Patient was apparently asymptomatic two months back. She has an history of dog bite on right cheek for whick she was treated and follow all four doses of vaccines.
Two nights ago when she had developed headache which did not subside followed by and episode of vomiting yesterday after having breakfast which consisted of food particles.
10 episodes of vomiting which mostly consisted of food particles.
In the afternoon she was unable to speak, she was able to understand the attender's speah but she could not answer.
Followed by shortness of breath gradually in onset, progressive in nature from grade 2 yesterday afternoon to grade 4 by tonight.
She was taken to the local hospital and she was reffered here.
She is not a known case of Diabetes mellitus, hypertension, bronchial asthma, tuberculosis, epilepsy.
O/E-
Pt was
PR- 133
BP- unrecordable
RR-40
SpO2- 88
GRBS- 346
CVS- S1 S2 no murmurs
RS- trachea central
Bilateral crepitations in infra mamillary and infra axillary regions
Patient was intubated in view of falling saturations.
4/10
Soap notes day 2
S - Pt on Mechanical ventilator. ACMV - VC MODE - TV -360ml
FI02-80%; RR -14/min; PEEP -5 com of h2o
Pt GCS-E1 Vt M4
Pt comatose and withdrawal present to deep painful stimulus. 2 episodes of ? GTCS. O
BP 90/60 mmhg on Nor ad 22ml/hr
Dobu -14 ml/hr
RS BAE PRESENT.
CVS-S1S2 HEARD
PR-160 bpm, regular ( ecg showing svt sinus tachycardia)
Tone increased
CNS - pupils - Dilated (secondary to
drugs)
Reflexes
B T S K A P
R. 2 2. 3 3 3 mute
L. 3 3 2 3 3 mute
A - Altered sensorium secondary to ? viral encephalitis (? rabies virus)
CARDIOGENIC shock secondary to hfref (? RECENT antero -septal wall MI)
? Viral pneumonia.
h/o dog bite 2 months ago. ? GTCS.
P-1) pt is on inotropes nor ad and dobutamine
2) RT FEEDS.
3) INJ PIPTAZ 4.5 G IV TID
4) IVF - NS/RL @ 30 ml/hr (slow iv) 5) TAB ECOSPRIN-AV (150/40mg )Od
6) Tab Clopitab 75 mg od 7) Tab pcm 650 mg RT sos
-Fundoscopy - normal
Plan for1) ct brain and lumbar puncture and send csf for rtpcr for rabdoviridae virus.
2) repeat Bed side echo abg yesterday night :
ph-7.27; pco2 45.6; po2- 125, so2-96; hco3- 20.6
A - Altered sensorium secondary to ? viral encephalitis (? rabies virus)
CARDIOGENIC shock secondary to hfref (? RECENT antero -septal wall MI)
? Viral pneumonia.
h/o dog bite 2 months ago. ? GTCS.
Pt blood pressure was low overnight inspite of increasing doses of nor adrenaline, dobutamine,vasopressin. Around 6 Am, in view of absent central pulse, cpr was started According to AHA guidelines and continued for 6 cycles. Inspite of above resucitative measures ,pt couldn't be revived and declared dead on 5/10/21 @ 6:42 AM.
IMMEDIATE CAUSE OF DEATH - Cardiogenic shock secondary to antero septal MI ANTECEDENT CAUSE OF DEATH - VIRAL ENCEPHALITIS (? rabies) ? Viral pneumonia.
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