Death Report AML + Small Secundum ASD+ Moderate MR+Cholestasis+Febrile

MF/3y/12Kg Neutrophenia+Epistaxis+Anemia+Trombositopenia+ Wasted + Respiratory

Failure
31/12/2018 Patient came from emergency department with chief complaint epistaxis since 1
day before admission, cough, fever. Patient is hemato-oncology outpatient clinic
with AML. GCS 456, HR 110 bpm, BP 100/50, RR 30 tpm, t 37oC, SpO2 99%. Lab:
Hb 7/Hct 23 /WBC 7350 /Plt 7000/ANC 660/Na 129/K 4.3/Cl 96/Ca 8.8/ CRP
206.6  antibiotic IV, PRC & TC transfusion, thermoregulation.
3/01/2019 Fever, no dypsnea, constipation. GCS 456. BP 90/60mmHg, HR 122bpm, RR 30
tpm, t 39oC. Lab: Hb 8.3/Hct 8.3/WBC 3910/Plt 16000/Na 129/K 2.3/Cl 85/Ca
7.6/Alb 3/BUN 10/Creat 0.3, Thermoregulation, SE correction, Adv.Pediatric
Surgery  mobilization, high fiber diet.
10/01/2019 Fever, vomiting, no sign of bleeding. GCS 456. BP 90/60mmHg, HR 122 bpm, RR
24 tpm, t 38oC . Lab: Hb 7.9/Hct 23/WBC 3300/Plt 7000/Na 128/K 3.3/Cl 87/Ca
9.1/ PPT 16.3/ APTT 31.3  Thermoregulation, antibiotic iv, PRC & TC
transfusion. Plan for Echocardiogrphy. Echo : Small Secundum ASD + Moderate
MR
14/01/2019 Fever, icteric, Gum bleeding. GCS 456. BP 100/60mmHg, HR 143 bpm, RR 34 tpm,
t 38.2oC . Lab: Hb 7.67/Hct 23.2/WBC 1580/Plt 4620/ANC 223/Na 124/K 5.2/Cl
83/Ca 7.7/AST 10/ ALT 25/ Alb 2.9  Thermoregulation, antibiotic iv, PRC & TC
transfusion. Adv Hepato Div : Cholestatis, Urdafalk, Fluimucil
17/01/2019 Fever, general seizure, epistaxis. GCS 113. Anisocoria Pupil. BP 100/seller, HR 160
bpm, RR 42 tpm, t 38.9oC, SpO2 98%. Lab: Hb 11.1/Hct 33.8/WBC 676/Plt
595/ANC 64. Adv Neuro Div : Plan for Head CT scan, Phenytoin Injection,
Diazepam Injection.
 Death Report AML + Small Secundum ASD+ Moderate MR+Cholestasis+Febrile
MF/3y/12Kg Neutrophenia+Epistaxis+Anemia+Trombositopenia+ Wasted + Respiratory
Failure
18/01/2019
06.00 Fever, dyspnea, epistaxis, subconjungtival bleeding. GCS 113. BP 100/seller, HR
167 bpm, RR 42 tpm, t 38.5oC, SpO2 87%. Lab: Hb 9.5/Hct 26/WBC 350/Plt
17000/ANC 60  O2 mask reservoir 10 lpm, Loading RL ~20 ml/kg
12.00 Fever, Seizure. GCS 112. BP 100/seller, HR 167 bpm, RR 18 tpm, t 37.8oC, SpO2
76%, BC excess 68.75 ml, UP ~11 ml/kg/h  O2 NIV Jackson Reese 10 lpm, Adv
Hematology Div : consult to ERIA, Family education.
15.00 Fever, inadequate spontaneous breathing. GCS 1x2. BP 100/seller, HR 140 bpm,
RR 20 tpm, t 37oC, SpO2 99%  plan for WB Transfusion.
21.00 BP 100/seller, HR 143 bpm, RR 40 tpm, t 39.3oC, SpO2 99%  Thermoregulation
19/01/2019
01.00 BP 100/seller, HR 122 bpm, RR 30 tpm, t 37.9oC, SpO2 97%  WB Transfusion,
Family education
02.00 BP 90/seller, HR 110 bpm, RR 24 tpm, t 37.8oC, SpO2 90%  Family education
03.00 BP 90/seller, HR 102 bpm, RR 20 tpm, t 37.9oC, SpO2 90%
05.00 BP 90/seller, HR 78 bpm, RR 14 tpm, t 36.6oC, SpO2 80%  Family education,
family refused Intubation, Adv ERIA div : PRC transfusion.
05.45 Gasping. BP unmeasurable, HR 45 bpm, RR 10 tpm, SpO2 50 %  active PPV,
Resuscitation
05.50 HR 30 bpm, RR 10 tpm, SpO2 undetectable  Resuscitation
06.20 HR 0, RR 0, pupil mydriated maximally  patient died