70 yr old female with aspiration pneumonia (rt lung consolidation) , acute cva 20 days ago
70 year female brought to casualty in a •unresponsive state which is since one day •no verbal response since 1 day
•fever since one day
5 years ago diagnosed with hypertension using Tab.Amlong 5mg OD
20 days ago complaints of giddiness followed by fall in bathroom injury to right
lower limb assc with displaced IT fracture
Admitted outside hospital diagnosed with moderate size acute non hemorrhagic infract in left caudate,lentiform nucleus ,chronic infarct left cerebellar hemisphere
Age related atrophy with small v/s ischemic changes -FAZEKAS GRADE 3
INTUBATION NOTES
Patient was electively intubated and connected to MV /v/o severe hypoxia and severe respiratory
distress with ET 7mm after adequate pre oxygenation and sedation ( inj.midaz 2 cc iv stat)
paralyzed (in.scoline 2cc iv stat) Connected to MVPEEP : 6CM H2OFI02: 100% TV : 3601:E: 1:2RR
16CPMPOST INTUBATION : PR: 120BPM BP 120/90 MMHGSPO2 : 96% WITH 100% FI02position
of ET TUBE confirmed with 5 point Auscultation and chest x ray
DEATH SUMMARY:
70-year-old female brought to casualty in unresponsive state no verbal response since one day
history of acute CVA 20 days ago ,right IT fracture patient was on oral liquid fluids for 15 days
(Alleged h/o giddiness and fall 20 days back followed by Fracture At presentation GCS E1V1M1
SPO2 -56% BP-1 30/80 MM HG ,pulse rate 98 GRBS 212 mg/dL RR-36 O/E -bilateral crepts present
injection Lasix 40 MG and nebuisation given and ABG showed PH -7.5 PCO2 -37.3 PO 2 39.8
MMHG HCO 3- 29.2 mmol patient was elective intubated in view of hypoxia and severe respiratory
distress and connected to mechanical ventilation ACMV Mode. patient was started on empirical
antibiotics,nebulization and other supportive measures .patient had sudden cardiac arrest at 12:30
PM six cycles of CPR was done in spite of all above measures patient couldn't be revived and
declared dead at 12:55 PM and ecg showed flat line on 11/5/22 at 12:55 PM immediate cause of
death-Type 1 respiratory failure secondary to aspiration pneumonia antecedent cause of death -acute
in farct at left causate and lentiform nucleus 20 days ago ,chronic in fact @left cerebellar
hemisphere, right lower limb IT fracture
On USG ABDOMEN AND PELVIS - NORMAL STUDY
CAROTID AND VERTEBRAL DOPPLER STUDY — RIGHT CAROTID PARTIALLY CAROTID SMALL PLAQUE (7.5X2 MM)AT BIFURCATION CAUSING NO STENOSIS
IMPRESSION —BILATERAL MILD ATHEROSCLEROTIC CHANGES .NO E/O THROMBOSIS.
NO E/O SIGNIFICANT STENOSIS.
PATIENT CAME TO CASUALTY IN UNRESPONSIVE STAGE WITH NO VERBAL RESPONSE ASSOCIATED WITH FEVER SINCE 1 DAY
NOT A K/C/O HTN , DM, ASTHMA
GENERAL EXAMINATION:
No Pallor , no icterus , cyanosis, clubbing , lymphadenopathy , edema present (non pitting b/l lower limbs)
Temp : 100.5 f
Pr :98 bpm
Bp:130/80 mmhg
Spo2: 56 @ra
Rbs : 212 mg/dl
SYSTEMIC EXAMINATION :
RS : Bilateral air entry present , BILATERAL CREPTS PRESENT
P/A : soft , non tender , bowel sounds present
CVS : S1 S2 present , no murmurs
CNS : E1V1M1
TREATMENT :
1 INJ AUGMENTIN 1.2 GM IV BD DAY 1
2 TAB AZITHROMYCIN 500 MG PO OD DAY 1
3 INJ MIDAZ @ 4 MG/HR 50 ML MIDAZ WITH MICRODIP AT 4 DROPS/MIN
4 INJ ATRACURIUM 4 MEQ / MIN (250 MG + 50 ML NS)
5 IVF NS RL @ 100 ML / HR
6 RT FEEDS 200 ML MILK + 100 ML NS 4 TH HY
7 INJ PAN 40 MG IV OD
8 INJ ZOFER 4 MG IV BD
9 INJ OPTINEURON 1 AMP + 100 ML NS IV OD
10 TAB ECOSPRIN AV 75 /20 PO H/S
11 TEMP CHARTING 4 TH HRLY
12 TAB DOLO 650 MG TID
13 INJ NEOMOL 1 GM IV TDS IF > 101 F
14 INJ LASIX 40 MG IV BD (IF SBP>100MMHG
