Death Report

March 7th,2013
Team : dr.Susi Andriani, dr.Rahmilna, dr.Seri Amni Siregar, dr.Rinni Andriani dr.Edo Yudistira, dr.Farah S Effendi, dr.Rangga Lunesia

Yuliarti, female, 52 y.o

Patient was admitted to ward (7th day

hospitalized)with: WD : - Decrease of consciousness cb uremic encephalopathy cb CKD stg V cb nephropathy DM - Septic shock cb BP Duplex - Type 2 DM controlled by diet normoweight - Cirrhosis Hepatic post necrotic std Decompensate - Suspect Relapse Lung TB

March 7th, 2013, 15.20 WIB Patient was assisted to duty team in condition : S : Decrease of consciousness O : GA : Severe, Consc : Sopor, BP : 80/pols, Heart rate: soft and rapid Respiration rate : 14x Temp : 37,8C Eyes : Pupil isochors, Light reflex +/+ decrease, conj anemic -/-, icteric -/Lung: Bronchovesicular, Rales +/+ Cor : Sinus rhythm , regular, murmur (-) Abdomen : Shifting dullness (+) Ext Sup- Inf- or : Oedem +/+, RF +/+, RP -/-

Lab : March 2nd, 2013 : Hemoglobin : 13,8 Hematocrite : 39,8 Leucosite : 9400 Trombosit : 215.000

Analysis of Fluid Acites: LDH : 190 cell : 25 Protein : 3,9 Glucose: 157 Rivalta : (-) ->A: urinalisa : protein ++

Transudat Na/K : 132/4,5 Ur/Cr : 179/5,2 Albumin : 1,9 Globulin : 5,7 GDS : 139 HbsAg : (+)

March 7th, 2013 : pH : 7,24 pCO2 : 34 pO2 : 141

HCO3 BE SO2

: 14,6 : -12,8 : 99%

Therapy : Rest/NGT/Diabetic Diet 1500 kkal,RG II RP gr, DH 1 IVFD Eas Primer:NaCl 0,9% 12 hours/kolf Drip Dopamin 20gtt/I Inj Ceftriaxon 1x2gr iv Inj Levofloxacin 1x500mg Inj Dexametason 3x5mg Inj Ca Gluconas 3x1amp Lactulose syr 3xC1 Spironolactan 1x100gr

Curcuma 1x40mg As folat 1x5mg Bic Nat 3x500mh Correction Meylon 100mEg on 100cc NaCl

March 7th, 2013, 16.00 WIB S : Decrease of Consciousness (+) O : GA : Severe, Consc : Sopor, BP : 80/pulse, Heart rate : soft and rapid Respiration rate : 18x Temp : 37,8 A : Septic shock cb Bronchopneumonia (HAP) (no resolve yet) Decrease of consciousness cb uremic encepalopathy P : - Combination with Dobutamin drip 2 ampul on 500cc NaCl 0,9% start from 5 gtt until blood pressure 100 - KI /15 minutes

March 7th, 2013, 16.30 WIB S : Decrease of Consciousness (+) O : GA : Severe, Consc : Sopor, BP : 70/pulse, Heart rate : soft and rapid Respiration rate : 16x Temp : 37,8 A : Septic shock cb Bronchopneumonia (no resolve yet) P : - Dobutamin drip 10 gtt/ (increase the titrasi) - KI /15 minutes

March 7th, 2013, 17.20 WIB Patient was apnea Blood pressure : unmeasurable Heart rate : unmeasurable Pupil : maximal dilatation ECG : Flat Patient was sentenced die in front of family and friends, with COD : MODS

Sutiani, Female, 66 y.o

Patient was admitted to ward (11st day hospitalized)with: WD :
Septic cb Bilateral Bronchopneumonia with

respiratory failure type II Type 2 Diabetic Melitus controlled with insulin, underweight CHF fc II LVH RVH sinus rhythm cb ASHD SOPT

March 7th, 2013, 16.30 WIB Patient was assisted to duty team in condition : S : Breathlessness (+), Fever (-) O : GA :Moderate , Consc :CMC , BP : 130/80 , Heart rate : 102x Respiration rate : 28 Temp : 36,5 Eyes : anemia (-), sclera icteric (-) Lung: bronchovesicular, Rales +/+, wh -/Cor : cardiomegali, murmur(-) Abdomen : Hepar palpable 1 finger BAC Ext Sup- Inf- or : Oedem -/- , RF +/+, RP -/-

Lab :

Hb : 10,5 Ht : 37,1 Leucosite : 4.240 Trombosit : 206.000 : 140/2,6

March 2nd, 2013 : -Total Cholesterol : 146 -LDL : 91,6 -HDL : 40 -Trigliserida : 72 March 7th, 2013 : -pH : 7,27 -pCO2 : 101 -pO2 : 54 -HCO3 : 46,4 -BE : 19,5 -SO2 : 83%

Na/K

February 25th,2013 - Ur/Cr : 29/0,7 - SGOT/SGPT : 22/15 - Alb/Glo : 3,2/4,4

March 7th, 2013 : Fasting Glucose : 114 2hours Post Prandial Glucose :162

Consult to Pulmonology Consultant : Impression : Type II Respiratory Failure Advice :

Optimalization nebu Aminophylin drip Corticosteroid inj

Blood gas analyse

Not necessary to consult the patient to ICU yet

because patient was conscious

Therapy : Rest/DJ II DD 1700kkal IVFD NaCl 0,9% 8hours/kolf Farbivent nebu /4hours Inj Methyl Prednisolon 2x62,5 Inj Ceftriaxon 1x2gr Inj Lasix 1x1amp Ramipril 1x2,5 Ascardia 1x80mh Ambroxol 3xc1 Dulcolax 1x2tab KSR 2x1 tab Inj Novorapid 3x6iu Urine Catheter (Fluid Balance)

17.30 WIB S : Breathlessness (+), Fever (-) O : GA :moderate, Consc :aphatic , BP : 120/80, Heart rate : 110x/ Respiration rate : 34x/ Temp : 37,8 A : Septic cb Bronchopneumonia duplex with SOPT P : Continue the therapy Blood Gas Analyze
18.00 WIB Repeat Blood Gas Analyze had been sent but the sample return because it was not enough

18.30 WIB S : Breathlessness (+) Fever (+) O : GA : severe, Consc :sopor, BP : 110/80, Heart rate :120 Respiration rate : 38, Temp : 37,8 Eyes : Pupil isochors, Light reflex +/+ decrease, Ext Sup- Inf- or : Lateralisation (-) , RF +/+, RP -/A : Decrease of Consciousness cb type 2 respiratory failure cb SOPT P : Blood Gas Analyze Intensive control /15 minutes

19.15 WIB Patient was apnea Blood pressure : unmeasurable Heart rate : unmeasurable Pupil : maximal dilatation ECG : Flat Patient was sentenced die in front of family and friends, with COD : Type 2 Respiratory Failure