MORTALITY REPORT

NAME: SAADIAH BT MAT ARIS

AGE : 57 Y/O
MRN : 260952
DATE OF ADMISSION : 3/3/14
p/w
bilateral leg swelling for 1/52
-worsening

fever for 1/7
-started today at hospital
-claimed no fever at home

had nausea but no vomiting
+poor oral intake, claimed d/t reduced appetite

otherwise,
no abdominal pain
no sob or chest pain
no URTI/UTI sx
no dirrhea/constipation
no recent insect bite
claimed recent fall at bathroom 2days ago


O/e
alert,pink
warm peripheries
good pulse volume

V/s
BP 123/59
PR 101
RR 24
SPO2 96%
T 37.6
Dxt 7.0

Lungs clear
CVS drnm
P/a soft non tender

Lower limb examination:

bilateral leg odema up to mid shin
+erythematous > right side
+warm on touch
+mild tender on palpation
+no punctum seen
no blood/pus discharge

ECG: SR, HR 92, + flattened T waves

US bilateral lower limb: no evidence of DVT

X-ray tibia/fibula: no fracture/dislocation, no gas shadow

Imp: bilateral lower limb cellulitis
Ix
Hb: 12/1
Wcc :6.1
Plt : 208
Urea : 1.5
K :3.8
Creat : 88
Alt : 32
Alp : 67
Fbs : 4.3





PLAN

Observe trend of viral fever
Repeat FBC cm
For iv. cloxacillin 1g stat qid
Send septic work up

5/3/14
progress,
pain reducing
low grade fever
not ambulating yet
on IV cloxacillin day 2

o/e:
alert & conscious
comfortable
not toxic looking
not in respi distress
dry lips
pink
warm peripheries
good pulse volume
crt<2sec

v/s:
t- 37.1
bp- 108/54
pr- 84
rr- 21
spo2-95% under npo2

lungs: bibasal crept

leg measurement:
Left : 48 --> 43cm , eryhtematous, warm, non tender
right: 52cm --> 48.5cm swollen, erythematous, warm & mild tender
local exam of right lateral chest wall:
wound about 4x4cm
clean base
no pus discharge

plan

take swab c&S
For daily dressing of skin ulcer
encourage ambulation
s/c fondaparinux 2.5mg od for dvt prophylaxis
6/3/14
progress,
pain reducing
low grade fever
not ambulating yet
on IV cloxacillin day 4

o/e
Vs:
bp: 105/58
Hr 80
Rr 20
T: 37
Spo2 : 96

thromboplebitis on the right arm

Plan
change venofix
trace blood culture
7/3/14
progress
leg : swelling reducing, claimed not painful anymore
low grade temp due to thromplhebitis of the right arm, temp settle
pt comfortable
not tachypneic
not tacycardic
o/e
Bp : 104/58
Hr : 77
Rr: 22
T: 37
Spo2 : 97

Plan:
enc ambulation
probe up
refer chest physio

8/3/14
progress,
pain reducing
not ambulating yet
on IV cloxacillin day 6
mild sob

o/e
thromboplebitis on the right arm
wound : having minimal d/c
bilateral leg swelling reducing

Plan:
cont cloxa
take fbs

x
Hb 10.1
Wcc 8.4
Plt 201
Urea 4.3
Na 131
K 3.8
Creat 222
Blood c+s : no growth
Sputum c+s : no growth
Urine c+s : candida sp
Swab c+s: pseudomonas
earoginosa
9/3/14
progress,
pain reducing
no fever
on IV cloxacillin day 7
o/e
Alert, conscious
Not tacypneic

Lung : bibasal crept

Ix
Hb : 10.1
Wcc : 10
Plt : 189
Urea : 6.2
Na : 128
K : 4.5
Creat : 316



imp:
1)bilateral lower limb cellulitis
2)aki secondary to possible dehaydration

PLAN
cont cloxa
4 pint ns over 24h
i/o charting
rpt fbc , rp cm

10/3/14
progress,
generalized abdominal pain , worst on suprapubic and right illiac fosa
swab from previous wound : pseudomonas aeroginosa
low grade fever
worsening aki
on IV cloxacillin
i/o positive balance

lungs : bilateral ronchi

p/a
non guarding ,non distended, b/s present

imp:
1) tro acute abdomen
2) aki secondary to dehyration
3) right lateral chest wall skin ulcer
Ix
Hb : 9.8
Wcc : 10
Plt : 201
Urea : 8.4
Na : 128
K : 4
Plt : 377


Abg
Ph : 7.5
Pco2: 22.8
Ppo2 : 147
Spo2 : 100
Hco3: 17.8
Tco2 : 19
Be : -3.3

Plan
to refer surgical tro acute abdomen/acute appendicitis, infected
wound
rpt septic w.u
rpt xray abdomen
change dvt prphylasis to clexane
neb salbutamol stat and 4hourly
abg
t/o to acute
knbm
s/b surgical team

PA
soft thick abdomen, tender over left lumbar and RIF
during deep palpation

AXR: prominent bowel, fecal loaded picture
VS stable
PR: empty rectum

imp:
treat as constipation colic
Plan

allow orally now
syp lactulose 15mls TDS
if still having persistent abdomen pain to keep patient NBM
to reassess back cm
cont medical plan
10/3/14
7.10pm
Bp : 172/118, hr 92, rr 21, spo2 95%
Dxt 4.4
11pm
Bp: 98/57 , hr 106, rr 21, spo2 98%

11/3/14
7.30 am
Bp : 62/29, hr 39, rr 21, spo2 71
Dxt : 7.8
7.47 am
Bp, hr unrecordable




11/3/14
noted patient unresponsive at 7.25am
pulse not palpable
no spontaneous breathing
bp unrecordable

was put on cardiac monitor , noted asystole
cpr commenced for 30 minutes
patient was intubated with ETT size 17
given adrenaline 4x

however after 30 minutes of resuscitation,
pulse still not palpable
cardiac monitor showed asystole
no spontaneous breathing
bp unrecordable
pupils fixed dilated

unable to revive patient

pronounced death at 7.47am, 11/3/2014
cause of death: sepsis with multiorgan failure