ANDAL, ANDALES, ANG. Bioethics Case. HISTORY. GENERAL DATA MA, 43/F, married, Roman Catholic, R-handed from Quezon City CHIEF COMPLAINT Dyspnea. CLINICAL HISTORY. PATIENT PROFILE
MA, 43/F, married, Roman Catholic, R-handed from Quezon City
A diagnosed case of Breast CA, Stage 3B (Apr 2008); undergone 4 cycles of chemotherapy (latest session Mar 2009 PGH-CI)
Nondiabetic and non-asthmatic
4 months PTA, pt’s chemotherapy session was deferred due to decreased CBC results and occurrence of left pleural effusion. Pt was lost to follow-up and noted to be experiencing dyspnea, necessitating nebulization with salbutamol at least 4x/day.
3 weeks PTA – pt had onset of cough with whitish phlegm, (+) easy fatigability, fever (relieved by paracetamol 500 mg/tab prn), 2-pillow orthopnea
2 weeks PTA, (+) worsening of dyspnea, New Era Hospital, admitted, Dx: Malignant Pleural effusion; chest tube thoracotomy done (L); Meds: tramadol, co-amoxiclav, other unrecalled meds
3 days PTA, discharged; referred to PGH for 2D echo and continuation of radiation therapy; still with mild dyspnea
Day of admission: worsening of symptoms, (+) generalized weakness, consulted at PGH, admitted
2nd HD 7/20/09 DAY MHAPOD: Pertinent PE: Pale conjunctivae, + chest lag, L,decrease breath sounds and fremiti, L, (-) crackles/wheeze. (+) breast mass, L with purulent discharge.
Breast Carcinoma Stage IV with Liver Metastasis (t/c Lung Metastasis)
with Secondary Bacterial Infection
Malignant Effusion, R
s/p CTT with pleurodesis (July 2009)
8th HD 726/09 Still hooked to Dopamine 2 ampules in 250 cc D5W at 48 cc/hr (20 mcg/kg/min) at max dose; BP was stable at 110-90/70-60, HR 140s, RR48;
9th HD 7/27/09 9 AM Patient referred for BP 60/40, HR 68, RR 36; Soon after, second code was called; ACLS was started.
At 9 mins post arrest, pt’ s husband decided to stop further resuscitation attempt.
Patient maintained on 02 support via facemask on continuous ambubagging; no CPR was pursued until cardiac monitor read as asystole. Patient was then declared dead.