MORTALITY PRESENTATION

DR ADENIRAN
 PRESENTING COMPLAINT
• NAME`- MR O S
• AGE- 18years
• Sex – male
• Admitted – 23/05/2018 @ 1:08pm

• COMPLAINT- Difficulty breathing

• Scalp injury
• multiple abrasions X 1hour
duration
 HPC
• Autopedestrian victim admitted 23/5/2018 at
1;08pm
• Patient was knocked down by the sidemirror of a
fast moving BRT bus at palmgrove ,he sustained
chest injury,scalp laceration, multiple abrasion.

• History of difficulty breathing, dypneic

,tachypneic , minimal bloodloss , no history of
loss of conscious, no cfo bleeding,
• He was brought here by lasambus given Im
PCM 600mg enroute
• On examination – patient is conscious, pale
++, in respiratory distress evidence by flaring
of alai nasi and intercoastal recession. No
pedal swelling..

• CNS- conscious and restless

• GCS – 15/15 E- 4,V -5 ,M - 6
• Pupillary reflexes both eyes where dilated
about 3cm..and reactive to light
• Head and neck – 2cm laceration on the frontal aspect
,another 2cm laceration of the parietal aspect ,multiple
abrasion on the frontal,parietal, right helix and
antihelix aand posterior aspect of the right ear.

• Chest – RR- 44c/m…SPO 68%

• No distended veins noticed,moves with resp
• trachea is central
• ,no abrasion
• CCT - ? positive
• Breath sound – crepitations all lung zones
• Thoracocentesis{pleural tap} was done on
each pleural spaces .
• 5mls of blood on the left and right was
aspirated….at this point
• Urgent bilateral thoracotomy was planned for.
• CARDIOVASCULAR= PR- 108b/m ,regular, low
volume .BP- 137/53mmhg. S1s2

• ABDOMEN– full,soft, moves with respiration,

• abrasion on the left flank
• BS- hypoactive
• PCT- negative.
• Musculoskeletal – abrasion on the left knee
and foot.
• Deformity on the distal end of the left wrist
joint,crepitus present
• SLR both limbs
• Nil neurovascular deficit
• ASSESSMENT - Blunt chest injury
• kiv abdominal injury..
• Fracture to the left wrist and soft tissue injury
follow RTA
 PLAN
• He was admitted
• Apply cervical collar
• Commence intranasal oxygen
• Iv access with 2 wide bore cannula
• Bilateral thoracotomy asap
• Fbc, grp and xmatch 2 pint of blood/transfuse with 2 pint of blood.
• Ivfluids, antibiotics, analgesic
• Cathheterize patient
• Backslab applied
• Local wound care
• Monitor vital signs /input-output
• For referral to tertiary centre
• Thoracotomy was done ASAP.@ 2:15am
• Vitals pre POST
• RR- 44C/M 38c/m
• PR- 134B/M 126b/m
• SPO%-- 54% 47%
• BP – 131/76mmhg 131/63mmhg
• Right tube drained 300mls of blood
• Left tube drained 200mls of blood
• Was also transfused with a pint of blood
• AT 3PM
• Abdomen was noticed to be a bit distended,soft
moves with respiration..no organomegaly
• VITALS
• RR- 26C/M
• Pr – 124b/m regular, small volume
• Bp – 137/69 mmhg
• SPO% -- 40%
 REVIEWED
• At 4pm
• Vitals
• Rr – 36c/m
• Spo% --30%
• Pr – 125b/m
• Bp – 144/69mmhg
• He made 70mls of concentrated urine @
about 4pm
• 5:10PM
• RR- 40C/M
• PR- 123B/M
• BP- 136/64MMHG
• SPO% - 31%
• ABDOMEN– Said to have increased in girth
since admission
• Transfused with 1 pint of blood
• 5:15pm
• Patient was noticed to be gasping
• CPR commenced immediately
• Absent spontanous cardiopulmonary activities
• Absent carotid/ peripheral pulses
• Fixed and dilated pupils
• Patient was certified dead a 5:35pm
THANK YOU FOR LISTENING

GOODMORNING