Internal Medicine Mortality Report May 2022

MORTALITY REPORT- MAY, 2022 INTERNAL MEDICINE DR. F.O.N. ARTHUR 1

SUMMARY OF OPD ATTENDANCE C. ROOMS INSURED NON-INSURED TOTAL MALE FEMALE S.TOTAL MALE FEMALE S.TOTAL G.TOTAL CR1 509 1621 2,103 209 201 410 2513 CR2 422 1438 1860 137 165 302 2162 CR3 210 780 990 66 72 138 1128 2

OPD ATTENDANCE MONTHS NO. OF ATTENDANCE JANUARY 5028 FEBRUARY 4721 MARCH 5646 APRIL 4774 MAY 5803 3

SUMMARY OF WARD ADMISSIONS WARDS MALES FEMALES TOTAL ADMSSIONS MMW 0 51 62+51+36= 146 FMW 0 62 ANNEX 36 BOTH F&M 0 ICU/PR 0 2 MMW 3 0 NO. OF DEATHS FMW 0 2 7 ANNEX 0 2 ICU/PR 0 48 51 +29 (ANNEX) NO. OF DISCHARGES 86 4

TABULAR REPRESENTATION MONTH NO. OF ADMISSIONS NO. OF DEATHS MORTALITY RATE JANUARY 72 11 15.3% FEBRUARY 66 8 12.1% MARCH 115 7 6.1% APRIL 116 8 6.9% MAY 149 7 4.6% 5

GRAPHICAL PRESENTATION MORTALITY RATE MAY 10% JANUARY 34% APRIL 15% MARCH 14% FEBRUARY 27% JANUARY FEBRUARY MARCH APRIL MAY 6

SUMMARY OF SUMMARY OF MORTALITIES IN MAY MORTALITIES IN MAY 7

MORTALITY RATE 16 14 12 10 8 6 4 2 0 Jan feb mar apr may 8

NO INITIALS AGE SEX WARD DOA DOD DIAGNOSIS CAUSE OF DEATH 1 J.K 53YS F ANNEX 1/05/22 09/05/22 KNOWN RVI COMPLICATED BY 1.HYPOVOLEMIC SHOCK SEC INFECTIVE DIARRHEA WITH SOME DEHYDRATION AND ELECTROLYTE IMBALANCE 1.SEPTIC SHOCK 2.SEIZURE ?CAUSE CNS TOXOPLASMOSIS 2 KOFI M. TWUMASI 43YRS M MMW 04/05/22 11/05/22 1.DECOMPENSATED CHRONIC LIVER DISEASE SEC TO CHRONIC HEP B INFECTION COMPLICATED BY ESOPHAGEAL VARICES SEC PORTAL HYPERTENSION -MASSIVE ASCITES -HEPATORENAL SYNDROME -HEPATIC ENCEPHALOPATHY STAGE 2 MULTIPLE ORGAN DYSFUNCTION 9

NO INITIALS AGE SEX WARD DOA DOD DIAGNOSIS CAUSE OF DEATH 3 E.D 60YRS F FMW 13/05/22 15/05/22 1.SEPTIC SHOCK SEC TO INFECTED LEG ULCER SURGICAL 2.OLD STROKE WITH EXPRESIVE APHASIA AND TETRAPARESIS 3.PNEUMONIA 4?LEFT LEG DVT 5.UPPER AND LOWER LIMB CONTRACTURES RESPIRATORY FAILURE 4 A.B 63YRS F FMW 13/05/22 17/05/22 ACUTE UNTYPED STROKE WITH EXPRESSIVE APHASIA AND RIGHT HEMIPARESIS WITH RISK FACTORS HPT/DM . SEPTIC SHOCK SEC UROSEPSIS AND BIVENTRICULAR FAILURE PRECIPITATED BY PNEUMONIA SEPSIC SHOCK 10

NO INITIALS AGE SEX WARD DOA DOD DIAGNOSIS CAUSE OF DEATH SUMMARY OF MORTALITIES C.T 41YRS F ANNEX 5 16/05/22 18/05/22 SEPTIC SHOCK IN NEWLY DIAGNOSED RVI WITH SEVERE ANAEMIA PNEUMONIA R/O PTB ACUTE GASTROENTERITIS ACUTE SUPURATIVE OTITIS MEDIA SEPTIC SHOCK 6 A.K 80YRS M MALE MEDIC AL WARD 09/05/22 18/05/22 SEVERE ANEMIA SEC PROSTATE CA MESTASTIC PROSTATE CA BILATERAL PNEUMONIA R/O PTB PARAPARESIS SEC TO RTA THE (SPINAL INJURY ) HPT CLD 11

SUMMARY OF MORTALITIES NO INITIALS AGE SEX WARD DOA DOD DX CAUSE OF DEATH 7 J.A 63YRS M MMW 24/05/22 27/05/22 1. RECURRENT CVA WITH DEFICIT OF RIGHTHEMIPLEGI A WITH RISK FACTORS OF OLD AGE, ATRIAL FIBRILLATION SEPTIC SHOCK 2. 2. MALARIA WITH MODERATE ANAEMIA 3. 3. SEPSIS(WBC 21.88) 12

INDEX CASES VITALS ON ARRIVAL @2:36 PM DOA-1 T-35.8 BP-113/98 MMHG PR-106BPM RR-20CPM RBS-9.4MMOL/L SP02-98% ORA PC: ABDOMINAL PAIN AND ABDOMINAL SWELLING 2/7 HPC:CLIENT IS KNOWN TO ABUSE ALCOHOL,HE WAS IN THIS STATE OF HEALTH UNTIL A 2 MONTHS PRIOR TO PRESENTATION WHEN HE STARTED HAVING THE SUDDEN ONSET,EPIGASTRIC PAIN,STABBING CHARACTER,NON RADIATING,EXACERBATED BY FOOD INTAKE,ASSOCIATED WITH VOMITING(YESTERDAY,2 EPISODES,DARK),EARLY SATIETY AND PROGESSIVELY INCREASING IN ABDOMINAL SWELLING.HE RATED THE OAIN 5/10,REPORTED TO THE OPD A WEEK AGO WITH THE ABOVE COMPLIANS DIAGNOSIS OF CLD SEC HEP B INFECTION WAS MADE AND DISCHARGE HOME TAB CIPROFLOXACIN,METRONIDAZOLE,LASIX,SPIROLACTONE.SYMPTOMS STILL PERSISTED SO REPORTED HERE FOR FURTHER MANAGEMENT ODQ:JAUNDICE+,FEVER+,CHILL-,PROFUSE SWEATING+,HEADACHE-,DIZZINESS-,GBW+,PALPITATION-,SLEEP DISTURBANCE+,CONFUSION- ,HEMATEMESIS+,MELENA+,DYSURIA+,FREQUENCY-,URGENCY- PMHX: ADMITTED ON ACCOUNT OF AN RTA, SURGERIES-, HEMOTRANSFUSION- 13

DHX:TAB CIPROFLOXACIN,METRONIDAZOLE,LASIX,SPIROLACTONE, HX OF HERBAL PREPARATION INTAKE . FHX:NIL SHX:HE IS A FARMER,LIVES IN AGOGO,HAS A WIFE AND 5 CHILDREN, HX OF ALCOHOL INTAKE(2 TOT A DAY ) BUT ACCORDING TO HIME HE STOPPED 4 MONTHS AGO,HAS NO SMOKINING HISTORY. O/E:A MIDDLE-AGED MAN,LOOKS CHRONICALLY ILL,CACHECTIC, NOT PALE,SEVERELY JAUNDICED,WARM TO TOUCH(6.3),NOT IN OBVIOUS RESPIRATORY DISTRESS,HS IS FAIR. CHEST-RR-22CPM SP02 97%ORA AIR ENTRY IS REDUCED BILATERALLY,BRONCHIAL BREATH SOUNDS CVS-S1+S2+M0 P-96 BPM RGV BP-127/103 CRT <3 SEC BILATERAL BIPEDAL EDEMA UP TO THE KNEE ABDOMEN- DISTENDED,NON TENDER,FLIUD THRILL+,LIVER,SPLEEN,2K COULDNT BE ASSESSED BECAUSE OF THE MASSIVE ASCITES,LIVER BOWEL SOUND PRESENT AND NORMAL CNS- CONSCIOUS AND ALERT, GCS- 15/15.NO PEDAL SWELLING,FLAPPING TREMORS+ 14

HEP B-REACTIVE HEP C-NON-REACTIVE LFT:GLOBULINS- 42.5 TOTAL PROTEINS-87.1 AST-261 ALT-149 ALP-715 DIRECT BIL- 80.8 TOTAL BIL-88.1 GGT-1397.7 RFT:CREATININE -175.5 UREA-16.4 ABDOMINAL ULTRASOUND-THE LIVER IS INCREASED IN ECHOGENICITY WITH A COARSE ECHOTEXTURE AND AN IRREGULAR LIVER CONTOUR NOTED. THE PORTAL VEINS ARE DECREASED IN ECHOGENICITY. NO INTRAHEPATIC MASS SEEN. MASSIVE FLUID AROUND THE LIVER. GALLBLADDER- DISTENDED WITH AN ECHOGENIC COLLECTION ( SLUDGE) NOTED WITHIN IT. NORMAL WALL SEEN IMP:1.DECOMPENSATED CHRONIC LIVER DISEASE SEC TO CHRONIC HEP B INFECTION COMPLICATED BY UPPER G.I BLEEDING 1. -MASSIVE ASCITES 2. -HEPATORENAL SYNDROME 3. -HEPATIC ENCEPHALOPATHY STAGE 2 DDX:ALCOHOLIC LIVER DISEASE 15

PLAN@ 2:45 PM 4/05/22 ADMIT TO THE CD TO DO FBC,BF FOR MPS,HEP B PROFILE, VIRAL LOAD,RETRO,URINE DIPSTICK,CHEST XRAY IV CEFTRIAXONE 2G DLY X 48HRS ORAL METRONIDAZOLE 400MG TDS X 48HRS TAB LIVOMYN 1 TAB DAILY X 30 IV LASIX 40MG BD X 48HRS TAB SPIRONOLACTONE 25MG DAILY X 30 SYRUP LACTULOSE 15MLS TDS X 14/7 SYRUP AMINOPEP 15MLS TDS X 14/7 TAB PROPRANOLOL 40MG BD X 7/7 TAB TRANEXAMIC ACID 500MG TDS X 24/7 TAB OMEPRAZOLE 20MG DLY X 14/7 SYRUP NUGEL 15MLS TDS X 14/7 IV PABRINEX 1&2 IN 500MLS DNS TAB THIAMINE 100MG DLY X 30/7 ORAL GLUCOSE 50G TDS X 30/7 ADDENDUM + DR REXFORD@8;45 PM TO DO ABDOMINAL PARACENTESIS 16

5/05/22 @1:02 AM PROCEDURE :ABDOMINAL PARACENTESIS PATIENT WAS PLACE IN A SUPINE POSTION ,UNDER ASEPTIC CONDITIONS ABDOMEN WAS CLEANED WITH SPIRIT AND THEN SALVON A 16G CANNULA WAS INSERTED WAS INSERTED @THE Mc BURNEYS POINT CONNETED TO A GIVEN SET AND URINE BAG CONNECTED TO A GIVEN SET AND URINE BAG AND 3L OF SEROUS FLUID DRAINED VITALS BP:129/87 PR:66bpm RR: 20cpm SpO2:100% ORA TOTAL AMOUNT DRAINED-: 3L POST PROCEDURE CONDITION-SATISFACTORY FULL BLOOD COUNT HB-14.2 WBC-10.79 PLT-432 17

DOA-2 REVIEW@MWR VITALS BP-95/70 P-53 T- 36.3 FBS: 5.3MMOL/L BODY WEIGHT- 60KG ABD CIRCUM- 92CM PLAN: 1.MODIFY ORAL GLUCOSE TO 100MG QID 2.ABDOMINAL TAP AND DRIAN 2L DLY 3.EGG THERAPY 4CONT OTHER TREATMENT 18

REVIEW @ MWR DOA:3 C/O- INABILITY TO SLEEP AND DIARHOEA(HAS PASSED STOOLS ABOUT 6TIMES) ODQ: ABDOMINAL PAIN+, ABDOMINAL DISTENSION+, ASCITIC DRAIN REMOVED SPONTANEOUSLY, FEVER- O/E:LOOKS CHRONICALLY ILL BUT BETTER THAN PREVIOUS DAY,NOT PALE,SEVERELY JAUNDICED, VITALS: BP-96/69 P-54 T- 36.4 SPO2-96?% ON RA FBS: 6.1MMOL/L CHEST-AIR ENTRY IS REDUCED BILATERALLY, VESICULAR BREATH SOUNDS WITH NO ADDED SOUNDS CVS-S1+S2+M0 ABDOMEN- DISTENDED,NON TENDER,LIVER, SPLEEN AND KIDNEYS NOT BALLOTABLE, BS PRESENT AND NORMAL ASCITIC DRAINED ABOUT 2000MMLS OF ASCITIC FLUID 19

HEPATITIS B PROFILE SHOWS: HBsAG- POSITIVE HBsAB- NEGATIVE HBeAG- NEGATIVE HBeAB- NEGATIVE HBcAB- POSITIVE IMP: CHRONIC INACTIVE HEPATITIS B INFECTION ABD USG FINDINGS-LIVER IS INCREASE IN ECHOGENCITY WITH A COARSE ECHOTEXTURE AND AN IRREGULAR LIVER CONTOUR NOTED .THE PORTAL VEINS ARE DECREASE IN ECHOGENECITY NO INTRAHEPATIC MASS SEEN .MASSIVE FLUILD NOTED AROUNG THE LIVER . KIDNEY-NORMAL ABDOMINAL CAVITY THE LOOPS APPEAR NORMAL WITH NORMAL PERISTALSIS ,APPENDIX WAS NOT PROPERLY VISUALISED .MASSIVE FLUID COLLECTION NOTED IN THE PERITONEUM . DOA-4 -TB AMYTRYPTYLLINE 25MG NOCTE X 5/7 HOLD ON SYRUP LACTULOSE FOR TODAY -TO DO FBC, AFP, -TO TRANSFUSE WITH FFP -TO TAKE 2EGGS BD -TO CT ORAL GLUCOSE -MONITOR RBS 20

DOA:4 VITALS: BP-95/70 P-53 T- 36.3 FBS: 5.3MMOL/L BODY WEIGHT- 60KG ABD CIRCUM- 92CM PLAN CT MANAGEMENT 21

DOA-5 C/O- NIL VITALS: BP-95/53 P-54 T- 36.4 FBS: 6.3MMOL/L BODY WEIGHT- 60KG PLAN -CT MEDICATIONS -EXTEND IV CEFTRIAZONE AND IV METRONIDAZOLE FOR 48HRS -TB TRAMDOL 50MG TDS X 7/7 -SYRUP LACTULOSDE 10MLS TDS X7/7 -MONITOR RBS -TB AMYTRYPTYLLINE 25MG NOCTE X 5/7 -MONITOR VITALS 22

DOA-6 ADDENDUM -COUNSEL WIFE ON PROGNOSIS -TO DO AN ASCITIC TAP -CT MANAGEMENT -TB METRONIDAZO;E 400MG TDS X 7/7 -ORAL GLUCOSE 100MG TDS 23

DOA-7 VITALS TEMP-BP-79/58 P-46 T- 36.5 RBS: 6.4MMOL/L PLAN + SNR COLLEGUE -MONITOR RBS -CT MEDICATIONS -MONITOR VITALS -TB METRONIDAZOLE 400MG TDS X 7/7 -ORAL GLUCOSE 100MG TDS 24

TIME: 11-MAY-2022 @12:36 PM ADDENDUM CALLED TO SEE PATIENT WHO WAS UNRESPONSIVE AND WITH NO CARDIPULMONARY ACTIVITY CPR WAS DONE FOR ABOUT 10MINUTES. PUPILS WERE FIXED AND DILATED, NO CARDIOPULMOARY ACTIVITY.PATIENT DECALRED CLINICALLY DEAD AT 11: 42AM PLAN INFORM RELATIVES INFORM MORGUE PERFORM LAST OFFICES 25

CHALLENGES 1. -POOR AWARENESS ON HEPATITIS B AND C PREVENTION,TREATMENT ,MODE TRANSMISSION IN THE GENERAL PUBLIC AND THE RURAL AREA . 2. FINANCIAL DIFFICULTIES IN OBTAINING ALL 3 DOSE OF VACCINATION 3. MISSING THE TIMING OF THE DOSES OF VACCINATION 4. LATE REPORTING OF HEPATASIS B INFECTED PATIENTS (MAY HAVE DEVELOPED COMPLICATIONS) 26

RECOMMEDATION 1. POOR PUBLIC AWARENESS ON MEDIA PLATFORMS ESPECIALLY RADIO STATIONS 27

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THANK YOU FOR YOUR ATTENSION THANK YOU FOR YOUR ATTENSION 29