1. Department of Internal Medicine & Allied Units
Mortality & Morbidity Report For The
Month of Poush,2067
Dr.Roshan Shrestha
Dr.Sharad Bhattarai
MD Residents
Internal Medicine
National Academy of
Medical Sciences(NAMS)

2. Male, 99, 57%
Female, 75, 43%

3. UNIT
Total
Number Male Female AGE ALS cALS
MEAN MODE Median Days Days
Unit 1 24 13 11 53.17 55.00 55.00 10.67 10.76
Unit 2 16 6 10 52.44 50.00 62.50 7.00 7.13
Unit 3 17 11 6 52.29 40.00 52.00 7.59 7.50
Unit 4 19 9 10 41.11 23.00 36.00 6.00 6.00
Cardio 19 11 8 63.37 70.00 70.00 7.72 8.43
Nephro 19 12 7 45.37 55.00 49.00 9.00 10.50
Neuro 21 10 11 52.14 70.00 55.00 5.71 4.71
Gastro 17 12 5 40.53 37.00 37.00 6.88 7.27
Liver 22 15 7 49.00 56.00 45.00 6.77 7.00
Total 174 99 75
Total number of bed available X Total Days of Months
ALC ----------------------------------------------------------------------------
Total number of patient admitted in that months

4. 24
16
17
19 19 19
21
17
22
13
6
11
9
11
12
10
12
15
11
10
6
10
8
7
11
5
7
0
5
10
15
20
25
30
Numberofpatient
Department
Number of Admissions in different department
Total
Number
Male
Female

5. 10.66
7.00
7.58
6.00
7.72
9.00
5.70
6.80 6.70
10.76
7.13
7.50
6.00
8.42
10.50
4.70
7.20
7.00
0.00
2.00
4.00
6.00
8.00
10.00
12.00
Unit 1 Unit 2 Unit 3 Unit 4 Cardio Nephro Neuro Gastro Liver
Department
Days
Average stay in hospital
ALS
in days
cALS
in Days

6. Percentage not filled up out of total cases:
UNIT
Front Page
Summary
Front Page
Final Diagnosis
Front Page
Other Points
Admission
Note
Daily
Notes
Investigation
Note
Unit 1 9 21 13 1 8 100
Unit 2 44 25 25 0 0 100
Unit 3 12 12 47 0 6 100
Unit 4 0 11 21 0 0 100
Cardio 16 11 26 0 11 100
Nephro 5 21 26 0 0 100
Neuro 24 14 29 0 0 100
Gastro 12 47 76 0 0 100
Liver 32 23 59 0 0 100

7. Unit 1 Unit 2 Unit 3 Unit 4
Diagnosis 24 Diagnosis 16 Diagnosis 17 Diagnosis 20
COPD with AE 6 COPD 3 COPD 3 COPD 1
DM 4 DM 1 PTB 1 PTB 2
Pneumonia 1 Pleural Effusion 1 TB pleural effusion 1 Tubercular pleural effusion 3
Bronchogenic CA 1 PTB 1 Pneumonia 2 ITP 4
PTB 2 Pneumonia 3 DM 1 Aplastic Anaemia 1
Dhatura poisoning 1 AGE with ARF 1 ILD 1 Alpha Thalessemia 1
Aplastic anemia 1 Aplastic anemia 1 CA lung 1 IDA 1
AGE with pre-renal ARF 1 Zn phos poisoning 1 Enteric Fever 2 OP poisoning 1
Enteric Fever 1 ILD 1 Hemorrhagic CVA 1 Bronchial asthma/addisonian crisis 2
ILD 2 CML 1 Bronchiectasis 1 Acute rheumatic fever 1
Megaloblastic anemia 1 IDA 1 AML 1 Zinc phosphide poisoning 1
Urosepsis 1 OP poisoning 1 CLD 1 Non hodgkin`s lymphoma 1
ITP 1 Pneumothorax 1 PNH 1
Hemophilia A 1

8. Cardio Nephro Neuro Gastro Liver
Diagnosis 19 Diagnosis 19 Diagnosis 21 Diagnosis 17 Diagnosis 22
CCF- DCM 7 DM/HTN/CKD 6 CVD- Ishemic 6 UGI bleeding/PUD 3 ALD with HE 8
COPD Corpulmonale 5 IGA nephropathy 1 CVD- Haemo 10 UGI bleeding/EV 6 ALD with variceal bleeding 9
RHD/AF 4 Urosepsis 1 Seizure Disorder 1 Gastritis 5 ALD with SBP 1
NSTEMI 2 PSGN 1 TIA 2 DU 2 Hepatitis B/HCC 1
Pericardial effusion 1 CGN 5 Meningitis 1 TB abdomen 1 ATT induced Hepatitis 1
FSGS/SBP 1 Quadriparesis 1 Alcohol Withdrawal 1
MCTD 1 Alcoholic Hepatitis 1
Nephrotic syndrome 3

9. UNIT
Number of
Admission Death
Death With in
24
Hours
Overall
Mortality
%
Mortality %
Excluding death
within 24 hours
Over view of ause of death
Unit 1 24 2 8.33 8.33
1.COPD/DM/HTN/PVD
2. ILD/Vasculitis-ANCA +ve/CKD
Unit 2 16 1 6.25 6.25 1. COPD/Cor-pulmonale
Unit 3 17 2 11.76 11.76 1. Hemorrhagic CVD
2.COPD/Cor-pulmonale
Unit 4 19 2 10.53 10.53
1.PTB with ARF
2. Bronchial Asthma/Addison`s Crisis
Cardio 19 1 5.26 5.26 1. DCM
Nephro 19 3 2 15.79 5.26
1.Urosepsis
2.SAH/ESRD
3.DM/HTN/CKD
Neuro 21 3 14.29 14.29
1.Hemorrhagic CVD
2.Hemorrhagic CVD
3.Ischemic CVD/Left hemiparesis
Gastro 17 1 5.88 5.88 1. ALD/Oesophageal varices
Liver 22 5 1 22.73 18.18
1.CLD/Oesophageal varices/HRS
2.CLD/Sepsis
3.CLD/SBP
4.CLD/Oesophageal varices/HE
5.CLD/GB Mass
Total 174 20 11.49 9.77

10. Mortality

11. Particulars of the patient
• Mrs. . M. Manandhar
• 36yrs/female
• Gongabu/Ktm
• DOA:16/09/2067
• DOD:28/09/2067

12. Case Summary
• A 36yrs/lady, non smoking, non alcohol consuming with
significant past medical h/o bronchial asthma since 15 yrs, h/o
ingestion of multiple medications with suicidal intent 7yrs
back requiring ICU admission for 3 days, h/o RPGN seven
months back and multiple hospital admissions over last
7months presented with epigastric abdominal pain for 3
months and multiple episodes of vomiting for 3 months.
• She was evaluated for same complaints at one of the centers
in KTM where no apparent cause was found and was
discharged on request following which she was brought to Bir
Hospital.

13. Cont…
• She presented at Bir Hospital on 16/09/2067 at 4:31 PM
• She was admitted under Medicine unit IV in ICU on
16/09/2067 and was treated with I/V antibiotics,I/V Pantocid,
I/V Aminophylline, I/V fluids, Inj.Heparin,Diuretics and
antiemetic.

14. On Examination
• Young female in run down health
• Mild pallor, B/L pitting pedal edema, Icteric-mild,
Hyperpigmentation of buccal and perioral mucosa
• BP:80/50mmhg, Pulse:102/min, Temp:afebrile, RR:14/min
• Chest: B/L wheeze
• CVS:S1 S2M0
• P/A:distended,tender epigastrium, shifting dullness+
• CNS:GCS-15/15,Grossly NAD

15. ER Management
• Inj.Nutridex 25% 100ml I/V stat
• Inj.40mg In 100ml N/S I/V stat

16. Investigations at ER
• Total count:11,300/cumm(N84L16), Hb:11.8gm/dl,
Platelets:2,53,000cumm.
• RBS:103mg/dl,Urea:30mg/dl, creatinine:0.7mg/dl, Na:122,
K:4.3meq/L
• PT:17 sec,INR:1.22
• T.Bil:2.0mg/dl, Conj.Bil:1.3mg/dl , ALT:25IU/L, AST:29IU/L,
ALP:304.7IU/L, T.Protein:4.1mg/dl, Alb:1.2mg/dl
• Urine R/E:albumin-trace,3-4pus cells,1-2 RBCs,Acetone-negative
• ECG: Sinus tachycardia,T inversions in leads I,II,V3-V6
• USG: Hepatomegaly with Fatty changes, Moderate ascites
• D-dimer:0.2mg/L

17. Treatment on Admission
Diagnosis:Addisonian
crisis/Gastroduodeinitis
• Inj.Pantocid 40mg bd
• Inj.Tazaar 4.5gm tds
• Syp.sucralfate 2tsf
• Inj.heparin 5000 units s/c bd
• T.levflox 750mg od
• Inj.ondem 8mg i/v tds
• Inj.aminophylline 250mg i/v stat then 500mg over next 24 hrs.
• I/V fluids(NS)
• Syp.Cremaffin 30ml hs
• Inj.torsinex 20mg iv stat.
• A+I nebulization 2 hrly

18. Day 2 of admission
• General condition same
• No fever
• I/O= 800/1350ml
BP= 100/80mmHg Pulse= 120bpm RR= 28/min
• SPO2= 92% with oxygen
Investigations:
HIV I&II,HBsAg,Anti-HCV-Negative,RBS:132mg/dl, PT:18sec,
INR:1.63,urea:17,Creat:0.6,Na:126,K:3.5
T.count:7,500(N84L16),Platelets:54,000,Hb:10
Management:CST(Anti HAV IgM ,Anti HEV IgM ,S.cortisol-sent)

19. Day 5 of admission
General condition :same
BP:80/40, Pulse:136/min,Temp:98.9,RR:35/min, Spo2:77%
Chest:B/L Crackles ,B/L wheeze
I/O:2450/800
Investigations:
T.Bil:5.0,Conj.Bil:3.3,ALT:27,AST:31,AlP:160
T.Count:3500(N82L18),Platelets:53000,Hb:6gm/dl
ABG:pH-7.45,PCO2-29,PO2-98,HCO3-21.8,Anion gap-19.1
Management: Patient transfused with I pint of packed cells

20. Day 8 of admission
General condition:Improving
BP:100/60, Pulse:126/Min, RR:24/min,SPO2:94%,I/O:2750/1800
Chest:B/L wheeze,B/L crepts
CVS:S1S2
P/A:Soft,Epigastric tenderness,BS+
Investigations:
Anti-HEV IgM/Anti HAV IgM-negative,S.cortisol:408ng/ml,Stool
for OBT-positive,Hb:8.8gm/dl,urea-27,Creatinine-1.1,FBS-
36mg/dl
ANA-sent

21. Day 10 of admission
• No vomiting/ No fever
• BP:90/60,Pulse:100/min,RR:30/min,Temp:afeb,SPO2:94% with
O2,I/O:2950/1550
• Chest:B/L Wheeze,B/L basal crepts
• P/A: Distended, Shifting Dullness+
Investigations:
T.Count:20,700(N93L7),Hb:8.5,Plt:99,000,T.protein:4.4,Albumin2.
5, T.Bil:2.7,D.BIL:1.7, ALT:32,AST:25,ALP:157,ANA-negative

22. Day 11
Call attended for patient being unresponsive
O/E,
Patient unresponsive
Pulse and BP-unrecordable
No spontaneous breathing
Patient resuscitated for 30 mins but couldn’t be revived
Cause of Death:cardiorespiratory arrest secondary to sepsis?ACS

23. Thank You