moreblessing lefani fiiiiiiiiiiinal.pptx

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1. 17 year old para gravida 1 EGA ?16w Referral from concession hospital where she presented with a 3 day history of headache, sore throat and fever. Also had 1 day history of not communicating and started fitting on arrival 4 episodes of seizures prior to arrival to MNMH Unbooked pregnacy HIV status unknown FBC done at concession WCC 2.7 Hb 2.4 PLT 47 MCV 67

2. Examination Ill patient, pale. LOC 10/15 BP 163/89 P 89 T 36.7 SpO2 95% ABD –HOF 18 CHEST – clear CVS – unremarkable

3. Diagnosis: New onset seizures ?cause ? eclampsia ? meningoencephalitis rule out malaria Plan Admit c3 Fbc , u and e, lft , MPS, RDT, Iron studies, ESR, CRP, HIV Mgso4 course Ceftriaxine 1g iv bd Metronidazole 500mg po tds Fit chart Methyl dopa 500mg po tds Larmotrigine 50mg po od EEG, CT brain Transfuse 4 packed cells- 1 unit transfused in casualty

4. Results Fbc WCC 11.7 HB 11.6 PLT 183 MCV 63.6 U and E Na 148 K 3.1 Cr 49 Ur… Cl … LFT AST 18 GGT 11 ALB 32 ALP 43 TBIL 17 ALT …. Glucometer 8.5 Malaria parasites negative Serum crag negative

5. PROGRESS DAY 1 POST ADMISSION 2 episodes of fitting LOC 7/15 BPs 125 to 167 on 78 to 98 P 97 to 115 Plan to admit to ICU but no bed available

6. DAY 2 POST ADMISSION Critically ill patient LOC 7 on 15 BP 106 to 136 on 67 to 80 Hypertonia noted Certified dead at 1530hrs

7. Post mortem findings Brain Pus on meninges R>L Cerebral oedema Chest Pulmonary oedema Bilateral effusion Straw coloured fluid R-450ml L-150ml Abdomen Hepatosplenometally Gravis uterus. Fetus CRL 14cm. Wt 194g Cause of death MENINGITIS

8. DELAYS DELAY 1 Delay in booking pregnancy Delay in seeking health care after noting symptoms DELAY 3 Discrepancies between Concession and Parirenyatwa FBC Delay in securing ICU bed Delay in getting imaging (CT scan brain and EEG)

9. ICD CODE G03.9 Meningitis , unspecified

10. AVOIDABLE OR UNAVOIDABLE AVOIDABLE