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PPM 1 - 70M with gradually progressive shortness of breath since 2 months beginning with NYHA 2 admitted with NYHA 4.
PPM 1 - This was his initial chest X-ray which was suggestiive of emphysema consistent with his history of smoking for 20 years although he has stopped since 20 years.
PPM 1 -
PPM 1 - The next chest X-ray after admission showed alveolar opacities and the differentials hovered between cardiogenic vs non cardiogenic pulmonary edema and an HRCT at this juncture didn't resolve the diagnostic uncertainty.
PPM 1 - The subsequent chest X-ray revealed further progression of pulmonary edema and by the time there was a clue in the ECG.
PPM 1 - The anterior wall chest leads provided that clue and once again consolidated the epidemiological stronghold of left ventricular failure NCD over pneumonia CD in terms of commonality for routine management of cardiopulmonary emergencies.
PPM 1 - In retrospect even the ECG during admission was a harbinger of his CAD and we remember pointing it out on Monday but again had no way to predict how it would evolve @PPM3 @PPM4.
Age/Gender : 70 Years/Male
Discharge Type: Expired
Admission Date: 28/12/2024 09:02 AM Death Date:1/1/2025
Diagnosis
CAD[CORONARY ARTERY Disease] ACS-NSTEMI[ACUTE CORONARY SYNDROME] TYPE 1 RESPIRATORY FAILURE 2° TO - SEVERE ARDS[2° TO COMMUNITY ACQURED PNEUMONIA]
-? CARDIOGENIC PULMONARY EDEMA 2° TO CAD ACS NSTEMI ON MECHANICAL Ventilation DAY 0
SEPTIC SHOCK 2° TO CAP CORPLUMONALE 2° TO COPD DYSELECTROLYTEMA 2° TO DIURETICS K/C/O HTN SINCE 2YRS
Case History and Clinical Findings
C/O BREATHLESSNESS SINCE YESTERDAY NIGHT.
HOPI: PATIENT WAS Apparently ASYMPTOMATIC TILL 2 MONTHS AGO, THEN HE DEVELOPED SHORTNESS OF BREATH (GRADUAL ONSET, GRADE II-III MMRC, NOT ASSOCIATED WITH CHEST PAIN, PALPITATIONS, PEDAL EDEMA, FEVER, COUGH) INTERMITTENTLY AGGRAVATED WITH EXERTION, RELIEVED WITH REST AND Aggravated TO GRADE-IV SINCE YESTERDAY NIGHT.
NO C/O FEVER, CHEST PAIN, COUGH, COLD, PEDAL EDEMA, DECREASED URINE OUTPUT, VOMITINGS, LOOSE STOOLS.
PAST HISTORY:-
K/C/O HTN SINCE 2 YEARS (ON TAB AMLODIPINE 5MG PO/OD)
NOT A K/C/O DM, CAD, CVA, TB, ASTHMA, EPILEPSY, THYROID DISORDERS
PERSONAL HISTORY: WAS A SMOKER, 20 BIDIS/DAY, STOPPED 20 YEARS AGO
GENERAL EXAMINATION :
PATIENT IS C/C/C
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHEDENOPATHY, PEDAL EDEMA BP: 140/80 MMHG
PR: 104 BPM
RR: 23 CPM SPO2: 80% AT RA GRBS: 198 MG/DL
APPETITE- NORMAL BOWELS- REGULAR MICTURITION- NORMAL ADDICITIONS-NIL
SYSTEMIC EXAMINATION :
CVS: S1S2+, NO MURMURS, NO JVP RAISED
RS: BAE+, B/L BASAL CREPITUS + DIFFUSE WHEEZE +
P/A: SOFT, NON TENDER, NO ORGANOMEGALY
CNS:-
NFND GCS: E4V5M6 RIGHT LEFT
TONE UL N N LL N N
POWER UL 4/5 4/5 LL 4/5 4/5 REFLEXES B +2 +2
T +2 +2
S +2 +2
K +2 +2
A +1 +2 P F F
Investigation
IVE
RFT 28-12-2024 09:26:AMUREA 35 mg/dl 50-17 mg/dlCREATININE 1.2 mg/dl 1.3-0.8 mg/dlURIC
ACID 3.8 mmol/L 7.2-3.5 mmol/LCALCIUM 8.5 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 2.3 mg/dl 4.5-
2.5 mg/dlSODIUM 102 mmol/L 145-136 mmol/LPOTASSIUM 2.4 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
70 mmol/L 98-107 mmol/L
ABG 28-12-2024 09:26:AMPH 7.42PCO2 18.8PO2 101HCO3 12.1St.HCO3 16.3BEB -10.3BEecf -
11.6TCO2 24.2O2 Sat 97.8O2 Count 16.7
LIVER FUNCTION TEST (LFT) 28-12-2024 09:26:AMTotal Bilurubin 1.00 mg/dl 1-0 mg/dlDirect Bilurubin 0.19 mg/dl 0.2-0.0 mg/dlSGOT(AST) 39 IU/L 35-0 IU/LSGPT(ALT) 17 IU/L 45-0
IU/LALKALINE PHOSPHATASE 215 IU/L 119-56 IU/LTOTAL PROTEINS 4.9 gm/dl 8.3-6.4
gm/dlALBUMIN 2.5 gm/dl 4.6-3.2 gm/dlA/G RATIO 1.04
RBS 188 mg/dl. 100 - 160 GOD - POD
HBsAg-RAPID 28-12-2024 09:26:AM NegativeAnti HCV Antibodies - RAPID 28-12-2024 09:26:AM
Non ReactiveHIV 1/2 Rapid Test Non Reactive Immuno Chromatography
C-Reactive Protein Positive(2.4mg/dl) mg/dl 0-0.6 mg/dl Latex Agglutination
E S R 75 mm/ 1 st hour 3 - 15 Westergren
COMPLETE URINE EXAMINATION (CUE) 28-12-2024 09:26:AMCOLOUR Pale yellow APPEARANCE Clear REACTION Acidic SP.GRAVITY 1.010ALBUMIN +SUGAR Nil BILE SALTS Nil BILE PIGMENTS Nil PUS CELLS 3-6EPITHELIAL CELLS 2-4RED BLOOD CELLS Nil CRYSTALS Nil CASTS Nil AMORPHOUS DEPOSITS Absent OTHERS Nil SERUM ELECTROLYTES (Na, K, C l) 28-12-2024 04:12: PM SODIUM 118 mmol/L 145-136
mmol/LPOTASSIUM 2.8 mmol/L 5.1-3.5 mmol/LCHLORIDE 81 mmol/L 98-107 mmol/L
HEMOGRAM (28/12/2024):-
HAEMOGLOBIN 11.6 gm/dl 13.0 - 17.0 Colorimetric TOTAL COUNT 11,000 cells/cumm 4000 - 10000
Impedence NEUTROPHILS 88 % 40 - 80 Light Microscopy LYMPHOCYTES 07 % 20 - 40 Light
Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 04 % 02 - 10 Light
Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 29.0 vol % 40 - 50 Calculation M C V 72.7 fl
83 - 101 Calculation M C H 29.1 pg 27 - 32 Calculation M C H C 40.0 % 31.5 - 34.5 Calculation RDW-
CV 12.8 % 11.6 - 14.0 Histogram RDW-SD 33.1 fl 39.0-46.0 Histogram RBC COUNT 3.99
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 2.15 lakhs/cu.mm 1.5-4.1 Impedence SMEARRBC Normocytic normochromic with few microcytes Light Microscopy WBC With in normal limits Light Microscopy PLATELETS Adequate in number and distribution Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic blood picture
SERUM ELECTROLYTES (Na, K, C l) 28-12-2024 04:12:PMSODIUM 118 mmol/L 145-136
mmol/LPOTASSIUM 2.8 mmol/L 5.1-3.5 mmol/LCHLORIDE 81 mmol/L 98-107 mmol/L
RFT 28-12-2024 10:08:PMUREA 33 mg/dl 50-17 mg/dl CREATININE 1.2 mg/dl 1.3-0.8 mg/dlURIC
ACID 4.5 mmol/L 7.2-3.5 mmol/LCALCIUM 8.2 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 2.0 mg/dl 4.5-
2.5 mg/dl SODIUM 126 mmol/L 145-136 mmol/LPOTASSIUM 2.8 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
90 mmol/L 98-107 mmol/L
ABG 28-12-2024 10:08:PMPH 7.52PCO2 29.4PO2 43.8HCO3 24.1St.HCO3 25.9BEB 2.1BEecf
1.4TCO2 48.6O2 Sat 76.4O2 Count 11.6
Urinary Chloride 90 mmol/L
SPOT URINARY POTASSIUM 14.0 SPOT URINE SODIUM 168 mmol/L
SERUM ELECTROLYTES (Na, K, C l) 29-12-2024 06:53:PMSODIUM 132 mmol/L 145-136
mmol/LPOTASSIUM 4.3 mmol/L 5.1-3.5 mmol/LCHLORIDE 96 mmol/L 98-107 mmol/LABG 29-12- 2024 07:13:PMPH 7.48PCO2 27.6PO2 45.1HCO3 20.8St.HCO3 22.9BEB -1.3BEecf -2.1TCO2
42.3O2 Sat 77.7O2 Count 11.7
FBS 87 mg/dl 70 - 110 GOD - POD
HbA1c 6.0 %
RFT 29-12-2024 11:34:PMUREA 35 mg/dl 50-17 mg/dlCREATININE 1.2 mg/dl 1.3-0.8 mg/dlURIC
ACID 3.5 mmol/L 7.2-3.5 mmol/LCALCIUM 8.4 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 2.5 mg/dl 4.5-
2.5 mg/dl SODIUM 133 mmol/L 145-136 mmol/LPOTASSIUM 3.1 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
87 mmol/L 98-107 mmol/L
HEMOGRAM(29/12/2024):-
HAEMOGLOBIN 11.3 gm/dl 13.0 - 17.0 Colorimetric TOTAL COUNT 15,200 cells/cumm 4000 - 10000
Impedence NEUTROPHILS 90 % 40 - 80 Light Microscopy LYMPHOCYTES 05 % 20 - 40 Light
Microscopy EOSINOPHILS 00 % 01 - 06 Light Microscopy MONOCYTES 05 % 02 - 10 Light
Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 26.9 vol % 40 - 50 Calculation M C V 75.1 fl
83 - 101 Calculation M C H 28.2 pg 27 - 32 Calculation M C H C 38.2 % 31.5 - 34.5 Calculation RDW-
CV 13.1 % 11.6 - 14.0 Histogram RDW-SD 35.7 fl 39.0-46.0 Histogram RBC COUNT 3.94
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 2.12 lakhs/cu.mm 1.5-4.1 Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC Increased on smear Light Microscopy PLATELETS Adeqaute Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic blood picture with leucocytosis
ABG 29-12-2024 11:34:PMPH 7.51PCO2 25.6PO2 41.3HCO3 20.7St.HCO3 23.5BEB -0.5BEecf -
1.9TCO2 40.3O2 Sat 72.6O2 Count 13.8
ABG 30-12-2024 08:53:PMPH 7.50PCO2 26.0PO2 46.1HCO3 20.3St.HCO3 22.9BEB -1.5BEecf -
2.5TCO2 40.9O2 Sat 81.2O2 Count 12.5
HEMOGRAM(30/12/2024):-
HAEMOGLOBIN 11.1 gm/dl 13.0 - 17.0 ColorimetricTOTAL COUNT 15,400 cells/cumm 4000 - 10000
Impedence NEUTROPHILS 91 % 40 - 80 Light Microscopy LYMPHOCYTES 04 % 20 - 40 Light
Microscopy EOSINOPHILS 01 % 01 - 06 Light MicroscopyMONOCYTES 05 % 02 - 10 Light
Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 31.0 vol % 40 - 50 Calculation M C V 78.5 fl
83 - 101 Calculation M C H 28.0 pg 27 - 32 Calculation M C H C 35.7 % 31.5 - 34.5 Calculation RDW-
CV 15.5 % 11.6 - 14.0 Histogram RDW-SD 48.3 fl 39.0-46.0 Histogram RBC COUNT 3.95
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.87 lakhs/cu.mm 1.5-4.1 Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC increased counts on smear with increased neutrophils Light Microscopy PLATELETS Adeqaute Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic with neutrophilic leukocytosis
RFT 30-12-2024 11:37:PMUREA 41 mg/dl 50-17 mg/dl creatinine 1.2 mg/dl 1.3-0.8 mg/dl URIC
ACID 2.5 mmol/L 7.2-3.5 mmol/L CALCIUM 8.7 mg/dl 10.2-8.6 mg/dl PHOSPHOROUS 2.0 mg/dl 4.5-
2.5 mg/dl SODIUM 136 mmol/L 145-136 mmol/LPOTASSIUM 2.9 mmol/L. 5.1-3.5 mmol/L.CHLORIDE
94 mmol/L 98-107 mmol/L
Blood Lactate 15.0 mg/dl venous : 4.5 - 19.8 arterial : 4.5 - 14.4 Colorimetric
HEMOGRAM (31/12/2024):-
HAEMOGLOBIN 11.8 gm/dl 13.0 - 17.0 Colorimetric TOTAL COUNT 13,600 cells/cumm 4000 - 10000
Impedence NEUTROPHILS 85 % 40 - 80 Light Microscopy LYMPHOCYTES 09 % 20 - 40 Light
Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 05 % 02 - 10 Light
Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 34.1 vol % 40 - 50 Calculation M C V 80.8 fl
83 - 101 Calculation M C H 27.9 pg 27 - 32 Calculation M C H C 34.6 % 31.5 - 34.5 Calculation RDW-
CV 15.4 % 11.6 - 14.0 Histogram RDW-SD 48.7 fl 39.0-46.0 Histogram RBC COUNT 4.23
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.86 lakhs/cu.mm 1.5-4.1 Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC increased counts on smear with neutrophils Light Microscopy PLATELETS Adeqaute Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy IMPRESSION Normocytic normochromic with neutrophilic leukocytosis
ABG 30-12-2024 11:37:PMPH 7.53PCO2 26.3PO2 32.0HCO3 22.2St.HCO3 24.3BEB 0.8BEecf - 0.2TCO2 44.6O2 Sat 53.7O2 Count 8.7
ABG 31-12-2024 10:44:PMPH 7.43PCO2 30.4PO2 49.0HCO3 1909St.HCO3 21.6BEB -2.9BEecf -
3.7TCO2 39.7O2 Sat 79.2O2 Count 14.3
ABG 1-1-2025 12:25:PMPH 7.47PCO2 32.2PO2 5702HCO3 23.6St.HCO3 25.1BEB 1.0BEecf 0.4TCO2 47.2O2 Sat 89.9O2 Count 14.9
HEMOGRAM (1/1/2025):-5.37AM
HAEMOGLOBIN 12.0 gm/dl 13.0 - 17.0 Colorimetric TOTAL COUNT 11800cells/cumm 4000 - 10000
Impedence neutrophils 89 % 40 - 80 Light Microscopy LYMPHOCYTES 07% 20 - 40 Light
Microscopy EOSINOPHILS 01 % 01 - 06 Light Microscopy MONOCYTES 03 % 02 - 10 Light
Microscopy BASOPHILS 00 % 0 - 2 Light Microscopy PCV 38.5 vol % 40 - 50 Calculation M C V 82.2 fl
83 - 101 Calculation M C H 27.6 pg 27 - 32 Calculation M C H C 33.6 % 31.5 - 34.5 Calculation RDW-
CV 15.6 % 11.6 - 14.0 Histogram RDW-SD 15.6 fl 39.0-46.0 Histogram RBC COUNT 4.69
millions/cumm 4.5 - 5.5 Impedence PLATELET COUNT 1.70 lakhs/cu.mm 1.5-4.1 Impedence SMEAR RBC Normocytic normochromic Light Microscopy WBC increased counts on smear with neutrophils Light Microscopy PLATELETS Adeqaute Light Microscopy HEMOPARASITES No hemoparasites seen Light Microscopy
IMPRESSION Normocytic normochromic with neutrophilic leukocytosis
H.S TROPONIN-1 72.5 1/1/25 06:25 PMPM
H.S TROPONIN-1 176.1 1/1/25 10:30PM
SERUM ELECTROLYTES (Na, K, C l) 1-1-2025 10.29PM
SODIUM 135 mmol/L 145-136
mmol/L
POTASSIUM 6.7 mmol/L 5.1-3.5 mmol/L
CHLORIDE 99 mmol/L 98-107 mmol/L
BLOOD LACTATE 12.6 MG/DL 1/1/25 06.26PM
RFT 1-1-2025 06.10AMUREA 58 mg/dl 50-17 mg/dl
CREATININE 1.2 mg/dl 1.3-0.8 mg/dl
URIC ACID
3.4 mmol/L 7.2-3.5 mmol/L
CALCIUM 9.2 mg/dl 10.2-8.6 mg/dl
PHOSPHOROUS 3.10 mg/dl 4.5-2.5
mg/dl
SODIUM 135 mmol/L 145-136 mmol/L
POTASSIUM 3.8 mmol/L. 5.1-3.5 mmol/L.CHLORIDE 98
mmol/L 98-107 mmol/L
Treatment Given(Enter only Generic Name) INTERMITTENT CPAP AND O2 SUPPLEMENTATION IVF-NS @50ML/HR
INJ MEROPENEM 1GM IV/TID INJ LINEZOLID 600MG IV/BD
INJ DOBUTAMINE [250MG IN 50ML] @ 1.6 ML/HR INCREASE/DECREASE TO MAINTAIN MAP>65 MMHG
INJ.NORAD [8MG IN 50ML]@5ML/HR TO INCREASE/DECREASE TO MAINTAIN MAP>65 MMHG INJ PAN 40 MG IV/OD
INJ HYDROCORT 100MG IV/BD
INJ.MIDAZOLAM 30MG + FENTANYL 2AMP IN 16ML NS @4ML/HR NEB WITH DUOLIN 6TH HOURLY, BUDECORT 8TH HOURLY
INJ LASIX 100MG IN 40ML NS@3ML/HR (6MG/HR]
INJ.OPTINEURON 1AMP IN 100ML NS IV/OD INJ.HEPARIN 5000 IU IV/STAT
SYP GRILLIACTUS 10ML PO/TID
SYP POTKLOR 15ML IN GLASS OF WATER RT/TID
RT FEEDS 100ML MILK 4TH HRLY WITH 2 SCOOPS OF PROTINE POWDER 50ML WATER 2ND HRLY
T. PCM 650 MG PO/SOS TAB.FLUVIR 75MG PO/BD T.CLOPITAB A 75MG RT/OD T.ATORVASTATIN 40MG RT/HS T.METXL 12.5MG RT/OD STRICT I/O CHARTING
2ND HRLY POSITION CHANGE MONITOR VITALS AND INFORM SOS
Follow Up
DEATH SUMMARY
A 70 YEAR OLD MALE WHO WAS ADMITTED ON 28/12/24 I/V/O SOB SINCE 2 MONTHS PRESENTED TO CASUALTY WITH VITALS BP 140/80 MMHG,PR 104 BPM,RR 28CPM,SPO2 80% ON RA,ASCULTATION REVEAL B/L BASAL COURSE CREPTS ,ABG SHOWED METABOLIC ACIDOSIS[PH 7.338,HCO3 6.1,PCO2 111.6,PO2 55.5,SO2 82.8],Bicarbonate CORRECTION WITH 200MEQ NAHCO3 WAS DONE,SERUM Electrolytes REVELED NA+: 102,K+:2.4,CL 70,3% NS AND KCL INFUSION WERE STARTED 2D ECHO REVEALED DILATED RA,RV WITH EF
60%,GOOD LV SYSTOLIC FUNCTION,PT WAS PROVISIONALLY DIAGNOSED AS CARDIOGENIC PULMONARY EDEMA,COR PULMONALE,DYS ELETROLYTEMIA 2° TO DIURITICS I/V/O PERSISTENT HYPOXIA ON RA.HRCT CHEST WAS DONE WHICH SHOWED ALVEOLAR OPACITIES IN RT LUNG UPPER LOBE,LT LUNG UPPER LOBE AND APICAL SEGMENT OF LT LUNG LOWER LOBE WITH MILD B/L PLEURAL EFFUSION S/O INFECTIVE ETIOLOGY.TLC INCREASED FROM 11,000 TO 15,200 ANTIBIOTICS WERE ESCALATED PATIENT HAD FEVER SPIKES AND HAD ONLY MILD NON PRODUCTIVE COUGH AND SOB,HENCE PT WAS DIAGNOSED AS ATYPICAL PNEUMONIA PAO2 /FIO2 ON 30/12/24 8AM WAS 156 S/O MODERATE ARDS AS PER MODIFIED BERLINS CRITIRIA I/V/O HYPOTENSION.INJ NORAD WAS STARTED,PT HAS SHOWED NO SIGNS OF IMPROVEMENT ANS CXR REVELED INCREASED oPACITIES,HENCE ANTIBIOTICS WERE FURTHER ESCALATED TO MEROPENeM AND LINEZOLID BLOOD AND URINE CULTURES SHOWED NO GROWTH.
SERIAL CHEST X RAYS REVELED RAPIDLY CHANGING OPACITIES IN B/L LUNG S/O ? NON CARDIOGENIC PUL.EDEMA[SEVERE ARDS ACCORDING TO Modified BERLIN'S Criteria PAO2/FIO2 93.6]
PT MAP HAS IMPROVED,NORAD WAS TAPERED ,BUT I/V/O TYPE 1 RESPIRATORY FAILURE AND Respiratory DISTRESS,ELECTIVE INTUBATION WAS PLANNED ON 31/12/24,BUT PATIENT'S ATTENDER DENIED FOR INTUBATION AND MECHANICAL VENTILATION ON 1/1/25 CXR REVEALED FURTHER WORSENING OF PULMONARY EDEMA AND I/V/O TYPE 1 Respiratory FAILURE ,RESIRATORY DISTRESS DESPITE INTERMITTENT CPAP PT WAS INTUBATED ON 1/1/25 AT 6:30PM.I/V/O ECG AND 2D ECO CHANGES WHICH WERE S/O CAD ACS NSTEMI CARDIOLOGY OPINION WAS TAKEN AND PT WAS STARTED ON HEPARIN,ANTIPLATELETS,STATINS AND B BLOCKERS.PT AGAIN DEVELOPED HYPOTENSION,INOTROPES NORAD ABD DOBUTAMIN WERE STARTED.
AT AROUND 9:40 PM PT DEVELOPED SUDDEN BRADYCARDIA,CENTRAL AND PERIPHERAL PULSES WERE ABSENT,CRP WAS INITATED ACCORDING TO LATEST AHA GUIDELINES,PT Achieved ROSC AFTER 4 CYCLES OF CPR SERIAL TROP 1 WERE ELEVATED[72 TO 176] ECGS WERE S/O NSTEM1.TRIPLE LUMEN CATHETER WAS INSERTED 11:00PM PATIENT AGAIN DEVELOPED SUDDEN BRADYCARDEA,CENTRAL AND PERIPHERAL PULSES WERE Absent,CPR WAS INITIATED ACCORDING TO LATEST AHA GUIDELINES AND CONTINUED FOR 30 MINS.
DESPITE ALL THE ABOVE RESUSCITATORY EFFORTS,PT COULD NOT BE REVIVED AND DECLARED DEATH ON 1/1/25 AT 11:38PM.
IMMEDIATE CAUSE OF DEATH-CAD[CORONARY ARTERY DISESAE] ACS-NSTEM1[ACUTE CORONARY SYNDROME]
ANTECEDENT CAUSE OF DEATH
1. TYPE 1 RESPIRATORY FAILURE 2° TO - SEVERE ARDS[2° TO COMMUNITY ACQURED PNEUMONIA]
- CARDIOGENIC PULMONARY EDEMA 2° TO CAD ACS NSTEMI ON MECHANICAL VENTILATIOM DAY 0
2. SEPTIC SHOCK 2° TO CAP
3. CORPLUMONALE 2° TO COPD
4. DYSELECTROLYTEMA 2° TO DIURETICS
5. K/C/O HTN SINCE 2YRS
Death Date Date:1/1/25 Ward:ICU Unit:6
Faculty Signature
SIGNATURE OF PATIENT /ATTENDER :
SIGNATURE OF PG/INTERNEE:
SIGNATURE OF ADMINISTRATOR :
SIGNATURE OF FACULTY:
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