AUDIT DENGUE DEATH

M.A.Q.B.M.B.H
DR NAJIDAH HANUM MOHD ROMALI
PEGAWAI PERUBATAN JABATAN KECEMASAN DAN TRAUMA
HOSPITAL RAJA PEREMPUAN ZAINAB II
 HISTORY
• Fever x 2/7
• Headache
• Reduced oral intake x 1/7
• No bleeding tendency
• No vomiting
• No loose stool
• No abdominal pain
• Not from dengue prone area
 PHYSICAL EXAMINATION ON
PRESENTATION
(30/9/2019)
• Alert, crying with tears, pulse volume adequate, CRT <2s, CW:15 kg
• BP: 95/64
• PR:169
• RR:31
• T:37.4
• Spo2:98% under RA
• Lungs: clear, A/E equal
• Cvs:s1s2
• P/A: soft, nontender, no organomegaly
TIME HOSPITAL TUMPAT 12.15am (RZ) 1.20am 2.20 am 3.30am 4.30am 5.20am – 8 am
BP 109/73 112/70 86/63 89/66 80/64 95/76 119/92 114/82
PR 170 130 137 130 125 141 141 173
LUNGS clear clear clear clear clear Clear Reduced A/E Reduced A/E bilateral
*plasma bilateral LZ LZ
leakage in
US
TWC 7.4 6.1 7.4 7.3 7.4 7.3 9.3 5.2
Hb 15.8 15.3 15.8 16.1 14.4 14.8 17.5 13.8
Hct 46.4 43 47.2 53 47.3 48.4 55.4 45.2
Platelets 49 33 35 40 48 48 35 28
VBG
pH 7.3 7.33 7.29 7.28
hco3 16.6 18.4 17.5 20.4
lactate 3.7 5.6 1.5
Fluid regiment IV NS 10cc/kg IVD 10cc/kg IV sterofundin IV IV PC tx -Add PC tx -intubate
(complete at 10cc/kg sterofundin gelafundin 10cc/kg /2H 5cc/kG -RT: fresh blood
YZ HPRZ @ /H(150cc) 10cc/kg/H 10cc/kg ( 150cc) -IV -IV gelafundin 20cc/kg
11.35pm) (150cc) ( while gelafundin IV gelafundin 10cc/kg
awaiting PC) 20cc/kg IV gelafundin 10cc/kg
 BEDSIDE ULTRASOUND FINDINGS
• 3.30am: minimal free fluid at hepatorenal region, spleenorenal
region, minimal pericardial effusion, bilateral pleural effusion
• 5.30am:free fluid in abdomen increasing, good contractility of heart,
IVC kissing
• 6.30am: IVC: 1.31cm
THANK YOU