Dr. Saumya Agarwal Presents Case of 64-Year-Old Male Farmer with Right Hip Pain
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A 64-year-old male farmer presented with right hip pain after a fall. He had a history of right hemiplegia and hypertension. Examination revealed tenderness and limited range of motion of the right hip. Investigations showed anemia. He was admitted for skin traction and surgery. The night before surgery, he developed respiratory distress. His condition deteriorated and he suffered cardiopulmonary arrest. Resuscitation efforts were unsuccessful and he was declared dead due to a suspected pulmonary thromboembolism.
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Dr. Saumya Agarwal Presents Case of 64-Year-Old Male Farmer with Right Hip Pain
- 1. PRESENTER- Dr. Saumya Agarwal Junior resident Dept of Orthopaedics J.N.Medical College and Dr. Prabhakar Kore Hospital and MRC, Belgaum
- 2. Name- ABC Age- 64 yrs Sex- Male IP No. – 123456
- 3. Occupation- Farmer Address- Hukkeri, Belagavi DOA- 24/11/14
- 4. Pain over right hip since 8 days
- 5. Patient was apparently alright 8 days back, when he sustained a fall due to skid at his home After fall he complains of pain over right hip Pain was dull aching in nature and continuous throughout the day
- 6. After the accident he was taken to a local hospital where x-rays were taken and was referred to KLE for further management No history of loss of conciousness ENT bleed seizures vomiting fever
- 7. Patient is a known case of right side hemiplegia since 16 years and is on phenobarbitone 60mg twice daily Patient is a known case of hypertension since 16 years and is on amlodipine 25 mg twice daily No history of DM/TB/Asthma
- 8. Diet – mixed Appetite – not decreased Sleep - Not disturbed Bowel & Bladder - regular No addictive habits
- 10. Patient is moderately built and nourished Conscious and oriented to time, place and person Pallor present No Icterus Clubbing Lympadenopathy Edema Cyanosis.
- 11. Temperature- Afebrile Pulse – 80 /min Blood pressure- 130/80 mmhg Respiratory rate – 22 /min
- 12. CVS - S1 and S2 heard, No murmurs RS - Air entry equal on both the sides P/A - Soft, no organomegaly, bowel sounds heard CNS – right side hemiplegic
- 13. Glasgow Coma Scale E4V5M6 15/15 Revised Trauma Score GCS4 SBP4 RR4 12/12 Pupils reactive to light
- 14. Patient was lying in supine position Attitude of the right lower limb was externally rotated and abducted Cannot walk
- 15. Swelling was present over hip Patient was not able to move his right side of the body No engorged veins or sinuses No visible pulsations
- 16. Inspectory findings are confirmed No local rise of temperature Tenderness present over right hip ROM of right hip – not possible
- 17. Pelvic compression test positive Chest compression test negative No limb length discrepancy B/L Peripheral pulses well felt Toe movements were absent
- 18. Patient was admitted in ortho free ward on 24/11/2014 at 3 pm Vital signs were stable Skin traction given Investigations send Treatment started
- 19. Hb - 7.1 gm% WBC - 3000/cmm Differential count – N58, L37, E02, M03, B00 ESR – 76 mm PCV – 21 % Platelet Count - 1.50 lakhs/cmm RBC - 1.60 millions/cmm
- 20. Blood Urea – 28 mg/dl S. Creatinine - 1.1mg/dl S. Sodium - 142meq/l S. Potassium - 3.9meq/l S. Uric acid - 4.5mg/dl Blood group – A +
- 21. Intra venous fluids NS/RL @50ml/hr Inj Rantac 2cc iv 1-0-1 Inj Inac im 1-0-1 Tab Calcium 500 mg 1-0-0 Cap Becosules 0-0-1
- 23. Patient was posted for surgery on 26/11/14 Surgical fitness was obtained by physician on 25/11/14 in the afternoon Chest x-ray was advised
- 24. On 25/11/2014 at 2 pm : Patient started complaining of mild discomfort in breathing Respiratory rate was 29 /min Salbutamol nebulisation was started Patient was given O2 at 3 lit/min Patient felt better and relieved No fresh complaints
- 25. On 26/11/2014 at 2 am : Patient complaint of chest pain and difficulty in breathing BP was 100/60 mmhg SpO2 was 90% Pulse was 90 /min, Resp. rate was 30 /min Patient was given propped up position
- 26. Salbutamol nebulisation given O2 started at 3 lit/min On duty physician was informed He advised to shift the patient to ICU Patient attenders refused
- 27. Meanwhile, patient was on oxygen at 3 lit/min Arterial blood gas analysis was sent Patient was maintaining saturation at 90% Pulse, BP , RR monitoring was going on half hourly Patient was feeling better again.
- 28. At 7 am : Pulse was 92 /min BP was 100/70 mmhg Respiratory rate was 31/min SpO2 85% Salbutamol nebulisation repeated with O2 continuing at 3 lit/min
- 29. At 8 am : Patient started gasping Pulse was not recordable BP not recordable CPR started
- 30. Inj.Atropine 2cc iv given Inj. Adrenaline 1mg iv given Patient intubated with endotracheal tube
- 31. At 8:15 am : Pulse was not recordable BP not recordable CPR continued Inj.Atropine 2cc iv given Inj. Adrenaline 2cc iv given
- 32. Pupils became dilated, fixed and non reactive to light CVS – S1 S2 absent RS – breath sounds absent ECG – no voltage Defibrillation attempted but patient did not revived
- 33. Inspite of all resuscitation measures patient could not be revived & patient declared dead at 8:30 am on 26/11/14 at KLE Hospital, Belgaum Post mortem was advised but patient attenders refused.
- 34. Immediate cause : Cardio – pulmonary arrest secondary to pulmonary thromboembolism ?? Antecedent cause : fracture neck of femur right hip / right side hemiplegia