HEART FAILURE WITH MID RANGE EJECTION FRACTION( EF 44%) WITH RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS WITH RIGHT MIDDLE LOBE PLEURAL EFUSION WITH CHRONIC PANCREATITIS WITH SEPSIS WITH GRADE 2 BED SORE WITH K/C/O DM II SINCE 20 YEARS WITH K/C/O CAD-S/P: PTCA DONE 2 YEARS AGO D9-S/P: TRACHEOSTOMY
Case History and Clinical Findings
PATIENT CAME WITH C/O LOWER BACK ACHE SINCE 3 WEEKS RADIATING TO LEFT LOWER LIMB
HOPI:PATIENT WAS APPARENTLY ASYMPTOMATIOC 3 WEEKS BACK SINCE THEN, PATIENT COMPLAINTS OF LOWER BACK ACHE WHICH IS SUDDEN ONSET,NON PROGRESSIVE,AGRAVATES ON MOVEMENT RELEIVES ON REST H/O TRAUMA(SLIP AND FALL FROM STEPS) 3 WEEKS BACK ,WAS TAKEN TO OUTSIDE HOSPITAL FOUND TO HAVE L5 BURST FRACTURE ON CT PELVIS AND CAME HERE FOR FURTHER MANAGEMENT NO H/O LIFTING OF HEAVY WEIGHTS,FEVER BURNING MICTURITION BOWEL AND BLADDER INCONTINENCE PAST HISTORY OF RIGHT PROXIMAL FEMUR FRACTURE AND DONE IMILN 10 YEARS BACK. H/O PTCA DONE ONE AND HALF YEAR BACK AND IS ON REGULAR MEDICATION
K/C/O DM II SINCE 20 YEARS AND IS ON T. METFORMIN 500 MG + T. VOGLIBOSE 0.2 MG + T. GLIMIPERIDE 2 MG
GENERALEXAMINATION:
PATIENT IS CONSCIOUS,COHERENT AND CO OPERATIVE NO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS,EDEMA AND LYMPHADENOPATHY
VITALS: TEMP:AFEBRILE BP: 110/80MMHG PR:80BPM RR:18CPM
SYSTEMIC EXAMINATION:
CVS: S1,S2+; NO MURMURS
CNS:NAD
RS:NVBS +
P/A : SOFT,NON TENDER
B/L OF LS SPINE
: SKIN: NORMAL
SWELLING: ABSENT
TENDERNESS: PRESENT AT LUMBAR REGION
TRACHEOSTOMY WAS DONE ON 6/9/23 BLOOD TRANSFUSION WAS DONE ON 12/9/23
PULMONOLOGY REFERRAL WAS DONE ON 30/8/23 AND ADVISED FOR CT CHEST AND INDUCED SPUTUM FOR CBNAAT AND CULTURE SENSITIVITY
NEPHROLOGY REFERRAL WAS DONE ON 2/9/23 AND ADVISED FOR HAEMODIALYSIS
PULMONOLOGY REFERRAL WAS DONE ON 2/9/23 AND ADVISED FOR USG GUIDED TAP AND ICD PLACEMENT SURGERY REFERRAL WAS DONE 4/9/23 AND ADVISED FOR ASEPTIC DRESSINGS, CHANGE OF POSITION 4 HOURLY AND ALPHA BED
SURGERY REFERRAL WAS DONE 6/9/23 AND ADVISED FOR ASEPTIC DRESSINGS, CHANGE OF POSITION 2 HOURLY AND ALPHA BED
Investigation
RFT 29-08-2023
UREA 77 mg/dl
CREATININE 1.1 mg/dl
URIC ACID 2.9 mg/dl
CALCIUM 8.8 mg/dl
PHOSPHOROUS 4.8 mg/dl
SODIUM 121mg/dl
POTASSIUM 4.6 mEq/L
CHLORIDE 95 mEq/L
LIVER FUNCTION TEST (LFT) 29-08-2023
Total Bilurubin 0.76 mg/dl
Direct Bilurubin 0.19 mg/dl
SGOT(AST) 11 IU/L
SGPT(ALT) 13 IU/L
ALKALINE PHOSPHATE 321 IU/L
TOTAL PROTEINS 5.0 gm/dl
ALBUMIN 2.59 gm/dl
A/G RATIO 1.02
HBsAg-RAPID29-08-2023
Negative
Anti HCV Antibodies - RAPID29-08-2023 Non Reactive
COMPLETE BLOOD PICTURE (CBP) 29-08-2023
HAEMOGLOBIN 9.0 gm/dl 17.0-13.0 gm/dl TOTAL COUNT 15300 cells/cumm 10000-4000 cells/cumm
NEUTROPHILS 87 %
LYMPHOCYTES 10 %
EOSINOPHILS 01 %
MONOCYTES 02 %
BASOPHILS 00 %
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 30-08-2023 SODIUM 124 mEq/L
CHLORIDE 94 mEq/L
CALCIUM IONIZED 1.12 mmol/L
ABG 30-08-2023
PH 7.34 PCO2 31.4 PO2 58.4 HCO3 16.7 St.HCO
32-4 EPITHELIAL CELLS
2-3 RED BLOOD CELLS
Nil CRYSTALS
Nil CASTS
Nil AMORPHOUS DEPOSITS
Absent OTHERS Nil
ABG 29-08-2023
PH 7.43 PCO2 27.6 PO2 48.1 HCO3 18.3 St.HCO320.5 BEB-4.5 BEecf-5.2 TCO2 37.7 O2 Sat 86.1 O2 Count 12.4
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 30-08-2023 SODIUM 122 mEq/L
POTASSIUM 4.1 mEq/L
CHLORIDE 95 mEq/L
CALCIUM IONIZED 1.02 mmol/L
CREATININE 2.1 mg/dl
URIC ACID 2.0 mg/dl
CALCIUM 8.4 mg/dl
PHOSPHOROUS 6.3 mg/dl
SODIUM 135 mEq/L
POTASSIUM 5.0 mEq/L
CHLORIDE 104 mEq/L
ABG 30-08-2023
PH18.2
BEB-7.6
BEecf-7.9
TCO2 34.2
O2 Sat 89.7
O2 Count 15.2
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 30-08-2023 SODIUM 135 mEq/L
POTASSIUM 5.0 mEq/L
CHLORIDE 99 mEq/L
CALCIUM IONIZED 1.11 mmol/L mmol/L
ABG 30-08-2023
PH 7.10
PCO2 46.6
PO2 98.5
HCO3 14.0
St.HCO3 13.1
BEB-14.9
BEecf-13.8
TCO2 31.1
O2 Sat 93.4
O2 Count 14.5
RFT 30-08-2023
UREA
89 mg/dl
CREATININE 2.1 mg/dl
URIC ACID 2.0 mg/dl
CALCIUM 8.4 mg/dl
PHOSPHOROUS 6.3 mg/dl
SODIUM 135 mEq/L
POTASSIUM 5.0 mEq/L
CHLORIDE 104 mEq/L
ABG 30-08-2023
PH7.25
PCO2 33.5
PO2 112
HCO3 14.2
St.HCO3 15.2
BEB-11.7
BEecf-11.6
TCO2 31.0
O2 Sat 96.7
O2 Count 12.1
ABG 31-08-2023
PH 7.22
PCO2 38.3
PO2 82.6
HCO3 15.2
St.HCO3 15.5
BEB-11.4
BEecf-11.0
TCO2 32.4
O2 Sat 93.9
O2 Count 15.1
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 31-08-2023 SODIUM 134 mEq/L
POTASSIUM4.9 mEq/L
CHLORIDE 99 mEq/L
CALCIUM IONIZED 1.19 mmol/L
LIVER FUNCTION TEST (LFT) 01-09-2023 Total Bilurubin 2.14 mg/dl
Direct Bilurubin 0.50 mg/dl
SGOT(AST) 77 IU/L
SGPT(ALT) 38 IU/L
ALKALINE PHOSPHATE 267 IU/L
TOTAL PROTEINS4.5 gm/dl
ALBUMIN 2.05 gm/dl
A/G RATIO 0.84
RFT 01-09-2023
UREA 152 mg/dl
CREATININE 3.6 mg/dl
URIC ACID 10.1 mg/dl
CALCIUM 8.3
PHOSPHOROUS 6.5 mg/dl
SODIUM122 mEq/L
POTASSIUM 5.4 mEq/L
CHLORIDE 96 mEq/L
98-107 mEq/L
ABG 01-09-2023
PH 7.30
PCO2 20.0
PO2 96.9
HCO3 9.7
St.HCO3 12.3
BEB-15.4
BEecf-15.5
TCO221.8
O2 Sat 95.8
O2 Count 7.7
ABG 01-09-2023
PH 7.20
PCO2 36.3
PO2 92.3
HCO3 13.8
St.HCO3 14.4
BEB-12.8
BEecf-12.6
TCO2 30.3
O2 Sat 95.2
O2 Count 12.7
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 01-09-2023 SODIUM 122 mEq/L
POTASSIUM 5.5 mEq/L
CHLORIDE 94 mEq/L
CALCIUM IONIZED 1.00 mmol/L mmol/L ABG 01-09-2023
PH 7.18
PCO2 37.4
PO2 86.9
HCO3 13.5
St.HCO3 13.8
BEB-13.9
BEecf-13.2
TCO2 28.8
O2 Sat 94.6
O2 Count 16.1
LIVER FUNCTION TEST (LFT) 01-09-2023 Total Bilurubin 1.65 mg/dl
Direct Bilurubin 0.38 mg/dl
SGOT(AST) 64 IU/l
SGPT(ALT) 34 IU/L
ALKALINE PHOSPHATE 371 IU/l
TOTAL PROTEINS 4.7 gm/dl
ALBUMIN 2.02 gm/dl A/G RATIO 0.75
RFT 01-09-2023
UREA 182 mg/dl
CREATININE 4.5 mg/dl
URIC ACID 10.2 mg/dl
CALCIUM 8.4 mg/dl
PHOSPHOROUS 8.2 mg/dl
SODIUM 135 mEq/L
POTASSIUM 6.2 mEq/L
CHLORIDE 99 mEq/L
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 02-09-2023
SODIUM 124 mEq/L
POTASSIUM 5.5 mEq/L
CHLORIDE 98 mEq/L
CALCIUM IONIZED 1.10 mmol/L mmol/L
ABG 02-09-2023
PH 7.17
PCO2 43.4
PO2 95.3
HCO3 15.4
St.HCO3 15.0
BEB-11.9
BEecf-11.4
TCO2 34.1
O2 Sat 95.9
O2 Count12.4
ABG 03-09-2023 12:42:AM
PH 7.29
PCO2 30.8
PO2 69.8
HCO3 14.4
St.HCO3 15.8
BEB-10.7
BEecf-10.9
TCO2 30.9
O2 Sat 94.3
O2 Count 12.4
ABG 03-09-2023
PH 7.30
PCO2 26.3
PO2 116
HCO3 12.7
St.HCO3 14.8
BEB-12.2
BEecf-12.4
TCO2 27.5
O2 Sat 96.4
O2 Count 11.6
LIVER FUNCTION TEST (LFT) 03-09-2023 Total Bilurubin0.63 mg/dl
1-0 mg/dl
Direct Bilurubin 0.20 mg/dl
SGOT(AST) 68 IU/L
SGPT(ALT) 36 IU/L
ALKALINE PHOSPHATE 324 IU/L
TOTAL PROTEINS 4.2 gm/dl
ALBUMIN 1.91 gm/dl
A/G RATIO 0.83
RFT 03-09-2023
UREA196 mg/dl
CREATININE 4.7 mg/dl
URIC ACID 10.1 mg/dl
CALCIUM 8.2 mg/dl
PHOSPHOROUS 8.6 mg/dl
SODIUM 136 mEq/L
POTASSIUM 5.3 mEq/L
CHLORIDE 98 mEq/L
ABG 03-09-2023
PH7.277
PCO2 28.2
PO2 135
HCO3 12.8
St.HCO3 14.0
BEB-12.8
BEecf-12.7
TCO2 29.5
O2 Sat 97.3
O2 Count 4.8
ABG 03-09-2023
PH 7.24
PCO239.0
PO2 38.4
HCO3 16.1
St.HCO3 16.0
BEB-10.1
BEecf-9.8
TCO2 35.4
O2 Sat 64.9
O2 Count 8.1
ABG 03-09-2023
PH 7.28
PCO2 30.8
PO2 101
HCO3 14.2
St.HCO3 15.1
BEB-11.2
BEecf-11.1
TCO2 33.3
O2 Sat 97.5
O2 Count 2.6
COMPLETE URINE EXAMINATION (CUE) 04-09-2023
COLOUR Pale yellow
APPEARANCE Clear
REACTIONAcidic
SP.GRAVITY 1.010
ALBUMIN Trace
SUGAR Nil
BILE SALTS Nil
BILE PIGMENTS Nil
PUS CELLS 2-3
EPITHELIAL CELLS 2-3
RED BLOOD CELLS Nil
CRYSTALS Nil
CASTS Nil
AMORPHOUS DEPOSITSAbsent
OTHERS Nil
ABG 04-09-2023
PH 7.26
PCO2 30.4
PO2 99.6
HCO3 13.2
St.HCO3 14.7
BEB-12.4
BEecf-1.4
TCO2 28.7
O2 Sat 96.0
O2 Count12.5
LIVER FUNCTION TEST (LFT) 04-09-2023
Total Bilurubin 1.63 mg/dl
Direct Bilurubin 0.26 mg/dl
SGOT(AST) 27 IU/L
SGPT(ALT) 32 IU/L
ALKALINE PHOSPHATE 399 IU/L TOTAL PROTEINS 4.5 gm/dl
ALBUMIN 1.86 gm/dl
A/G RATIO0.70
RFT 04-09-2023
UREA 196 mg/dl
CREATININE 4.5 mg/dl
URIC ACID 7.5 mg/dl
CALCIUM 8.2 mg/dl
PHOSPHOROUS 8.6 mg/dl
SODIUM 133 mEq/L
POTASSIUM 4
CHLORIDE 97 mEq/L
ABG 04-09-2023
PH 7.23
PCO2 31.2
PO2 46.6
HCO3 12.6
St.HCO3 13.6
BEB-13.5
BEecf-13.4
TCO2 28.0
O2 Sat -8.0
O2 Count 8.9
ABG 05-09-2023
PH 7.23
PCO2 32.1
PO2 48.1
HCO3 13.0
St.HCO3 13.9
BEB-13.1
BEecf-13.1
TCO2 28.8
O2 Sat 78.9
O2 Count 8.9
LIVER FUNCTION TEST (LFT) 05-09-2023 Total Bilurubin1.35 mg/dl
Direct Bilurubin 0.24 mg/dl
SGOT(AST) 43 IU/L
SGPT(ALT) 21 IU/L
ALKALINE PHOSPHATE 288 IU/L
TOTAL PROTEINS 6.8 gm/dl
ALBUMIN 3.4 gm/dl
A/G RATIO 1.0
RFT 05-09-2023
UREA 205 mg/dl
CREATININE 3.8 mg/dl
URIC ACID 8.7 mg/dl
CALCIUM 7.5 mg/dl
PHOSPHOROUS 8.9
SODIUM 130 mEq/L
POTASSIUM 4.6 mEq/L
CHLORIDE 98 mEq/L
ABG 06-09-2023
PH 7.25
PCO2 28.0
PO2 105
HCO3 12.0
St.HCO3 13.7
BEB-13.6
BEecf-13.7
TCO2 26.5
O2 Sat 96.3
O2 Count 10.8
LIVER FUNCTION TEST (LFT) 06-09-2023 Total Bilurubin 2.00 mg/dl
Direct Bilurubin0.64 mg/dl
SGOT(AST) 39 IU/L
SGPT(ALT) 22 IU/L
ALKALINE PHOSPHATE 334 IU/L
TOTAL PROTEINS 6.0 gm/dl
ALBUMIN 3.1 gm/dl
A/G RATIO 1.06
RFT 06-09-2023
UREA 169 mg/dl
CREATININE3.4 mg/dl
URIC ACID 8.2 mg/dl
CALCIUM 8.9 mg/dl
PHOSPHOROUS 6.0 mg/dl
SODIUM 127 mEq/L
POTASSIUM 4.8 mEq/L
CHLORIDE 96 mEq/L
ABG 06-09-2023
PH 7.20 PCO2 23.6
PO2 56.8
HCO3 8.9
St.HCO3 10.4
BEB-17.7
BEecf-17.6
TCO2 20.9
O2 Sat 86.9
O2 Count 3.7
ABG 07-09-2023
PH 7.32
PCO2 26.9
PO2133
HCO3 13.5
St.HCO3 15.5
BEB-11.1
BEecf-11.4
TCO2 29.3
O2 Sat 97.9
O2 Count 11.1
ABG 07-09-2023
PH 7.16
PCO2 41.2
PO2 50.2
HCO314.2
St.HCO3 13.8
BEB-13.2
BEecf-12.8
TCO2 32.0
O2 Sat 75.3
O2 Count 8.6
BLOOD UREA165 mg/dl
SERUM CREATININE 2.1 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 07-09-2023
SODIUM 131
POTASSIUM 3.9 mEq/L
CHLORIDE 98
CALCIUM IONIZED 1.40 mmol/L mmol/L ABG 07-09-2023
PH 7.26
PCO2 16.7
PO2 113
HCO3 7.3
St.HCO3 10.1
BEB-18.6
BEecf18.7
TCO2 16.4
O2 Sat 96.0
O2 Count 8.1
ABG 08-09-2023
PH 7.26
PCO2 29.5
PO2 84.6
HCO3 13.0
St.HCO3 14.5
BEB-12.5
BEecf 12.6
TCO2 28.4
O2 Sat 94.8
O2 Count 11.4
BLOOD UREA 96 mg/dl
SERUM CREATININE 2.0 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM
SODIUM 129 mEq/L
POTASSIUM 4.5 mEq/L
CHLORIDE 96 mEq/L
CALCIUM IONIZED 0.97 mmol/L mmol/L
ABG 08-09-2023
PH 7.40
PCO2 23.5
PO2 69.1
HCO3 14.3
St.HCO3 17.0
BEB-9.1
BEecf-9.6
TCO2 30.4
O2 Sat 94.9
O2 Count 11.3
ABG 09-09-2023
PH 7.37
PCO2 23.8
PO2 67.1
HCO3 13.7
St.HCO3 16.3
BEB-10.0
BEecf-10.5
TCO2 29.2
O2 Sat 92.5
O2 Count 10.9
ABG 09-09-2023
PH7.37
PCO2 26.9
PO2 50.6
HCO3 15.3
St.HCO3 17.0
BEB-8.9
BEecf-8.9
TCO2 34.3
O2 Sat 87.7
O2 Count 5.8
BLOOD UREA72 mg/dl
SERUM CREATININE 1.3-0.9 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 09-09-2023 SODIUM 132 mEq/L
POTASSIUM 4.9 mEq/L
CHLORIDE 99 mEq/L
CALCIUM IONIZED 1.03 mmol/L mmol/L BLOOD UREA 29 mg/dl SERUM CREATININE1.1 mg/dl SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 09-09-2023
SODIUM 124 mEq/L
POTASSIUM 5.4 mEq/L
CHLORIDE 96 mEq/L
CALCIUM IONIZED 1.07 mmol/L mmol/L SERUM CREATININE 1.0 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM
SODIUM 123 mEq/L
POTASSIUM 4.9 mEq/L
CHLORIDE 96 mEq/L
CALCIUM IONIZED 1.20 mmol/L mmol/L BLOOD UREA 24 mg/dl
SERUM Creatinine1.1 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM
SODIUM 130
POTASSIUM 4.7 mEq/L
CHLORIDE 97 mEq/L
CALCIUM IONIZED 1.18 mmol/L mmol/L BLOOD UREA26 mg/dl
SERUM CREATININE 1.0 mg/dl
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM
SODIUM 120 mEq/L
POTASSIUM 4.8 mEq/L
CHLORIDE 96 mEq/L
CALCIUM IONIZED 0.98 mmol/L mmol/L
RFT 13-09-2023
UREA 53 mg/dl
CREATININE 0.8 mg/dl
URIC ACID 4.7 mg/dl
CALCIUM 8.7 mg/dl
PHOSPHOROUS 4.0 mg/dl
SODIUM 123 mEq/L
POTASSIUM 4.1 mEq/L
CHLORIDE 89 mEq/L
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM
SODIUM 123 mEq/L
POTASSIUM 4.5 mEq/L
CHLORIDE 82 mEq/L
CALCIUM IONIZED 0.95 mmol/L mmol/L
RFT 15-09-2023
UREA 50 mg/dl
CREATININE 0.8 mg/dl
URIC ACID 4.2 mg/dl
CALCIUM 8.2 mg/dl
PHOSPHOROUS 4.5 mg/dl
SODIUM 133 mEq/L
POTASIUM 4.2
CHLORIDE 99 mEq/L
HEMOGRAM: 30/8/23
HEMOGLOBIN: 8.9 MG/DL
TLC: 30,000 CELLS/CUMM
PLT:2.4 LAKHS/CUMM
2/9/23
HEMOGLOBIN:7.2 MG/DL
TLC: 22,00 CELLS/CUMM
PLT:1.5 LAKHS/CUMM
5/9/23
HEMOGLOBIN: 7.0 MG/DL
TLC: 23,600 CELLS/CUMM
PLT: 1.63 LAKHS/CUMM
8/9/23
HEMOGLOBIN: 6.9 MG/DL
TLC: 24,300 CELLS/CUMM
PLT: 2.6 LAKHS/CUMM
12/9/23
HEMOGLOBIN: 6.5 MG/DL
TLC: 20,500 CELLS/CUMM
PLT: 2.43 LAKHS/CUMM
15/9/23
HEMOGLOBIN: 6.2 MG/DL
TLC: 19,200 CELLS/CUMM
PLT: 1.5 LAKHS/CUMM
2D ECHO (30/8/23)- TACHYCARDIA, MILD LHF-RWMA; APEX, ANTERIOR WALL AND LATERAL WALL HYPOKINESIA- TRIVIAL MR/AR, NO TR- SCLEROTIC AV, NO AS/MS- EF= 44%, MODERATE LV DYSFUNCTION- NO DIASTOLIC DYSFUNCTION, NO PAH/PE
HRCT OF CHEST (31/8/23)- RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS- FOCI OF CONSOLIDATION IN RIGHT MIDDLE LOBE, LINGULA AND APICAL SEGMENT OF LEFT LUNG LOWER LOBE- LARGE LOCULATED RIGHT PLEURAL EFFUSION EXTENDING INTO THE MAJOR FISSURE.- A POCKET OF LOCULATED MEDIASTINAL PLEURAL EFFUSION ON RIGHT SIDE- CHRONIC CALCIFIC PANCREATITIS
Diagnosis
HEART FAILURE WITH MID RANGE EJECTION FRACTION( EF 44%) WITH RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS WITH RIGHT MIDDLE LOBE PLEURAL EFUSION WITH CHRONIC PANCREATITIS WITH SEPSIS WITH GRADE 2 BED SORE WITH K/C/O DM II SINCE 20 YEARS WITH K/C/O CAD-S/P: PTCA DONE 2 YEARS AGO D9-S/P: TRACHEOSTOMY
USG ABDOMEN 2/9/23 NO SONOLOGICAL ABNORMALITY DETECTED
Treatment Given(Enter only Generic Name) 1.INJ.LEVIPIL 1GM IV/BD FOR 16 DAYS
2. INJ. NORAD AT 1.1 ML/HR FOR 7 DAY 3.INJ. DOBUTAMAMINE IV FOR 7 DAYS 4.INJ. VASOPRESSIN AT .5 ML/HR FOR 6 DAYS
5.FENTANYL+ MIDAZOLAM FOR 8 DAYS 6.INJ. HEPAIN FOR 13 DAYS 7.TAB. TOLVAPTAN FOR 6 DAYS
8.INJ. THIAMINE FOR 7 DAYS
9.INJ. HAI FOR 16 DAYS
10.INJ. PIPTAZ 2.25 GMS IV/TID FOR 5 DAYS
11.TAB.ATORVASTATIN+ ASPIRIN 75 MG RT/HS FOR 16 DAYS
12. TAB. OROFER XT RT/OD FOR 16 DAYS 13.NEBULIZATION WITH IPRAVENT 6TH HOURLY AND BUDECORT 4TH HOURLY FOR 16 DAYS
14.INJ.MEROPENEM 500MG IV/BD FOR 12 DAYS
15.TAB.FLUCONAZOLE 150MG RT/OD FOR 8 DAYS
16.INJ.VANCOMYCIN 500MG IV/BD FOR 5 DAYS
17.CHANGE OF POSITION 2 HRLY AND DAILY DRESSING OF BED SORE
Follow Up
DEATH SUMMARY A 55 YEAR OLD MALE WITH L5 (UNSTABLE) BURST FRACTURE (3 WEEKS) OLD AND WAS TRANSFERRED FROM ORTHOPEDICS TO GENERAL MEDICINE I/V/O HIGH GRBS. PATIENT SUGARS WERE CONTROLLED WITH INSULIN INFUSION AND HANDED OVER TO ORTHOPEDICS. AFTER 1 HR PATIENT DEVELOPED ALTERED SENSORIUM AND TRANSFERED TO GENERAL MEDICINE, ALTERED SENSORIUM MIGHT BE DUE TO ?HYPONATREMIA WHICH WAS CORRECTED WITH 3% NACL. NEXT DAY I/V/O FALLING SATURATION PATIENT WAS INTUBATED. HE ALSO HAD BRADYCARDIA AT THAT TIME FOR WHICH CPR WAS INITIATED,AND PATIENT REVIVED. AS THERE WERE DECREASED BREATH SOUNDS ON RIGHT SIDE OF CHEST, HRCT CHEST WAS DONE ON 31/8/23 ON WHICH PATIENT WAS FOUND TO HAVE RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS, LARGE LOCULATED PLEURAL EFFUSION, EXTENDING INTO MAJOR FISSURE, POCKET OF LOCULATED MEDIASTINAL EFFUSION ON RIGHT SIDE WITH CHRONIC CALCIFIC PANCREATITIS. PATIENT DEVELOPED HEART FAILURE WITH EJECTION FRACTION 44% INITIALLY 65%). DDIMER FOUND TO BE ELEVATED INITIALLY, PULMONARY EMBOLISM WAS SUSPECTED AND HEPARIN WAS ADDED TO THE TREATMENT. PATIENT HAD HYPOTENSION FOR WHICH HE WAS PLACED ON IONOTROPE SUPPORT. AS THERE WERE RAISED TLC AND FEVER SPIKES IN BETWEEN . PATIENT WAS STARTED ON ANTIBIOTICS. PATIENT HAS DECREASED URINE OUTPUT AND INCREASED SERUM UREA AND CRETININE. DIURETICS WERE ADDED TO THE TREATMENT AND GRADUALLY HIS URINE OUTPUT WAS INCREASED. HE WAS MAINTAINED ON VENTILATOR AND TRIPLE IONOTROPE SUPPORT. HIS BLOOD PRESSURE WAS GRADUALLY IMPROVED AND TRIPLE IONOTROPE SUPPORT WAS TAPERED GRADUALLY. PATIENT HAD RECURRENT EPISODES OF SEIZURES(DUE TO ?HYPOXIC ISCHEMIC ENCEPHALOPATHY) IN BETWEEN AND WAS CONTROLLED WITH ANTIEPILEPTICS. ON 6/9/23 PATIENT WAS TRACHEOSTOMISED AND MAITAINED ON VENTILATOR.ON 12/9/23 PATIENT WAS CONNECTED TO T PIECE AND MAINTAINED ON OXYGEN. DUE TO LOW HB LEVELS 1PRBC TRANSFUSION WAS DONE ON 12/09/23. SEPSIS WAS RESOLVING GRADUALLY AND PATIENT WAS DE-ESCALATED FROM ANTIBIOTICS.GRADUALLY OXYGEN SUPPORT WAS TAPERED AND PATIENT WAS MAINTAINING ON ROOM AIR ON 14/09/23. ON 16/9/23 AT AROUND 2AMPATIENT WAS AGAIN CONNECTED TO OXYGEN SUPPORT I/V/O FALLING SATURATIONS AND MAINTAINED ON IT FOR ABOUT 2 HOURS AND AROUN 5 AM PATIENT HAD FALLING SATURATION EVEN WITH HIGH FLOW OXYGEN SUPPORT AND HAD BRADYCARDIA. AT AROUND 5 AM CPR WAS STARTED ACCORDING TO ACIS GUIDELINES AND CONTINUED FOR 30 MINS.INSPITE OF ALL THE ABOVE EFFORTS, PATIENT COULDN'T BE REVIVED AND DECLARED DEAD ON 16/09/23 AT 5:36 AMAND ECG SHOWED FLAT LINE. IMMEDIATED CAUSE OF DEATH: ACUTE DECOMPENSATED HEART FAILURE ANTECEDANT CAUSE OF DEATH: RIGHT LOWER LOBE COLLAPSE WITH BRONCHIECTASIS WITH RIGHT MIDDLE LOBE PLEURAL EFFUSION WITH SEPSIS WITH GRADE 2 BEDSORE WITH CHRONIC PANCREATITIS WITH CAD (S/P PTCA 2 YEARS AGO) K/C/O DM SINCE 20 YEARS.
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