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Death audit dr subba reddy
- 1. Medical audit 29.04.16 Dr. Subba reddy RESIDENT DEPARTMENT OF PEDIATRICS
- 2. Baby Akshya 5 months, female R/O Panruti DOA :14.03.16, 6:05pm Date of demise :14.03.16, 07:30pm Duration of hospital stay : 180 min Presenting complaints : Fast breathing 2 days Fever
- 3. HOPI Apparently well 15 days back Cough and cold- dry cough, associated with coryza H/o ? Aspiration 2 days back H/o fast breathing X 2 days H/o fever X 2 days H/o excessive crying + H/o decreased urine output/ decreased feeding X 2 days
- 4. Family history : 6 yrs 9 mon 5 mon Birth history: LSCS/2.74kg/CSAB/ LATE PRETERM/ARTHROGRYPOSIS MULTIPLEX CONGENITA Developmentally NORMAL Immunized for age
- 5. At admission in ER HR – 190/Min peripheral pulses- bounding RR - tachypneic, 84/ min, retractions, audible stridor + SpO2 – 90 % in room air 100% with 02 CFT - 2 secs Shifted to PICU with oxygen support. RESPIRATORY CAUSE IMPENDING RESPIRATORY FAILURE
- 6. General examination… • Weight : 4.7 kgs (well thriving) • Cyanosis present •No Pallor •No generalized lymphadenopathy •No icteru •No rashes
- 7. Systemic examination… • RESPIRATORY SYSTEM: SCR/ ICR+ Supra sternal retraction + Respiratory rate:84/min Air entry equal on both sides B/L coarse crepts + B/L Inspiratory stridor + B/L Gurgling sounds+ CARDIOVASCULAR SYSTEM: S1 S2 heard in area No murmur
- 8. Systemic examination • Musculoskeletal system : k/c/o ARTHROGRYPOSIS MULTIPLEX CONGENITA • Other systems : within normal limits
- 9. 07/11/16 COURSE IN THE HOSPITAL 5 months old female baby by name Akshya was brought to MGMCRI casualty on 14.03.2016 at 5.55 PM with chief complaints of severe breathlessness & fever for two days and poor feeding for one day. On examination baby was mildly cyanosed with severe distress with inspiratory stridor and audible wheeze. With O2 support baby was rushed to PICU, Adrenaline and Salbutamol nebulisation was given, I.V line was secured and blood samples were collected. Baby was maintaining 100% saturation with O2 support and heart rate of 190-200. Since baby required further respiratory support, it was planned to intubate and connect to mechanical ventilator; written consent from parent was obtained for the same.
- 10. 07/11/16 At 6.20PM Intubation procedure was started with premedication (Inj. midazolam and Inj. Fentanyl). Since child had continuous cough and copious secretions, procedure was not successful. Anesthetist help was asked for. At 6.40PM Anesthetist intubated with premedications (Inj. succinylcholine, Inj. glycopyrolate and Inj. Midazolam). Baby had cardiac arrest immediately after intubation. Baby was resuscitated according to PALS protocol with Inj. adrenaline and Inj. atropine along with chest compressions. Inspite of prolonged resuscitation till 7.30pm, baby could not revived and declared dead on 14/03/2016 at 7.35PM. Cause of Death: Respiratory failure with severe pneumonia with septicemia.
- 11. 14/3/16 Hb-11.4 g% TC-6,600 cells/cumm N-52% L-48% PLT-5.62LAKHS /CUMM HEMOGRAM
- 12. BIOCHEMISTRY DATE 14/3/16 Na / K 139/5.5 Ur / Cr 37/0.4 Chloride 102 S.Calcium 11.0 S.Phosphorus 4.9 S. Uric acid 1.6
- 13. INVESTIGATION • BLOOD CULTURE(14/3/15)- contaminated
- 14. 0 min 30min 60min 90min 180min IMPENDING RESPIRATORY FAILURE OXYGEN SUPPORT THROUGH HIGH FLOW DEVICE RESPIRATORY FAILURE INTUBATED
- 15. Cause of death • RESPIRATORY FAIURE • SEVERE BRONCHOPNEUMONIA • SEPTICEMIA
- 16. THANK YOU