65 years old female with SOB and altered sensorium

65 years old female with SOB and altered sensorium




Dr.Pavan
Dr.Navya
Dr.Stimita

CHIEF COMPLAINTS

Patient came to casualty around 7:40 PM with C/O SOB(difficulty in breathing) since 10 days,
Fever since 10 days and altered sensorium since 2 days.


HISTORY OF PRESENT ILLNESS

Patient was apparently asymptomatic 10 days ago, then she developed   SOB which was grade 1 initially, then gradually progressed to grade 4

Fever since 10 days, low grade, gradually progressive

Orthopnea+

Altered sensorium since 10 days.


PAST HISTORY 

Not a k/c/o CAD,CVA,Epilepy
K/c/o HTN,DM 2 since 10 days 


GCS-E2V2M3

VITALS

PR 90 bpm
RR 38 cpm
BP 90/60 mm of hg
SPO2 77@RA

Investigation

ABG showed metabolic acidosis with ph 7.03,HCO3 9.1

Sr. Urea 253mg/dl

Sr. Creatinine 8.1

Serology - negative


WHAT WE DID WE DO?

Inj. Sodium Bicarbonate 50meq in 100 ml NS IV STAT SLOWLY

BUT,patient's saturation was falling.

Patient was intubated I/V/O low GCS and falling saturation.The moment we 

intubated,secretions started coming out of the ET tube.

We started CPR according to the AHA 2020 guideline I/V/O absent central and peripheral 

pulses.After all these efforts patient couldn't be resuscitated and declared dead with ECG showing flat line.

Immidiate cause - type 1 respiratory failure with severe metabolic acidosis

Antecedent cause- ?Aspiration pneumonia with? sepsis with Chronic renal failure with k/c/o DM 2 and HTN since 10 days








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