/K : 124/4,4 mmol/L


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Impression : Respiratory acidosis

Attitude :

- O2 : 2 L/1

- Intensive Controll every hour


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23. 00 Wib

Finish to apply CVP Line in OK, The condition patient :S/ the patient still unconscious

Breathlessness (+), Fever (-)O/

Sens : Severe Sens : Suporocomatus

BP : 110/80 mmHg HR : 110 x/minRR : 25 x/min T : 37 o C

Eyes : Pupils ishokor,Light reflex (+)

Neck : stiff neck (-)

Thorax : CVP line inserted eitherLung : Bronchovesiculer , rales +/+ smooth wet loud,

Wheezing : -/-


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A/

Decrease of Conscioussness Cb Multiple infarkcerebri

Septic Cb HAP

Type 2 DM controll by insulin with ulcus Right pedis

Ulcus decubitus grade II-III

Attitude :- Intensive Controll every hour

- Therapy continue

04 50 AM J 13 th 2014


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04.50 AM , January 13 th 2014 Patient apnue, BP unmeasure, pulselessness,



COD pulmonary embolism


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THANK YOU

Death Report 12 Th Januari 2013

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