feverprojr FUNGAL 81/M 202241628

 fungal - 20221005597 

ALTERED SENSORIUM[HYPOACTIVE]

TYPE -2 RESPIRATORRY FAILURE

UREMIC ENCEPHALOPATHY

AKI

RIGHT LUNG UPPER LOBE FIBROSIS[FUNGAL BALL]

LEFT LUNG LOWER LOBE ASPIRATION PNEUMONIA.

SINUS ARRHYTHMIA

POST DIALYSIS[ 6th,10th , 11th,13th,15th]

Case History and Clinical Findings


80 year old male was brought to casualty with clo sob, cough, Fever, patient is in altered sensonium at the time of presentation (and provisionally diagnosed to have Altered sensonium (hypoactive) to I-II Respiratory failure ? Stroke? Uremic encephalopathy with non oliguric AKT with& right upper lobe fibrosis. In view of sudden bradycardia and hyporia patient was intubated and connected to mechanical ventilator In view of Raising Creatinine and urea with no improvement in Sensorium on 6/10/22 central line was placed and hemodialysis was done CT Brain done to r/o structural causes showing no significant abnormality 5 sessions of dialysis were done on 6/10/22; 10/10/22, 11/10/22,13/10/22; 15/10/21 during which patient sensorium improved from E1, V1 M1, to E1 V1 M5 CT scan done showing ill f/s/o defined mass in RT LUNG 'fungal ball in right lung Mini BAL- culture negitive,stain negitive. Pulmanalogy referral done consider position, chest physiotherapy, ACMV mode Empricical ATT was started on 13/10/22 / Daily bed sore dressing done. GI-II In view of improved sonsorium, patient was planned for extubation and as patient has met etubation criteria.Extubated on 17/10/22 at 8:00pm and post extubation with vitals BP-110/60mmHg: RR-32pm'; PR-75bpm, -Spo2-97percentage •on 6LO2 GRBS-110mg/dl, Temp. Afebrile.

Patient shifted to dialysis at 10:00pm.on 17/10/2022, with vitals 100/50 mmtly; PR-90bpm, RR- 32bpm; Sat -99; GRBS-106 mg/dl Temp-97-1FPost dialysis vitals BP-110/60mmhg; PR-74bpm; Spo2, -96 on 10L O2 GRBS-125 mg/dl Temp-97.7-FAt around 7:36am, patient saturations suddenly fell and patient went into bradycardia. Atropine given. But patient had sudden cardiac arrest and CPR was started, Preoxygenated and revived and pre medication,reintubated CRP continued according to latest ACLS guidelines but despite of all the efforts patient could'nt be revived and declared dead at 8:18am with ECG showing flat lineImmediate Cause: Type II Respiratory failure 2° to ? pulmonary embolismAntecedent cause:RT upper lobe mass / Fungal ball ? cavity with mucus plugging- Pulmonary Koche-Tubulo intestitial nephritis.

ABG

PH:7.34

PCO2:36.4

PO2:76.9

HCO3:19.5

O2 SAT:95%

CBP

HB:7.4gm/dl

TL:15000 cells/cum

NNEUTROPHILS:86

EOSINOPHILS:05

BASOPHILS:

MONOCYTES;11


LYMPHOCYTES;00
Investigation
Treatment Given(Enter only Generic Name)
1. IVF NS,RL @ 50ml/H2. Inj MEROPENEM 1g (IV / BDIN 50ML NS3. Juj LASIX 80MG IV/BD9. Ryles feed-milk 100ml + protein power 4 hoursly-water-100ml (8th hourly)5 Tab DOLD 650mg6. Tab. AKT3 (2tab) + Pyrazinamide 1(tab)
7 Tab. AZITHOMYCIN 500MG / RT/OD8 AIR BED9. Nebulisation DUOLIN/BD, Asthalin TID,mucomist/TID
10. Frequent position changing[2 Hoursly]11- Daily Bed Son dressing.13. Monitor Vitals14. Tab- METXL 25mg |RT|OD.Physiotherapy of both UL AND LL with Chest Physiotherapy
Death Date
Date:19/10/2022




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