cpc-1-for-printing

UNIVERSITY OF THE EAST Ramon Magsaysay Memorial Medical Center  Aurora Boulevard, Boulevard, Quezon City

CLINICOPATHOLOGIC CLINICOPATHOLOGIC CONFERENCE Date:  July 15, 2015, 2015, CPC #1 Cha!ions "enue: Un  University Auditorium 1 & 2 Tie" "00 ! 10"00 A$

 

Discussants: 42nd Interscholastic Interscholastic CPC

Dr. Kea T. Cario ! Presentor Dr. Jeryl T. %u  Presentor Dr. Dr. $elissa T'erese (. )uillermo Dr. Darell C. *uisan Dr. +ria Ayn -. %arra Patholo#ist: Dr. Janelyn Aleis Dy/edesma $oderator: Dr. +dard $. (antos Reactors: Dr. -itor (. Dotor, Dr. /in (. Paillo Dr. Dr. $ilaros (. 3autista, Dr. Dr. $arieanneelle $arieann eelle P. P.  Talante  Talante

CA%E PROTOCOL  T'is is t'e ase o4 1 year old 4emale, ri't ri't 'anded, 6oman 6oman Cat'oli 4rom 4rom -alen7uela -alen7uela 'o 'o resented at t'e ediatri emereny room due to di8ulty o4 reat'in.

Chie& Co!laint: Dysnea o4 9 ee:s duration Histor' o& Present Illness: ;ine mont's rior to admission, s'e started to 'ave rodutive ou' and easy 4atiaility. *ei't loss as also oserved, rou'ly 50?@. T'ere as no 4ever, dysnea, or anoreia. ;o onsults ere done, or mediation iven.  T'ree mont's mont's rior to admission, admission, s'e s'e started to 'ave 'ave dysnea at rest, and ort'onea. ('e ('e sou't onsult at a rivate lini 'ere s'e as resried iom, 9 talets one a day, to 'i' s'e omlied. (ymtoms ere alleedly artially relieved. Bne mont' rior to admission, t'ere as a radual inrease o4 adominal irt' and iedal edema. ;o onsult as done.  T'irteen days rior to admission, admission, s'e eeriened eeriened orsenin orsenin o4 'er dysnea, it' an assoiated vaue 'est ain. ('e onsulted at (an /a7aro, 'ere s'e as admitted. ('e as iven - Peniillin and an unrealled diureti. A4ter t'ree days, it' artial relie4 o4 dysnea, s'e ent 'ome aainst medial advie. Bne day rior to admission, t'ere as reurrene o4 dysnea, 'i' romted onsult at t'e ediatri emereny room. Re(ie) o& s'stes: EF allor F ea:ness, loss o4 onsiousness, 'eada'es, sei7ures F ear dis'are, tinnitus F 'emotysis F 'ematemesis, adominal ain, Gaundie, diarr'ea, diarr'ea, onstiation, 'emato'e7ia, melena F oliuria, 'ematuria F musle ain F ras'es, easy ruisaility ruisaility Past edical histor': F ron'ial ast'ma, 'yertension, diaetes mellitus, alleries EF PT3 eosure ! nei'ors

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Fail' edical histor': EF 'yertension ! 4at'er EF diaetes mellitus ! mot'er *irth and aternal histor': ('e as orn 4ull term to a t'en 2H year old )1P0 via sontaneous vainal delivery at 'ome are o4 a midi4e, it' no 4etomaternal omliations. Iuni+ation histor': EF 3C), BP-9, DPT9, Ieatitis 3 9, measles Personal,social Personal,social histor': $ot'er is a 9 year old 'ousei4e, 4at'er is a 5 year old elder. Patient is t'e eldest o4  'ildren. Nutritional histor': Patient as 4ormula 4ed. Prior to 'er illness, 'er diet onsisted o4 rie and meat, it' no re4erenes. De(elo!ental De(elo!ental histor' Unremar:ale. Ph'sical E-aination Patient as aa:e, o'erent, in mild resiratory distress, it' t'e 4olloin vital sins" 3P 0L0, I6 120, 66 5, a4erile, it' a ei't o4 9.5 :. ('e 'ad aniteri slerae, ale onGuntivae, and eriorital edema. ('e 'ad alar Marin, and surasternal retrations. (everal ilateral ervial lym'adenoat'ies ere alated. ('e 'ad an adynami reordium. Bn ausultation s'e 'ad reular ardia r'yt'm, a loud P2, and no murmurs. ('e 'ad e
Course in the ER: ('e as 'oo:ed to B2 suort at 10 /P$, and an - Muid line as started D5/6F.  T'e 4olloin 4olloin ere re
Da' 2: Bn t'e seond ard day, s'e as aslee ut arousale, still it' allor. Ier 3P as 0L0, I6 110s, 66 20s, and s'e as a4erile. Cra:les ere ausultated ilaterally, and 'er etremities ere arm. +ndotra'eal asirate as sent 4or ram stain and ulture. A reeat C3C s'oed 'aemoloin o4 , 'ematorit 0.220, 63C 2., $C- HH.5, $CI 22.5, $CIC 29, 6D* 20.1, Platelet 51, and *3C 1.0. ;eutro'ils ;eutro'ils ere 0.2, lym'oytes 0.01, monoytes 0.05, eosino'ils 0.002, aso'ils 0.001. 3lood 'emistry s'oed ;a 19H, K .0, Cl 10. Patient as started on I6Q+, e4uroime, and 4amotidine it' a lan to start sildena=l and erarost. Da' /: Ier temerature raned 4rom 9HRC to 9RC. T'ere as ilous outut er ;)T. Paraetamol as added to t'e mediation reimen. ('e as also ein eaned o t'e me'anial ventilator. Da' 4: Bn t'e t' 'osital day, t'ere as an eisode o4 desaturation 0?F 'ile on iB2 o4 0?. At t'is time, 'er 3P as 100L0, I6 15010, 66 90, B2 saturation o4 ?. Patient as later rou't to radioloy 4or 'oloadominal ultrasound. At t'is time 'er 3P as 100L0, I6 15, 66 90, temerature temerature 9oC, and B2 saturation as ?. 3a: at t'e ard, atient as re4erred 4or I6S0 'ile endotra'eal sutionin as ein done. AC/( as er4ormed 4or 2H minutes. Patient as not revived. Aniteri slerae, ale onGuntivae, and eriorital edema. ('e 'ad alar Marin, and surasternal surasternal retrations. (everal ilateral ervial lym'adenoat'ies ere alated. ('e 'ad an adynami reordium. Bn ausultation s'e 'ad reular ardia r'yt'm, a loud P2, and no murmurs. ('e 'ad e
DIAGNO%TIC% Arteria l lood +6 at as am

Day 1, 12mn

iB2 I CB2 B2 ICB9 3+ B2sat

0 H.H 92. 5H 2 2 1.H

0 H.2 2. .2 1. 9. H.

Day 1 100 H.92 5. 2.2 2.H 2. .

Day 1, am

Day 1, 10am

Day 2, 2am

Day , 2am

Day , am

0 H.2 59.5 12. 2.2 1 .1

0 H.9 9H. 1. 20.2 . .2

0 H.5 2. .5 2.H 5. H.5

100 H.91 5. H 2. 2.5 .5

100 H.9 1 20. 90.H H.5 .5

Holoa0doinal Holoa0doinal 1ltrasound: $inimal asites. Pyone'rosis, ri't, annot rule out yelone'ritis it' asess 4ormation. ;ormal liver, sleen, anreas, le4t :idney. AF* sears: +ndotra'eal +ndotra'eal asirate" Day1 and Day2  neative. Urine" Day1, Day2, Day 9 ! neative.

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