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sample of mortality & Morbidity 2011
1. Perpetual Succour Hospital
Department of Family & Community Medicine
MORBIDITY & MORTALITY
CONFERENCE
FEBRUARY 2010
Presentors: Liza D. Mariposque, M.D.
Philip March Alquizar, M.D.
Marie Micheau Conference Room
February, 2011
2. TOTAL HOSPITAL ADMISSIONS 1,213
Internal Medicine 577 (47.57%)
Pediatrics 215 (17.72%)
Family Medicine 148 (12.20%)
Obstetrics and Gynecology 138 (11.38%)
Surgery 135 (11.13%)
3. FAMILY MEDICINE
Admissions : 148
OPD:
PSH : 273
Community : 14
House Case : 9
Co-managed : 44
Charity : 2
Mortality : 2
4. Family Medicine Cases
AdultMedicine 78 (68.42%)
Pediatrics 24 (21.05%)
Surgery 9 (7.90%)
OB & GYN 3 (2.63%)
5. FAMED LEADING CAUSES OF
MORBIDITIES
ADULT:
Community Acquired Pneumonia
Urinary Tract Infection
Acute Gastroenteritis
12. INTERNAL MEDICINE
RESPIRATORY SYSTEM 12
Acute Bronchitis 2
Pulmonary Tuberculosis 1
Class III w/ DM Type 2
Chronic Obstructive Pulmonary Disease 1
in Acute Exacerbation
w/ Ulcer-like-Dyspepsia
33. Mortality # 2
N.C.,50 y.o., male
CC: epigastric pain, dyspnea
Past medical History: HPN
Numbers of Hospital Stay: 4 Hours
34. Final Diagnosis
Septic Schock Syndrome 2ndary to CAP High
Risk with Concomittant Non-ST Elevation
Myocardial Infarction
35. MORBID CASE
V.V.,21y.o., male
Medical Representative
Talamban, Cebu City
CC: fever, headache, changes in
behavior
36. (-)HPN, (-) DM, (-) BA
VICES: alcoholic beverage drinker,
smoker
Allergy: shrimp
HFD: BA
37. PAST MEDICAL HISTORY
2009 – AGE (PSH)
April 2010 – Pneumonia (PSH)
June – Nov. 2010 – PTB (CVGH)
Oct. 2010 – Optic Pneuritis & Glaucoma 2ndary to
adverse drug reaction to Ethambutol.
38. HPI
2 wks PTA – undocumented on & off fever.
No History of cough.
5 Days PTA – still with fever associated with
body malaise & headache.
Day PTA – changes of behavior.
39. BP: 130/90mmHg HR: 86bpm
RR: 20cpm T: 36.1C
Skin: no lesions, warm
HEENT: anecteric, dilated R pupil (5mm) & non-
reactive to light. (+) L eye reactive to Light
Neck:(-) LAD, no neck rigidity
C/L: ECE, CBS, (-)rales, (-)wheeze
CVS: DHS, NRRR, no murmur
Abd.: flat, NABS, nontender, no mass
GUT: (-)KPS
Ext. : No edema, strong pulses, no limitation in
movement
40. CNS: drowsy, incoherent, follows command
I – N/A
II, III, - dilated R pupil & non-reactive to light, L
pupil is reactive to light.
III, IV,VI – (+)EOM
V, VII – No facial asymmetry
IX, X, XI – (+) gag reflex, tongue at medline,
able to swallow & protrude tongue
XI – no shoulder lag
41. Sensory: Intact
Motor Strength: 5/5 all extremities
Reflexes: RU = +2 LU = +2
RL = +2 LL = +2
(-) Babinski sign
(-) Kernigs sign
(-) Brudzinsky sign
46. CT-SCAN BRAIN PLAIN
Areas of ill-defined hypodensities with mass
effect in the R basal ganglia, R frontal & R
temporal lobes, R thalamus & R midbrain.
Consideration include:
1. Cerebritis
2. Vasogenic Edema
3. Infection from Vasculitis
47. Course in the Ward: Day 1-3
P: fever, headache, rashes
O: BP: 120/80-140/90 HR: 80-110bpm
RR: 20-24cpm T: 37.5-39C
Skin: (+) maculopopular rash, warm
HEENT: anecteric, dilated R pupil (5mm) & non-
reactive to light. (+) L eye reactive to Light
Neck:(-) LAD, no neck rigidity
C/L: ECE, CBS, (-)rales, (-)wheeze
CVS: DHS, tachycardic, no murmur
Abd.: flat, NABS, nontender, no mass
Ext. : No edema, strong pulses, no limitation in
movement
48. A: CNS INFECTION, R/I HIV INFECTION
P:For MRI of the brain w/ contrast.
> Rpt CBC
For HIV Test & VDRL.
For co-mgt w/ Neurologist.
Refer to Allergology for clearance.
Co-mgt w/ Infectious Specialist.
Keppra 500mg 1tab BID.
Mannitol 100cc IV q 6H.
Iterax 50mg 1tab OD.
d/c Ceftriaxone.
49. MRI OF THE BRAIN w/ Contrast
Mulltipleminimally enhancing cerebellar and
brain stem lesion w/ perilesional edema and
mass effect.
Primary consideration is an infectious CNS
process such as Toxoplasmosis.
50. HIV Test VDRL Test
Qualitative Result
– Negative
HIV Ag/Ab
457.71 s/co CBC
Remarks: Positive WBC = 3.72
N = 54
L = 26
M=8
E = 12
Plt = 165
Hb = 12.1
Hct = 32.5
51. Day 4-5
P: fever, no verbal output but patient response
upon calling his name, (+) rashes, unable to eat
O: BP: 110/70-140/90 HR: 80-150bpm
RR: 20-25cpm T: 39-41C
52. Skin: (+) maculopopular rash, warm
HEENT: anecteric, dilated R pupil (5mm) & non-
reactive to light and half open.
Neck:(-) LAD, no neck rigidity
C/L: ECE, CBS, (-)rales, (-)wheeze
CVS: DHS, tachycardic, no murmur
Abd.: flat, NABS, soft, nontender, no mass
Ext. : No edema, strong pulses, no limitation in
movement
53. A: HIV Infection, R/I CNS Infection
(Toxoplasmosis vs. Lymphoma)
UGIB etiology to be determine
P: NPO & NGT inserted.
- for HbsAg and anti-HCV determination.
- Piperacillin-Tazobactam 4.5G IV then 2.5G IV q
6H.
- Nexium 40mg IVTT OD.
- Fansidar 25/500mg 4tabs now then 1tab q 8H
once coffee ground vomitus disappeared.
- all P.O meds shifted to IV.
55. Day 6-8
P: fever, no verbal output but response upon
calling his name, recurrence of coffee ground NGT
drainage, (+) vesicular rash
O: BP: 110/70-130/90 HR: 85-140bpm
RR: 20-22cpm T: 38-40C
56. Skin: warm
HEENT: anecteric, dilated R pupil (5mm) & non-
reactive to light and half open.
Neck:(-) LAD, no neck rigidity
C/L: ECE, CBS, (-)rales, (-)wheeze
CVS: DHS, tachycardic, no murmur
Abd.: flat, NABS, soft, nontender, no mass
Ext. : No edema, (+) vesicular rash on the R thigh,
strong pulses, w/ limitation in movement
on the L side of the body.
57. A: HIV Infection, R/I CNS Infection
(Toxoplasmosis vs. Lymphoma)
UGIB etiology to be determine, Herpes Zoster R
Thigh
P: NGT feeding started.
- for CD4 count and Toxoplasma Serologic IgG &
IgM determination.
- hold fansidar.
- Zithromax 500mg IV drip OD.
- Dalacin 300mg 1tab/NGT q 6H hold
- Valtrex 1G 1tab q 8H/NGT hold
58. Dexamethasone 50mg IVTT q 6H.
Zovirax 500mg IV infusion.
Kabiven 1.4Kcal to run q 24H.
Ice bath done.
Refer to Neurosurgeon for possible brain
biopsy.
59. Day 9 - 12
P: fever, no verbal output but response upon
calling his name, (+) vesicular rash, (+) Chyne-
Stokes respiration
O: BP: 110/70-140/80 HR: 85-160bpm
RR: 20-23cpm T: 37.5-40.8C
60. Skin:warm
HEENT: anecteric, dilated R pupil (5mm) & non-
reactive to light and half open.
Neck:(-) LAD, no neck rigidity
C/L: ECE, CBS, (+)rales both Lung field, (-)wheeze
CVS: DHS, tachycardic, no murmur
Abd.: flat, NABS, soft, nontender, no mass
Ext. : No edema, (+) vesicular rash on the R thigh,
strong pulses, w/ posturing/extension of L
upper extremities.
61. A: HIV Infection, R/I CNS Infection
(Toxoplasmosis vs. Lymphoma)
UGIB probably 2ndary to Stress Ulcer, Herpes
Zoster R Thigh
P: - Rpt CXR done.
- Resume Valtrex.
- Paracetamol given RTC.
- Mucosta 100mg 1tab BID.
- Hold Pepiracillin.
- Cefipime 2G IVTT q 12H.
-
62. Acetylcytine 600mg mix in water BID.
Salbutamol nebulization q 6H.
Inc. Keppra 100mg 1tab BID.
Inc. Mannitol 100cc q 6H.
Family appraised for brain biopsy.
63. Day 13 - 21
P: fever, no verbal output but response upon
calling his name
O: BP: 100/70-140/80 HR: 90-143bpm
RR: 19-23cpm T: 37.4-39.8C
64. Skin:warm
HEENT: anecteric, dilated R pupil (5mm) & non-
reactive to light and half open.
Neck:(-) LAD, no neck rigidity
C/L: ECE, CBS, (+)rales both Lung field, (-)wheeze
CVS: DHS, tachycardic, no murmur
Abd.: flat, NABS, soft, nontender, no mass
Ext. : No edema, strong pulses, w/ limitation in
movement on the L side of the body.
65. A: HIV Infection, R/I CNS Infection
(Toxoplasmosis vs. Lymphoma)
UGIB probably 2ndary to Stress Ulcer, Herpes
Zoster R Thigh
P: - continue all meds.
- family opted to transfer to other hospital for further
mgt.