Morbidity

1
Morbidity MortalityConference

• September 26,2006

2
Morbidity and Mortality Conference

• CC
• LH - 47 y/o AA F with vomiting x 4 days
• HPI
• Pt known to Surgical Oncology service
• 1/2006- SS- repeated episodes of vomiting and
  dysphgia
• EGD showed Gastric adenocarcinoma in cardia
  region of stomach
• Referred to Surgical Oncology service
• 1/18/2006- Underwent Radical Total Gastrectomy,
  Partial Esophagectomy, Pancreatectomy,
  Splenectomy, Roux-en-Y Esophagojejunostomy and
  Feeding jejunosotomy
• Upon D/C was tolerating soft mechanical diet
• Chemotherapy instituted

3
Morbidity and Mortality Conference
4
Morbidity and Mortality Conference

• EGD- performed 9/12/2006 showed recurrence of at
  the site of esophagojejunal anastomosis
• Pt. presented on 9/14/06 with dehydration after
  multiple episodes of vomiting over the past two
  days
• PMHx- Breast Ca, Gastric adenocarcinoma, diabetes
• PSHX- B/L Mastectomy, Total Gastrectomy
• Meds- Protonix, metformin
• Allergy-PCN

5
Morbidity and Mortality Conference

• Vitals-AVSS
• Physical Exam
• Gen- Cachetic, AAO x 3, NAD
• HEENT- No lymphadenopathy, No scleral icterus, NO
  JVD, dry mucous membranes
• CVS-S1 S2
• Lungs- CTAB
• Abd- soft, ND, mild generalized tenderness,
  BS-active
• Skin- loss of skin turgor

6
Morbidity and Mortality Conference

• Labs- Na- 141 K-3.1 Cl-104 CO2-25
• BUN-9 Crea-O.9 GLU-95
• WBC-6.8 Hgb-10 HCt-30 Plt-326
• - A/P Mild Dehydration secondary nausea and
  vomiting
• Plan-GI- Stent placement

7
Morbidity and Mortality Conference

• EGD- E-J junction seen with nodularity suggestive
  of tumor recurrence. Scope passed to jejunum.
  Two wall stents placed. No complications
• Post-procedure
• Pt on floor unable to maintain O2 saturations
• Respiratory distress
• Pt intubated
• PEA
• ACLS protocol instituted
• 1 mg of Atropine given
• Pulse returns
• Transferred to ICU

8
Morbidity and Mortality Conference

• ABG- 7.25/43/92/21/96 on 100 02
• CXR- Diffuse infiltrates right greater than left
  consistent with pneumonia
• CT-Chest- moderate b/l pleural effusion with
  extensive consolidation, right greater than
  left-consistent with pneumonia

9
Morbidity and Mortality Conference

• Currently
• Remains intubated
• IV abx (primaxin, gentamicin)
• Dubhoff placed yesterday
• Prognosis poor