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Mortality Review

Mortality Review. Dr Ambika Prasad Dash Consultant – Laparoscopic and General Surgeon Apollo Hospitals, Bhubaneswar. Laxman Pradhan. 48 years, Male, from Janla , Khurda Sustained Blunt Trauma Abdomen due to RTA when car collided with a parked truck from back on 16 th 03 2013 at 2 AM.

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Mortality Review

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  1. Mortality Review Dr Ambika Prasad Dash Consultant – Laparoscopic and General Surgeon Apollo Hospitals, Bhubaneswar

  2. LaxmanPradhan • 48 years, Male, from Janla, Khurda • Sustained Blunt Trauma Abdomen due to RTA when car collided with a parked truck from back on 16th 03 2013 at 2 AM. • He Reported to our Hospital – Emergency at around 12 PM – Admitted to MICU at 1:00 PM • At arrival: • Patient was restless with profuse sweating, heart rate:134/m, RR: 44/m • Abdominal Distension - + • Mild to moderate diffuse abdominal pain • CBG > 500mg/dl • Sustained a bout of hypotension, responded to fluid resuscitation • History of DM - since long

  3. Lab Investigations and Imaging • FAST • Minimal Pleural Collection • Peritoneal Collection • CECT • Pneumoperitonium • Peritoneal Collection • Lab Parameters: • TLC – 2.1 x 103 µL • pH – 7.24 • Lactate – 6.2 mmol/l • Glucose – 571 mg/dl • SGOT – 124 U/dl • SGPT – 130 U/dl • Sr Amylase – 601 U/l

  4. Emergency Exploratory Laparotomy • Findings • 2-3 liters of peritonial collection with food particles • Ileal disruption at about 1 ft from I-C junction • Mesenteric tear with focal hemorrhagic collections

  5. Post Operative Period • Extubation not possible • Patient sent to ICU with ET tube • Patient required pressure support to maintain BP • Glycemia control achieved by insulin infusion

  6. POD - 1 • Patient quite irritable • Heart rate – 144 /m, BP: 124/66 mm Hg with vasopressors • TLC count: 2000/µl • At around 9PM patient had bradycardia and reccurrent VT(Heart Rate 260/m, Pulseless) • CPR done, VT controlled, BP Low • Gasping.

  7. 1 AM: Patient had AF Cardioversion done with 300 J • Planned for urgent dialysis for presistentLactacidosis and dialysis done at 1:40 AM • Patient got VT again at 9:30 AM (18-03-13), DC Cardioversion (200 J) given. • Gasping, BP:80/60 with high dose pressor agents, Temp: 1070F • Poor prognosis explained to patient attendants. • 1:40 PM: Patient had cardiac arrest, CPR done • Declared dead at 2 PM.

  8. Conclusion • Patient died of Cardiac Arrest due to repeated VT • Attributable causes may be: • Late presentation to Hospital • Uncontrolled diabetes for which patient was taking irregular treatment. • Severe Sepsis and Lactacidosis which could not be reverted back with adequate interventions.

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