70M Type 1 RF ; TB Meningitis ; PC Stroke ; DM
Case History and Clinical Findings
Diagnosis
TYPE I RESPIRATORY FAILURE
TB MENINGITIS WITH POSTERIOR CIRCULATION STROKE SECONDARY TO ? TUBERCULAR VASCULITIS WITH ? ASPIRATION PNEUMONIA
ALTERED SENSORIUM SECONDARY TO ACUTE MENINGITIS
ACUTE INFARCTS IN RIGHT THALAMUS AND STRIATO CAPSULAR REGION,LEFT MIDBRAIN,CEREBELLAR HEMISPHERE WITH ?OLD PULMONARY KOCHS[ON ATT SINCE 15//2/23 STARTED CLINICALLY]
K/C/O DM SINCE 9 YEARS WITH
GRADE -II BEDSORE
DEATH SUMMARY
70 YEARS OLD MALE PRESENTED WITH COMPLAINTS OF FEVER SINCE 3 WEEKS , ALTERED SENSORIUM SINCE 3 DAYS , DROWSINESS SINCE 1 DAY.
PATIENT WAS EVALUATED WITH CLINICAL AND APPROPRIATE INVESTIGATIONS . FUNDOSCOPY WAS DONE IN VIEW OF RAISED INTRACRANIAL PRESSURE AND LUMBAR PUNTURE WAS DONE AND CSF ANALYSIS WAS SUGGESTIVE OF ?TB MENINGITIS AND IN VIEW OF HIGH CLINICAL SUSPICION , ATT WAS STARTED AND DEXAMETHASONE WAS GIVEN . PATIENT RECOVERED SYMPTOMATICALLY FOR 2 DAYS , FOLLOWED BY THAT PATIENT BECAME DROWSY AND INABILITY TO MOVE THE LEFT UPPER LIMB AND LOWERLIMB .MRI BRAIN WAS DONE AND IT SHOWED MULTIPLE ACUTE INFARTS IN RIGHT THALAMUS , STRIATOCAPSULAR REGION , LEFT MIDBRAIN, AND CEREBELLAR HEMISPHERE. CSF SAMPLE SENT FOR CBNAAT WAS REPORTED NEGATIVE. NEUROLOGIST OPINION WAS TAKEN AND DUAL ANTIPLATELET MEDICATION WAS STARTED . PATIENT DEVELOPED HICCUPS, PERSISTENT HIGH FEVER SPIKES , FLUCTUATING SENSORIUM DURING THE COURSE AND WAS TREATED SYMPTOMATICALLY . PATIENT DEVELOPED INTERMITTENT DESATURATION AND OXYGEN SUPPORT WAS GIVEN . PATIENT DEVELOPED GRADE -2 BED SORE . GENERAL SURGERY OPINION WAS TAKEN AND DAILY DRESSING WAS DONE . ANTIBIOTICS WAS ESCALATED I/V/O BEDSORE AND FEVER SPIKES , AIR BED AND FREQUENT POSITION CHANGE ON 2/3/23 AT 4:00 AM PATIENT WAS DESATURATED AND SO ELECTIVE INTUBATION WAS DONE . AT 5: 00 AM PATIENT DEVELOPED BRADYCARDIA WITH ABSENT CENTRAL PULSES . CPR WAS INITIATED ACCORDING TO ACLS GUIDELINES . RETURN OF SPONTANEOUS CIRCULATION [ROSC] ACHIEVED . PATIENT CONNECTED TO MECHANICAL VENTILATOR SUPPORT . AT 6: 58 AM PATIENT AGAIN DEVELOPED BRADYCARDIA AND WENT INTO CARDIAC ARREST AND CPR WAS INITIATED AS PER ACLS GUIDELINES , DESPITE OF ALL THE ABOVE RESUSCITATIVE EFFORTS PATIENT COULD NOT BE REVIVED AND ECG SHOWED ISOELECTIIVE FLATLINE AND DECLARED DEAD ON 2/3/2023 AT 7 : 29 AM
IMMEDIATE CAUSE - TYPE 1 RESPIRATORY FAILURE
ANTECEDENT CAUSE - TB MENINGITIS WITH POSTERIOR CIRCULATION STROKE SECONDARY TO ? TUBERCULAR VASCULITIS WITH ? APIRATION PNEUMONIA WITH GRADE 2 BEDSORE WITH K/C/O TYPE 2 DIABETES MELLITUS SINCE 9 YEARS
Treatment Given(Enter only Generic Name)
RT FEEDS - 200 ML MILK 4 HRLY
- 200 ML WATER 2 HRLY
INJ PIPTAZ 4.5 MG IV TID
INJ CLINDAMYCIN 600 MG IV TID
IV FLUIDS NS AT 100 ML /HOUR
INJ OPTINEURON 1 AMP IN 1 UNIT NS AT 100 ML/HR
INJ DEXA 8 MG IV TID
INJ PAN 40 MG IV OD
TAB ISONIAZID 275 MG 4 TABLETS RT /OD
TAB RIFAMPICIN 550 MG 4 TABLETS RT/OD
TAB PYRAZINAMIDE 1550 MG 4 TABLETS RT/OD
TAB ETHAMBUTOL 825 MG 4 TABLETS RT/OD
TAB DOLO 650 MG RT/QID
TAB PYRIDOXINE 40 MG RT/OD
TAB ECOSPIRIN 150 MG RT/OD
TAB CLOPIDOGREL 75 MG RT/OD
TAB ATORVASTATIN 20 MG RT/OD
SYP CREMAFFIN 30 ML RT/HS
PROTEIN X POWDER 2 TBSP IN 1 GLASS OF MILK TID
NEBULIZATION WITH MUCOMIST 6 HRLY
GRBS 7 POINT PROFILE
EYE CARE LUBREX EYE DROPS
INPUT /OUTPUT CHARTING
LEFT UPPER LIMB AND LOWERLIMB , CHEST PHYSIOTHERAPY
2 HRLY POSITION CHANGE
AMBULATE PATIENT
LEG STOCKINGS
ORAL SUCTIONING 2ND HRLY
COLD SPONGING
