death discussion
DESCRIPTION
Death Case discussion of Medical Unit XI at Dhaka Shishu HospitalTRANSCRIPT
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Death Discussion
Dr. Nahid Farzana
Medical Officer
MU- XI
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Duration
From 02/10/2009 to 08/10/2009
Total No. of Admitted Pt. 27
No. of Current Death Nil
Carried Over Death 01
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Disease pattern
Diseases No. of PatientsBronchiolitis 05Pneumonia 01Perinatal Asphyxia 05Preterm Low Birth Weight 01Neonatal Sepsis 02Meningitis 02Acute Gastroenteritis 03AGN 01Nephrotic Syndrome 02Epilepsy 01
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CP with Pneumonia 01Down’s syndrome with pneumonia 01Viral Hepatitis 01Acute Abdomen 01
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Distribution
< 1 month
>1 mo. to <1 yr
> 1 yr
Male
Female
Age Distribution Sex Distribution
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Case Summary
Farzana , a 5 yrs old girl hailing from Joydevpur admitted on 31st March 2010 at 2.00 pm with the complains of irregular fever and multiple swelling in neck and behind the ear for last 2 yrs and multiple abdominal mass for 1 month. She had history of treatment with anti-TB drugs and course was completed 6 months ago.
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Case Summary contd.
Anti-TB drugs were restarted 1 month back as per advice by a qualified physician.
On examination the girl was ill looking , severely pale, edematous, regarding vitals pulse -110/min. RR.- 40/min. temp 1020. There was bilateral basal crepitation. There was generalized lymphadenopathy involving cervical , axillary, inguinal regions, largest one measuring 5x5 cm , non tender, discrete, rubbery in consistency, free from overlying skin.
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Regarding alimentary system examination, there were multiple nodular mass involving left hypochondriac, umbilical and left lumbar region, non-tender .Liver was enlarged 4 cm from Rt. Costal margin in the rt. Mid clavicular line, mildly tender, soft in consistency.
She was accompanied with a FNAC from lymph node which showed granulomatous lesion consistent with tuberculosis .
Case Summary contd.
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Provisional Diagnosis
Lymphoma
Differential Diagnosis
Disseminated TB
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Investigations sent
Blood group CBC with film Liver function test S. urea and Creatinine Chest X rayPlan
• USG of Whole abdomen
• Open biopsy of lymphnode
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Treatment on Admission NPO Propped up position O2 inhalation Inf. 10% Baby Saline Inj. Ceftriaxone Syp. Paracetamol Arrange for blood transfusion
Consultation with Dept. of Hematology and oncology done and they suggested for lymphnode biopsy.
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Follow upon 31/03/2010 at 10 pm
Pt. developed orthopnoea
O/E
HR- 160/min with Gallop rythm
Rx
• Continue previous treatment
• Inj. Lasix
• Packed cell transfusion
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Follow upon 01/04/2010 at 9.00 am
O/EModerately paleHR -120/minRR—30/min
Heart-s1 s2 audibleLungs- Bilateral basal
crepitationAdv.:
MT
Rx
Continuation of previous treatment
Packed cell transfusion
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Investigations CBC with Film
• Hb 6.5gm/dl
• TLC 15,300/cummDLC
• Neutrophil 83%
• Lymphocytes 10%
• Monocytes 01%
• Eosinophil 01%
• Band form 05%
• Platelet 2,43,000/cumm
• Film
• Hypochromia, anisocytosis, increased neutrophil with toxic granules
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Investigation
Blood Group “O” positive B. urea 5.8 mmol/L S. Creatinine 37.3 umol/L S. Electrolytes
• Na+ 133.3 mmol/L
• K+ 3.7 mmol/L
• Cl_ 85.7 mmol/L
SGPT 103 U/L S. Alk.Phos. 660 U/L
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Follow up on01/04/2010 at 4.00 pm
O/E
Dypnoeic
HR 130/min
RR 50/min
Temp. Normal
Rx
Previous treatment continued
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Follow up on02/04/2010 at 4.00 am
O/E
Gasping respiration developed
HR - 42/min
L-Air entry- poor
Temp –
Rx
Previous treatment continued
CPR started Inj. Adrenaline
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Follow up on02/04/2010 at 5.30 am
O/E
Gasping continued
Pupil fixed and dilated
HR- unrecordable
Plan
ABG
Rx
CPR continued
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Follow up on02/04/2010 at 6.00 am
O/E No sign of self respiration No cardiac motion Pupil widely dilated, fixed, non reacting to light No response to painful stimuli.
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So the patient declared dead at 6.00am due to irreversible cardio-respiratory failure as a consequence of Lymphoma with metastasis with Heart failure.
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