A 60 year old male came to casualty in unresponsive state


This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box"

Case History and Clinical Findings
C/O VOMITINGS 6-7 EPISODES ,EPIGASTRIC PAIN SINCE 1 DAY
H/O FEVER SINE 1DAY ,SOB SINCE 1 DAY
ALCOHOL BINGE SINCE 3 DAYS
UNRESPONSIVE SINCE 10 MINUTES
35 YEARS AGO-PATIENT UNDERWENT NEPHRECTOMY ? NO RECORDS
30 YEARS AGO- DIAGNOSED WITH DM,HN IS ON INJ HAI SINCE 30 YEARS,HTN-UNKNOWN
MEDICATION
1 MONTH AGO-H/O GRADE 4 SOB-CAG DONE ->MILD CAD,ECHO DONE-GLOBAL
HYPOKINESIA ,EF:46% AND STARTED ON ANTIPLATELETS
C/O VOMITINGS 6-7 EPISODES ,NON BILIOUS,ASSOCIATED WITH EPIGASTRIC PAIN ,FEVER
WHICH IS LOW GRADE SINCE 1 DAY ASSOCIATED WITH GRADE 2 SOB
 
PAST HISTORY-K/C/O DM/HTN SINCE 30 YEARS,POST NEPHRECTOMY SINCE 35 YEARS
NO SIGNIFICANT FAMILY HISTORY
GENERAL EXAMINATION :
NO PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMPHADENOPATHY, OEDEMA
TEMP - 98.6 F
PR - 30 BPM
SPO2 - 20 AT RA
GRBS - 400 MG/DL
CVS - S1 S2 HEARD AFTER 5 MINS NO HEART SOUNDS
RS - BAE PREAENT , AIR ENTRY DECREASED B/L
P/A - DISTENDED , FREE FLUID PRESENT
CNS - POWER NOT ELICITABLE
COURSE IN HOSPITAL :
PT HAD CARDIAC ARREST AT 1:55 PM , 6 CYCLES OF CPR DONE , AT 2:25 RETURN OF
SPONTANEOUS CIRCULATION ATTAINED

TREATMENT GIVEN :
1 INJ NAHCO3 100 MEQ IV STAT IN 100 ML NS
2 INJ NORADRENALINE 2 AMP + 48ML NS @ 10ML /HR3
3 INJ DOBUTAMINE 1 AMP + 48ML NS @ 3.6 ML /HR
4 200 ML NS IV BOLUS
5 FOLEYS CATHETERISATION
6 RYLES TUB INSERTION
7 INJ HUMAN ACTRAPID 6U IV STAT , CHECK GRBS AFTER 30 MINS

DEATH SUMMARY
60 YR OLD MALE WITH WITH PAST H/O DM, HTN , POST NEPHRECTOMY SINCE 30 - 40 YEARS AND HFPEF SINCE 1 MONTH WAS BROUGHT TO CASUALTY  IN GASPING
AND UNRESPONSIVESTATE WITH BP - NON RECORDABLE , NO PHERPHERAL PULSES AND
FEEBLE CENTRAL PUlSE
H/O VOMITING EPIGASTRIC PAIN SINCE 1 DAYU , FEVER SINCE 1 DAY , SOB SINCE 1 DAY ,
CHRONIC ALCOHOLIC SINCE 40 YEARS , H/O ALCOHOL BINGE SINCE 3 DAYS , OUTSIDE
USG ABDOMEN - ACUTE PANCREATITIS , ADMITTED OUTSIDE HOSPITAL WAS GIVEN
CONSERVATIVE MANAGEMENT AND OXYGEN I/V/O HYPOXIA , -PT WENT LAMA FROM
OUTSIDE HOSPITAL AND ON THEIR WAY TO HYD THEY NOTICED FALL IN SPO2 , PR AND
WAS BROUGHT TO OUR HOSPITAL

AT PRESENTATION GRBS 400MG/DL , BP - NR , PR 30 BPM , F/B SUDDEN CARDIAC ARREST ,
6 CYCLES OF CPR DONE , ROSC ATTAINED , INTUBATED
ABG SHOWED -
PH - 6.7 , PCO2 68.7 , PO2 138 , , ST HCO3 6 , HCO3 9.1
AFTER 10 MINS PT AGAIN HAD BRADYCARDIA F/B BP - NR , PR - NR , CARDIC ARREST , CPR
WAS INITIATED IMEDIATELY 4 CYCLES CPR DONE , INSPITE OF ALL ABOVE EFFORTS PR
WOULD NOT BE REVIVED AND DECLARED DEAD AT ECG SHOWED FLAT LINE AT 2:52 PM ON 10/5/22

IMMEDIATE CAUSE OF DEATH : SUDDEN CARDIOPULMONARY ARRET SECONDARY TO
REFRACTORY METBOLIC ACIDOSIS , REFRACTORY HYPOTENSION,

ANTECEDENT CAUSE OF DEATH : ACUTE PANCREATITIS WITH ?DKA , HFMEF WITH GLOBAL
HYPOKINESIA EF - 45% , COMORBIDITIES - DM , HTN,POST NEPHRECTOMY , HFPEF 

Ecg at presentation

2d echo
Post cpr ECG
Declared death at 2:52 pm on 10/5/22

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