Death Review

Death Review
March & April 2022

Medicine Department, CIMCH.
Dr. Mumtahina Mariam

Trainee Medical Officer
Department of Medicine, CIMCH.
Case-1
Particulars of the Deceased:
 Name of the deceased: Mrs.Joynab Begum.

 Age: 56 years
 Sex: Female
 Hospital Reg No: IP-2203603
 Department: Neurology.
 Bed No: Female- 06.
 Contact: 01817720293
 Marital status: Married.
 Address(Permanent): Nazumiahut, Hathazari,
Chittagong.
Short history
Mrs.Joynub Begum , 56 years female hailing from

Nazumiahut, Hathazari, Chittagong. , on 12.15 PM of
24th March, 2022, , presented with the complaints
 Acute confusional state & inability to eat for 2-3 days.

 Generalised weakness & Difficulty in walking for 2-3
months.
 Several bed sore at her back..
 Patient was a diagnosed case of schizophrenia & was
taking antipsychotic drugs for many years( 10-15
years).
 Patient was hypertensive & diabetic & had IHD.
During admission the examination finding was:
 Pulse: 120b/min.
 BP : 180/120 mm Hg(Both hand)
 Temperature : Normal.
 RR : 20 breaths/min.
SPO2 : 97% with room air
Lungs : Clear.
GCS : E4V3M5 =12/15.
Planter : Bilateral flexor.
After admission it was suspected as a case of stroke.
All routine investigations along with brain imaging was

advised.
But there was no acute changes in imaging. Then it was

diagnosed as:
Acute confusional state with UTI with secondary

parkinson’s disease with schizophrenia with Bed sore
with mild hypokalemia with Dyslipidemia with HTN
with DM.
Antibiotic was started.
Antihypertensive drug dose was adjusted.
Psychiatry on call given & antipsychotic drugs was adjusted

accordingly.
Patient’s vitals was normal except GCS 12/15 upto

30.3 22.
On 30.3.22 evening patient’s blood pressure flactuated
BP was :90/70 mmhg.
Antihypertensive was holded.
On 31.3.22 during morning follow up

 Pulse :70 b/min
 Bp: 110/80 mmhg( without antihypertensive).
 SPO2 : 97% with room air
Few hours later after morning follow up near at 9.30
AM on that day we found patient was
hemodynamically unstable:
 Pulse : feeble (?30b/ min)

 Bp: 70/40 mmhg
 SPO2 : 95 % with room air.
After that patient deteriorated further rapidly ,

Injection Hydrocortisone & adrenaline was given bt
there was no improvement then Patient expired on
31.3.22 at 10.30 AM.
Investigation profile
Case-2
Short history
Mrs.Sokina Begum , 47 years female hailing from ,Bolir

hut ,Khaza road ,Chandgaon on 10.30 AM of 26th March,
2022, presented with the complaints
 Respiratory distress for 2 days.

 Leg edema for 2 days.
During admission the examination finding was:
 Pulse: 90b/min.
 BP : 100/80 mm Hg.
SPO2 : 90% with 2L/min supplemental O2.
Lungs : creps (coarse)& ronchi on both lung field.
 GCS : 15/15.
 Flapping tremor : Present .
Patient was smoker for many years , was a known case of

COPD & had exacerbation of COPD several times.
All the routine investigations along with ABG
were advised .
Then diagnosis was –

Cor pulmonale with type 2 respiratory failure due
to acute exacerbation of COPD with pulmonary
hypertension with UTI with
dyselectrolytaemia(Hyponatraemia, hypokalemia)
The patient was transferred to HDU on 29.3 .22.
At that time patient had severe respiratory distress &
oxygen demand increased .
Spo2 was 95% with 10L oxygen.
Then NIV ( BiPAP) was started at HDU.
after using NIV patient’s condition improved & oxygen

demand decreased to 5L .
But from 31st march 2022 patient deteriorated since
morning .
Pulse: 100b/min.
BP : 120/80 mm Hg.
RR : 38 breaths/min.
SPO2 : 96% with 15L/min supplemental O2.
GCS :8/15.
NIV was stopped & patient party was counselled about

ICU( to start invasive ventilation ).But they refused to
shift.
On 1.4.22 at 1.10 PM patient further deteriorated &
vitals was ..
Pulse :30b/min.
Bp: 40/30 mmhg.
Spo2:60% with 15 L o2.
Injection hydrocortisone & Injection Adrenaline was

given IV STAT.
But still patient’s condition was deteriorating & patient

expired on 1.4.22 at 1.20 PM.
ABG reports :
Initial Management
 Diet: Normal+ fluid restriction upto 1200ml
 Oxygen inhalation [Target spo2 88-92%]
 Position :propped up.
 INJ.MOXACLAV (1.2 gm)
1 vial IV 8 hourly [SF 25.3.22]
 INJ.FUSID (20mg)
1 amp IV BD (8 AM,4 PM)
 INJ. COTSON (100mg)

1 amp IV TDS
 Tab.AMBRISAN(5mg)
1+0+1
 Tab.AGOXIN(0.25mg)
0+0+1 [ except Friday ]

 Tab.IVANOR (5mg)
1+0+1
 Tab. ODREL PLUS(75mg)
0+1+0(P/C)
 Tab FAMOTACK(20mg)
1+0+1 (A/C)
 Nebulization with V:IP:N/S (1:1:2)
TDS
 Then,
 INF N/S + KT (1 amp)
 INJ .THIASON(100mg)
1cc IV daily
 Tab.KLABEX (500mg)
1+0+1
 Tab. RIVAROX (15 mg)
1+0+1 for 14 days

 Tab. AMILIN (10mg)
0+0+1
 Tab . NACL
2+2+2
 NG tube inserted for feeding & medication after GCS
deteriorated.
Events at the time of death:
 Date and time of Admission:

26.3.22 at 10.23 AM
 Date and time of Death:
1.4.22 at 1.20 PM
Doctor(s) on duty (at death) with unit:
 Name: Diptta Bhattacharjee

 Unit : 1
Referral Information(fill if patient is referred
case)
 Referred from:
 Reason ofreferral:
 Appropriate referral:
Done/ Not done

 Management before referral:
Adequate/ Not adequate/ Not timely

 Management after referral in the hospital:
Adequate/ Not adequate/ Timely

Medical History
Medical History: (List e.g TB, HTN, Diabetes, Heart diseases)
 COPD, pulmonary HTN, IHD.
General Information Yes/ No Comments

Working diagnosis on admission No
(ED or GP)
Working diagnosis following initial Yes
clerking by inpatient team
Working diagnosis following consultant Yes
review
Was this diagnosis supported by tests? No
Co-morbidities Yes
 Was the deceased referred to any health
facility or hospital? -- No
 Cause of death :
Primary cause of death:
 Type 2 respiratory failure due to acute exacerbation of
COPD.
Secondary cause of death(if any):

 Corpulmonale
 IHD
 Pulmonary HTN
To be completed by-
Lead reviewer:
Responsible consultants:
Components Agree Disagree
I am satisfied with the cause of death as listed on
the death certificate
To my knowledge, no clinical incidents or adverse

events occurred during the course of the
admission
( Such as a fall, unexpected return to theatre,
unexpected readmission, prescribing error
To my knowledge, there were no issues in relation

to negative patient experience raised by the
patient or family, or known to me (such as a
complaint)
I consider this death to have been unavoidable

 Lessons learned and action to be taken:
 Consultant and discipline of co-reviewer:

Case-2
Particulars of the Deceased:
 Name of the deceased: Mrs.Fatema.

 Age: 65 years
 Sex: Female
 Hospital Reg No: IP-2203955
 Ward: HDU/CCU
 Bed No: HDU -1
 Contact: 01836830371
 Marital status: Married
 Address(Permanent):Tulatoli, Shatkania,Ctg.
Short history
Mrs. Asma Khatun , 65 years female hailing from

Tulatoli, Shatkania on 1:25 am of 1st April, 2022 presented
with the complaints of -
Central chest pain for 2-3 days

Respiratory distress for 2-3
hours
Deceased was a case of acute ST elevated MI , was
admitted into CMCH on 24.3.2022 & received injection
streptokinase there.
During admission the examination finding
was:
 Pulse: 110b/min(Feeble).
 BP : 80/50 mm Hg(right hand)
80/60mmhg(left hand)
Temperature : Normal.
Respiratory rate :28 br/ min.
 SPO2 : 94% with 10L/min supplemental O2.
Lungs : Bilateral basal creps.
 GCS : 15/15
CBG : 12.2 mmol/L
All the routine investigations along with ABG
were advised .
Our diagnosis was –

Cardiogenic shock with ALVF with type 1
respiratory failure due to STEMI (ant.) with CAP
with UTI with moderate hypokalemia with
normocytic normochromic anaemia with ?COPD
with pulmonary HTN .
After admission ,as MAP was 60 INJ.Dobutamine IV was
(on 1.4.22) started through syringe pump. When MAP
increased Injectable Frusemide was started through
syringe pump.
Patient was febrile & had UTI. Later lung & Xray finding
was suggestive of CAP then antibiotic was started.
When MAP increased we tried to tapper off dobutamine

dose but patients blood pressure was fluctuating .
We stopped dobutamine after tapering off gradually on

(10.4.22 at 8.00PM)
We stopped dobutamine after tapering off gradually on
(10.4.22 at 8.00PM) .
At that time
Pulse :112 b/min
BP: 100/40 ( BP was static to 100/40 throughout the day
& night).
Urine output:75ml/hour.
Spo2 :92% with 8L supplemental oxygen.
On 11.4.22 at 1.30 AM patient started deteriorating at that
time patient’s oxygen demand increased to 25 L.Then
HFNC was started .But SPO2 was 72% on HFNC with 45L
supplemental oxygen.
Patient party was counselled for icu support.
At 7.15 AM patient was in shock again

Pulse : 115 b/min.
BP:60/40mmhg.
Urine output: 10cc/hour.
INJ . Dobutamine started again but patient’s condition was
deteriorating rapidly.
Patient expired at 8.40 AM that day.

On going Management
 Diet : Normal.
 Position : propped up
 Absolute bed rest
 Oxygen inhalation [Target spo2 > or =94%]
 Inf N/S (1L)+ KT (2amp)
 Inj.ARIXON (2gm)
 Inj. CLARITH(500mg)
 Inj. METRO(500mg)
 Inj.THIASON (100mg)
 Inj.DOBUTAMINE
 Inj. LASIX (20mg)
 Inj PARINOX (60mg)
 Inj PANTONIX (40 mg)
 Tab.CLOPID(75mg)
 Tab.TICAREL(60mg)
 Tab. AGOXIN (0.25mg)
 Tab.AMBRISAN(5mg)
 Tab.RTV (10mg)
Events at the time of death:
Date and time of Admission:

1.4 22at 10.40 AM
Date and time of Death:
11.4.22 at 8.40 AM
Doctor(s) on duty (at death) with unit:
 Name: Dr.Ismat Ara Tithi

 unit: 1
Referral Information(fill if patient is referred case)
 Referred from:
 Reason of referral:
 Appropriate referral:
Done/ Not done

 Management before referral:
Adequate/ Not adequate/ Not timely

 Management after referral in the hospital:
Adequate/ Not adequate/ Timely

Medical History
Medical History: (List e.g TB, HTN, Diabetes, Heart diseases)
General Information Yes/ No Comments

Working diagnosis on admission No
(ED or GP)
Working diagnosis following initial Yes
clerking by inpatient team
Working diagnosis following consultant Yes
review
Was this diagnosis supported by tests? Yes
Co-morbidities No
 Was the deceased referred to any health facility
or hospital? -- No
 Cause of death :
Primary cause of deat
Cardiorespiratory failure due to cardiogenic shock
with ALVF due to STEMI.
Secondary cause of death(if any):

Type 1 respiratory failure due to CAP.
To be completed by-
Lead reviewer:
Responsible consultants:
Components Agree Disagree
I am satisfied with the cause of death as listed on
the death certificate
To my knowledge, no clinical incidents or adverse

events occurred during the course of the
admission
( Such as a fall, unexpected return to theatre,
unexpected readmission, prescribing error
To my knowledge, there were no issues in relation

to negative patient experience raised by the
patient or family, or known to me (such as a
complaint)
I consider this death to have been unavoidable

 Lessons learned and action to be taken:
 Consultant and discipline of co-reviewer:

Thank You

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Death Review

March & April 2022

Dr. Mumtahina Mariam

 Name of the deceased: Mrs.Joynab Begum.

Mrs.Joynub Begum , 56 years female hailing from

 Acute confusional state & inability to eat for 2-3 days.

All routine investigations along with brain imaging was

But there was no acute changes in imaging. Then it was

Acute confusional state with UTI with secondary

Antihypertensive drug dose was adjusted.

Psychiatry on call given & antipsychotic drugs was adjusted

Patient’s vitals was normal except GCS 12/15 upto

Antihypertensive was holded.

On 31.3.22 during morning follow up

 Pulse : feeble (?30b/ min)

After that patient deteriorated further rapidly ,

Mrs.Sokina Begum , 47 years female hailing from ,Bolir

 Respiratory distress for 2 days.

Patient was smoker for many years , was a known case of

Then diagnosis was –

Then NIV ( BiPAP) was started at HDU.

after using NIV patient’s condition improved & oxygen

NIV was stopped & patient party was counselled about

Injection hydrocortisone & Injection Adrenaline was

But still patient’s condition was deteriorating & patient

 INJ.MOXACLAV (1.2 gm)

1 vial IV 8 hourly [SF 25.3.22]

 INJ. COTSON (100mg)

0+0+1 [ except Friday ]

1+0+1 for 14 days

 Date and time of Admission:

Doctor(s) on duty (at death) with unit:

 Name: Diptta Bhattacharjee

Done/ Not done

Adequate/ Not adequate/ Not timely

Adequate/ Not adequate/ Timely

Medical History: (List e.g TB, HTN, Diabetes, Heart diseases)

 COPD, pulmonary HTN, IHD.

General Information Yes/ No Comments

Secondary cause of death(if any):

To my knowledge, no clinical incidents or adverse

To my knowledge, there were no issues in relation

I consider this death to have been unavoidable

 Consultant and discipline of co-reviewer:

 Name of the deceased: Mrs.Fatema.

Mrs. Asma Khatun , 65 years female hailing from

Central chest pain for 2-3 days

Our diagnosis was –

When MAP increased we tried to tapper off dobutamine

We stopped dobutamine after tapering off gradually on

At 7.15 AM patient was in shock again

Patient expired at 8.40 AM that day.

Date and time of Admission:

Doctor(s) on duty (at death) with unit:

 Name: Dr.Ismat Ara Tithi

Done/ Not done

Adequate/ Not adequate/ Not timely

Adequate/ Not adequate/ Timely

General Information Yes/ No Comments

Secondary cause of death(if any):