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Post Partum Death

This document summarizes the medical records of a 28-year old pregnant patient (Gravida 1, Para 0) who presented at 19 weeks gestation with vomiting and was diagnosed with hyperthyroidism and thyroid storm. She was admitted and treated supportively with IV fluids, beta blockers, anti-emetics and antibiotics. Her condition deteriorated with hypotension, tachycardia and hypokalemia requiring vasopressors and transfer to a higher level facility. Unfortunately she suffered a cardiopulmonary arrest and was declared clinically dead.

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Ferzada Sajiran
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75 views12 pages

Post Partum Death

This document summarizes the medical records of a 28-year old pregnant patient (Gravida 1, Para 0) who presented at 19 weeks gestation with vomiting and was diagnosed with hyperthyroidism and thyroid storm. She was admitted and treated supportively with IV fluids, beta blockers, anti-emetics and antibiotics. Her condition deteriorated with hypotension, tachycardia and hypokalemia requiring vasopressors and transfer to a higher level facility. Unfortunately she suffered a cardiopulmonary arrest and was declared clinically dead.

Uploaded by

Ferzada Sajiran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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NATIONAL SAFE MOTHERHOOD PROGRAM

DISEASE PREVENTION AND CONTROL


BUREAU
DEPARTMENT OF HEALTH, REGION 1X,
ZAMBO CITY

DATE OF REVIEW: NOV 6, 2019


• THYROID STORM
• HIGH OUTPUT FAILURE SECONDARY TO
THYROTOXIC CARDIOVASCULAR DISEASE
• G1P0 (0000) 19 2/7 WEEKS AOG BY LMP
• This is the case of patient A.C. Gravida 1 Para 0, 28 year old
at 19 2/7 weeks AOG
• Gravidity: 1
• Parity: 1
•
• Gestational Age 19 2/7 WEEKS AOG
•
• Pregnancy Outcome: Please check
•
• Preterm live birth: _________
• Term live birth :
• Fetal death: __1______
• Newborn death: _________
• Abortion : _________
Date of Death: March 15, 2019
• Place of Death: Siocon District Hospital
• Antenatal Care:
• First attended ANC:

• First Trimester: √
• Second Trimester:
• Third Trimester:
• How many ANC visits? 1
• Type of ANC provider: Midwife
• Type of Place: Barangay Health Station
• PAST OBSTETRIC HISTORY:
• No. of pregnancies: ___0___
• No of deliveries: ___0___
• Obstetric Score: G1P0(0000)
Chief Complaint: Vomiting
HISTORY OF PRESENT ILLNESSES
• Patient is Diagnosed with hyperthyroidism with
unrecalled medication
• LMP 3/15/2019
• AOG 19 2/7 Weeks AOG at the time of Admission
• 1 day noted onset of vomiting and Agitation, due
to persistence prompted consult
PHYSICAL EXAMINATION

• Vital signs: BP 110/60 HR 123 RR 40 Temp 38. 5C O2


• General Appearance: Conscious, Coherent, Agitated GCS 15
• Skin: Cold Clammy
• EENT: Anicteric Sclera, slightly Pale Palpebral Conjunctiva
• C/L: ECE, clear breath sounds
• Abd: soft non tender
• IE: (-) bleeding
PROGRESS NOTES DOCTORS ORDER
7/28/2019 ADMIT PATIENT, SECURE CONSENT TO CARE
NPO EXCEPT MEDS
10:49 am IVF: PNSS 1L FD 300CC THEN @ 30GTTS/MIN;
LABS: > CBC,PLT > CXR PA WITH ABDO SHIED
T 38.5 – 10
>UA > CREA, NA, K
HR 163 – 25
>FTU, TSH > 12 LEADS ECG CBG
AF – 10
CHF – 0 MEDS;
GI S/S – 10 PTU 50MG TAB 6 TAB 2 TABS Q 6 HRS PO
AGITATION – 10 PROPANOLOL 40MG TAB 2 TAB NOW THEN 2
PRECP – 10 PARACETAMOL 500MG 1 TAB Q 4 HRS
HYDROCORTISONE 100MG IV NOW THEN Q 8 HR
=75 METOCLOPRAMIDE 1AMP IV Q8 HRS PRN FOR
VOMITING
PROGRESS NOTES DOCTORS ORDER
VITAL SIGNS Q HOURLY AND O Q SHIFT
FAMILY APPRAISED, ADVISED TRANSFER
INAVAILABILITY OF PROPRANOLOL, MONITOR Q HOURLY
METOPROLOL 100MG 1TAB NOW THEN BID

7/28/2019 2:00 PM PNSS 500CC (REMAINING) FD NOW IVFTF: PNSS 1L + 40MEQS KCL @ 20GTTS/MIN * 2CYCLES
GCS 13
SD NOREPINIPHRINE 20CC/HR (0.2UGTTS/MIN) INTITRATE WITH 5CC/HR Q 15M TO ACHIEVE BP >
COLD CLAMMY
90/60
HR 90 BPM
D5NSS + 40MEQ KCL @ 20GTTS/MIN DO FD
BP 50/40
D10W 50CC IV BOLUS NOW
HOLD METROPOLOL PO NOW
K: 2.79 MMOL/L
INSERT FC TO UROBAG
BP Q 15 MINS; HOOK CARDIAC MONITOR
WT 50 KG
[NE] 32 MEQ/CC RANITIDINE 50MG IV NOW 1L Q 8 HRS
RATE = 18CC/HOUR CEFTRIAXONE 2G IV NOW 1L OD
HOLD METROPOLOL
CONTINUE OTHER MEDS
 FAMILY APPRAISED
 REPEAT SERUM K @ 9PM
 CBR
PROGRESS NOTES DOCTORS ORDER

7/28/2019 PLR 500CC FD NOW


10:45 PM UPTITRATE NOREPHINEPRINE MAX 100CC/HR
HYPOTENSIVE 50/40 START DOBUTAMIN 500MG DRIP AS 2AMP IN 250CC D5W MAINTAIN @
GCS 14 8CC/HR
COLD CLAMMY 12 LEAD ECG NOW
ECE CGS FETAL HEART TONE MONITORING Q HOURLY
ADVISED TRANSFER PHOTOCOPY LAB

PLR 500CC FD
IVF: PNSS 1L @ 20GTTS/MIN
D5NSS 1L @ 20GTTS/MIN
TRANFER TO HOSPITAL OF CHOICE

7/28/2019 HIGHLY CPR


10:50PM Continuous Ambubagig
REFER CARDIO FAMILY APPRAISED FOR POOR CONDITION
PULMUNARY ARREST @ EPINEPHRINE 1G IV Q 3 MINS
10:50PM NOTABLE FIXED DILATED PUPIL
PROCLAIMED CLINICALY DEAD @ 11:05 PM

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