Weekly Mortality Audit

General Medical Ward-І

 Patient Biodata
• Name: Usman Age: 3.7years Sex: Male Weight: 8 Kg
• MR #: 85875465
• Address: KOT M HUSSAIN VEHARI
• Date & Time of Admission in EW: 14/12/18 at 04:50PM
• Date & Time of Receiving in M1: 14/12/18 at 01:50AM
• Date & time of death: 24/12/18 at 05:00AM
• Duration of stay in ED : 8 hours
• Duration of stay in M1 : 9 days 4 hours
• Total Duration of stay in Hospital: 9 days 12 hours
 MEDICAL EMERGENCY
EXAMINATION
HISTORY • Sick pale child with severe
pallor with
•FEVER1 MONTH •No lymphadenopathy and
•COUGH 1 MONTH visceromegaly
•PROGRESSIVE PALLOR 2 •HR 110 / min
WEEKS
•RR 36 / min
•RESP DISTRESS 2 DAYS
•Afebrile
Past history is •Chest B/L crepts
insignificant •Abd: soft nontender with no
visceromegaly
•Vaccinated, •S1+S2+0
Developmentally normal •CNS: intact
DIAGNOSIS
with insignificant birth MANAGEMENT
• BRONCHOPNEUMONIA WITH
history
PLASTIC ANEMIA
•IV fluids ,FFPS,PCVs,Platlets
transfused
•IV antibioitics started
 MEDICAL WARD 1

HISTORY &
EXAMINATION

WERE same AS IN EMERGENCY DIAGNOSIS

BRONCHOPNEUMON
IA WITH EPSIS
MANAGEMENT IN
WARD

•Monitoring of vitals
•Repeated
Platlets,FFPs and pack
cells transfusion done
•IV Fluids
•Inj Tanzo, Cipro,
•Inj Nulcer
•H/Onco evaluation
done who advised bone
marrow biopsy
 COURSE OF EVENTS IN
WARD

• Patient received sick with oxygen

through facemask. Antibiotics were
continued, labs done in ward showed
pancytopenia with all three cell lines
were depressed.PCV, platelets and FFPs
were transfused and workup for aplastic
anemia and malignancy were planned
• CXR showed RT sided lobar
consolidation and CBC with peripheral
smear done sowed no blast cells and
retics were less than 0.5%. So bone
marrow biopsy were planned and done
which showed hyperplasia of myeloid
precursors with no evidence of plastic
anemia and malignancy with suspicion of
severe infection.
•Patient became sick and developed poor
peripheral pulses and respiratory distress
worsened, antibiotics were stepped up and
ionotropic support was started and call to
medical ICU was sent but no bed was
available. despite above measures patient
did not improve and developed NG bleeding
and gasping breathing
• ETT was passed and patient was put
on ambo bagging, patient started
bleeding from ETT tube and pave,
platelets and FFPs were transfused
and repeat call to MICU was sent
but no bed was available so patient
remained on ambo bagging and
expired on 24/12/2016
 H/ONCO
CONSULTATIONS
• CALL TO H/ONCO WAS SENT AND
BONE MARROW WAS ADVISED WHICH
SHOWED MYLOID HYPERPLASIA WITH
NO EVIDENCE OF APLASIA OR
MALIGNENCY AND ROLE OUT
SEVERE INFECTION WAS ADVISED
 Serial CBCs
14/12 15/12 17/12 18/12 20/12

WBCs 2.2 2.0 1.0 1.0 1.2

POLYS 30% TOO TOO TOO TOO
LOW LOW LOW LOW
FOR FOR FOR FOR
DLC DLC DLC DLC

HB 4.3 3.8 6.4 6.2 6.1

PLATLE 20 14 15 17 6
TS
RETICS 0.5%
BLAST NILL
CELLS
Other labs

14/5 16/5
T bilirubin 0.5 0.6
ALT 19 14
Alka 176 658
phosphatase
Urea 17 33
Creatini 0.5 0.6
Na+ 139 137
K+ 3.7 3.2
Ca++ 8.9 8.0
Mg++ 1.6 2.0
BSR 89
Phosphorous 3.7
 PATIENT CONTROL
PT 14 14
APTT 34 34
 BONE MARROW
BIOPSY

hyperplasia of myeloid precursors

•
with no evidence of plastic anemia
and malignancy with suspicion of
severe infection.
 TERMINAL EVENTS
• PATIENT REMAINED SICK DURING HIS HOSPITAL STAY AND REMAINED IN
ICU THROUGH OUT HIS STAY WITH PERSISTENT NASAL BLEED
• DURING HIS STAY IN WARD ICU PATIENT,S PLATLETS AND WBCs LOW
DESPITE REPEATED PLATLETS TRANSFUSSIONSON CALL TO MEDICAL ICU
WAS SENT BUT NO BED WAS AVAILBLE
• CARDIAC SUPPORT IN FORM OF DOPAMINE AND DOBUTAMINE STARTED
• ON 24/12/18 PATIENT WENT IN BRADYCARDIA AND SATURATION
DROPPED ,ATTANDANTS COUNCILLED ABOUT SICK CONDITION

• ETT was passed and patient was put on ambo bagging,

patient started bleeding from ETT tube and pave,
platelets and FFPs were transfused and repeat call to
MICU was sent but no bed was available so patient
remained on ambo bagging and expired on 24/12/2016
 Assessment Management Lab Labs Consultation
/ diagnosis issues investigations retrieved required

Bronchopneu
Emer Registrar/SR
monia/aplasti none Sent Yes
gency round
c anemia

Registrar/SR
Bronchopneu /Consultant
monia with rounds.done
Ward none Sent Yes
sepsis and H/ONCO
septic shock consultation
done
 Audit

• Assessment : Proper
• Monitoring : Needed meticulous care
• Management plan : Proper