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Death Report

March 21th,2013
Team : dr.Dinda Aprilia, dr.Rahmilna, dr.Andry Kurniawan, dr.Rinni Andriani dr.Edo Yudistira, dr.Farah S Effendi, dr.Rangga Lunesia

Bainar, female, 81 y.o, HCU


Female patient, 81 years old was hospitalized

since March 8, 2013 with: WD : - Septic shock cb Bronchopneumonia - AKI rifle F cb pre renal cb dehydration - Moderate anemia normocitic normochrome cb chronic disease

Therapy
Rest/Soft Diet High Carbohydrate high Protein/O2

3l/ IVFD NaCl 0,9% flush up to 2l, followed by NaCl 0,9% 8 hours/kolf Ceftriaxon inj 1x2gr (iv) Ciprofloxacin 2x100mg 125mEq meylon correction in 125 ml NaCl 0.9% drop rapidly Ambroxol 2x1 Paracetamol 3x500mg pairs catheter for fluid balance

Lab
Hb : 7.8

Ht

: 24 Leucosit : 57 400 Trombosit : 189 000 Ureum : 115 Creatinin : 3.7 pH : 7.32 Beecf : -14.8 pO2 : 22 HCO3-: 11.3 pCO2 : 80 SO2 : 85

Consult
Consult to Tropical Infection Consultant :
Impression : Septic Shock caused by Bronchopneumonia Advice : Blood and Sputum Cultures

Consult to Hematology Consultant : Advice : - Leukocyte repeat check - Check peripheral blood picture

Patient was admitted to ward (Thursday, March 21

2013, 13.30WIB ) with: WD : - Septic shock caused by Bronchopneumonia - AKI rifle F caused by pre renal caused by dehydration - Moderate anemia normocitic normochrome cause by chronic disease S : Conscious (+), Fever (-), Breathlessness (-), Pale (+) O: GA: Weak Consciousness: CMC

Eyes : anemic +, icteric Thorax :Lung : bronchovesiculer, Wh -/-, Rales +/+ Cor : regular, murmur (-) , cardiomegali (-) Abdomen: Liver and spleen unpalpable Ext : oedem -/Lab: Hb : 5,7 g/dl , HT : 16,5% Leukocyte : 83.650/mm3, Trombocite : 88.000/mm3

DPJP Visite Impression : Susp. Acute Leucemia Advice : -Check peripheral blood picture -Consult Hematology consultant
Therapy: Rest/Soft Diet High Carbohydrate high Protein/O2 3l/ Dopamin drip 2ampul in 500cc NaCl 0,9% starting from 5 drops / min, titrating up to 20 drops / minute or if systolic> 100 (currently 10 drops / min) Ceftriaxon 1x2gr Ciprofloxacin 2x100mg Ambroxol 3x1 Paracetamol 3x500mg

23.00 WIB

S : Conscious (+), Fever (-), Breathlessness (-), Pale (+) O: GA: Weak Consciousness: CMC BP: 80/50 Pulse: 92, RR: 24, Temp: 36C Impression : worsening septic shock Attitude : raising the dose of dopamine
23.30 WIB

S : Conscious (+), Fever (-), Breathlessness (-), Pale (+) O: GA: Weak Consciousness: CMC BP: 80/p Pulse: 105, RR: 22, Temp: 36,8C Dopamin : 20 drops/min Impression : septic shock was not resolved Attitude : began giving Vascon

23.45 WIB

S : Unconscious, Breathlessness (+), Fever (-) O: GA: Bad Consciousness: Somnolen BP: 80/p Pulse: 102, RR: 27, Temp: 37C Impression : septic shock was not resolved Attitude : Vascon dose optimization
00.45 WIB

S : Unconscious, Breathlessness (+) O: GA: Bad Consciousness: Sopor BP: 60/p Pulse: fast and soft RR: 25, Temp: 37C Impression : septic shock was not resolved

00.50

patients apnoe: blood pressure was not measured, no palpable pulse, pupil midriasis maximum, EKG flat.
The patient was declared dead in front of family and paramedics with COD : septic shock caused by bronchopneumonia