MORTALITY AUDIT

• PATIENT NAME : MR. KRISHNAMOORTHY

• 64 YRS / MALE

• DATE OF ADMISSION : 20/05/2021

• DATE OF DEATH : 21/05/2021

• UNIT: DR.TSR
 DIAGNOSES
• PERFORATION PERITONITIS

• SEPTIC SHOCK

• POST CARDIAC ARREST RESUSCITATION

• PROBABLE GANGRENE OF BOWEL

• ACUTE RENAL FAILURE

• DIABETES MELLITUS
 PRESENTING COMPLAINTS
• This 64years old gentleman has presented with complaints of abdominal
pain since yesterday (19/05/ 2021), abdominal distension for 2days.

• Breathing difficulty since today morning(20/05/2021), obstipation for 4-5

days & loose stools 6days ago.

• Patient was received in ER in gasping state and was intubated in ER in

view of low GCS.

• Patient was evaluated at outside hospital &came here for further

management.
 ON EXAMINATION

• Patient was intubated in ER in view of low GCS.

(E1VTM1)

• Heart rate - 92beats/min

• Blood pressure -100/60 mmHg

• Respiratory rate -20 cycles/min

• SpO2-96%
• RS: Bilateral air entry present

• CVS: S1S2 +

• P/A: Soft, distension-present.

Bowel sounds-absent.
 CO MORBIDITIES

• TYPE 2 DIABETES MELLITUS

 COURSE IN HOSPITAL

• This 64 years old gentlemen came with above

mentioned complaints to ER in gasping state, low
GCS, so emergency intubation done.
 UREA-69 Hb-12.1, TC-10.6,PLT- 505

CREATININE-3.9 CRP- 326, PROCAL- 53

Na+ 121 AMYLASE-120

K+ 6.2 LIPASE-263

HC03- 9 ABG-SEV METABOLIC

ACIDOSIS,LACTATE-106
• CT Abdomen &pelvis plain:

• Marked pneumoperitoneum & marked free fluid

suggestive of bowel perforation, air within the
mesenteric veins draining the mid ileum- bowel
ischaemia cannot be ruled out.
•
• Patient was planned for emergency laparotomy and
proceed.
• Patient blood sugars- high, so insulin infusion started.
• Bicarbonate correction given. Potassium correction
given.
• DR.PRC opinion sought for increased renal
parameters and fitness for surgery, he advised
haemodialysis & high risk for surgery without
dialysis.
• Anaesthetist opinion obtained over phone, advised
cardiology opinion for fitness for surgery.
• Patient had hypotension (80/50mmHg), started on
Inj. Norad infusion-15ml/hr(6pm).
• Patient condition & need for emergency surgery
explained to patient’s attenders.(consented after half
an hour).
• High risk explained.
• Patient was shifted to COVID screening ICU for initial
management.

• Patient had decreased BP:40/30mmHg(8:15pm) so norad

escalated & inj vasopressin, dobutamine, adrenaline were
started .

• Inspite of high inotropic support, patient’s blood pressure

was unstable, had bradycardia- developed
cardiorespiratory arrest at 8:15pm.

• CPR given as per ACLS protocol - revived.(after 20-

25mins of CPR)
• Inspite of being on full inotropic support, blood
pressure gradually declined, had bradycardia-
arrested at 4:10AM(21/05/2021), CPR given,
inspite of all supportive measures patient could
not be revived, declared dead at 4:30AM on
21/05/2021.
• CAUSE OF DEATH:
PERFORATION PERITONITIS
SEPTIC SHOCK
ACUTE KIDNEY INJURY
DIABETES MELLITUS