Fen 23rd

1. DR.Widad Al-Shukaili

2. Admitted in Rustaq hospital for 1 day with Dx of pancreatitis ,amylase >2000 ,, discharge LAMA 58 yrs , F , 1 day h/o abdo. Pain and loose motion At 01:00 AM

4. A patent B Spo2 96 % C HR 105,,BP 84/46 D GCS 15,reflo. 1.5 E 38C,dehydrated

6. KCO DM on insulin,HTN,IHD with EF 30 % , AF ( aspirin , digoxin , frusimide , simva. ,cavidelol) 6 D h/o constipation ,, followed by 1 D of diarrhea (?? Bloody ?? Mucus) after orange juice 1 D of colicky abdo. Pain mainly upper abdo. radiating to the back ,relieved by leaning forward 5 times vomiting (food particle) ,no heamatemesis Abdo. Distention ---  difficulty in breathing No h/o fever, no previous episode, no similar FH No genitourinary symptoms No chest complains or neuro.

8. Dehydrated , not jaundice , not pale, JVP not raised , no pedal edema , no clubbing Chest ----- b/l equal air entry , no added sound CVS------ s1s2 PA distended , gen. tenderness mainly upper abdo. , BS sluggish , hyperesonance PR no melena CNS intact

11. CBC HB 15,WBC 8.9,PLT 332 U/E ur. 17 , cr 200 ,K+ 4.8 , Na 143 LFT AST 899 LDH 583 Lipid profile WNL Coag. WNL Lactate 2.6 ABG heamolysed Amylase 2000 ( high)

12. Chest XRAY ----- normal CT abdomen ---verbal report : plain CT done as the pt with RF ,,,, acute pancreatitis with ascitis

13. 58 yrs lady , KCO HTN,DM,AF,IHD on x 6 D h/o constipation followed by 1 D diarrhea,rt lumber pain after orange juice No fever LAMA from Rust. Hosp. ,,,, amylase > 2000 O/e : dehydrated , hypotensive,hypoglycemic ,distended abdo. Inx : amylase 2000 , AST 899 , LDH 583 , lactate 2.6 with derange UE CT ------ acute pancrititis with ascitis

15. Pt admitted under medical word at 6 AM ------ Acute pancreatitis Pt continue to be hypotensive and febrile At 9 AM senior radiologist seen CT abdomen ?????? From 9 AM to 11 AM surgeon awaited final CT report At 11 AM the CT report finalized

45. At 12 AM surgeon review the pt and decided to operate on her but family refused At 1 :30 pt arrested ---------------- cleared dead

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