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Post-mortem Expert Witness/ Testimonial Dossier Essay
Patient or Population
JF is a 62 Caucasian male. He was admitted brought to the emergency department on October 8, 2019. For shortness of breath. He suffered from acute pain, causing a ground-level fall and various complications associated with his physical wellness. The treatment pathway in the emergency included ordering several investigational lab tests such as CMPO, CBC, CK, ABG, UA, UDS, D-dimer, and US and start oxygen treatment, Diuretics, IV fluids, and cardiac and renal monitoring. Within hours of admission to the emergency department, JF was admitted to more critical care in the CICU.
Intervention
The initial diagnosis and treatment were consistent with pulmonary congestion and overlapping deep vein thrombosis in the ICU. The physician planned to stabilize JF’s condition and transition his care back home to his family. In the CICU, the JF spent 15 days in critical and acute care as the doctors treated his heart failure, while stabilizing his circulation. He was placed on a ventilator to aid his breathing, and periodic assessments for arterial blood gases, and various lab tests for body chemistry were conducted. His cardiac activities were monitored using an EKG, and his urine output was collected and analyzed.JF was given both cardiac and pulmonary congestion using various furosemide therapy and was given crystalloid vasopressors and fluids for cardiac stability, chronotropic, and contractibility.
At the same time, he was put under heparin to assist him with the stability of the clot. Moreover, renal function was accessed periodically, and anticoagulation monitored using a PTT, PT, and periodic INR checks. Three days after starting treatment, JF stopped producing urine, and the furosemide therapy was stopped. Since his serum creatinine had increased from 1.5 at admission, his pressor therapy and IV fluids were carefully titrated. He developed an upper tract infection on day five, which was treated with antimicrobial agents. On the seventh day, his fever reduced, and he started getting weaned off the ventilator, and on day 8, he was transferred to the general care unit. At the same time, his home medications continued, including enoxaparin, while still getting heparin, which was stopped by the pharmacy. On day ten, home medication was administered, and enoxaparin was given to the patient without being halted together with the heparin. On day 12, the patient’s mental state was altered and had blood in his urine. He was given vitamin K, and protamine to help reverse the condition. Packed RBC was administered without improvement, which led to the death of the patient.
The patient admitted with breath shortness may be associated with pneumonia, asthma, bronchitis, congestive heart failure, allergic reaction, rib fracture, and pulmonary embolism.
Comparison
In treating the patient heart failure, the patients should have been given water pills, diuretics to ensure that they urinate more frequently and guarantee that the fluids are not collecting in JF boy. Diuretics such as furosemide reduce fluid in legs so that people can breathe better; thus, when the patient stopped urinating, he should have been continued with furosemide therapy.
Furthermore, since the enoxaparin and heparin have high drug-drug interaction and were stopped by the pharmacist, it should have stopped the other times the two medicines were treated together.
Outcome
- The intervention aims to stabilize his condition and transition his care back home.
- Ease his breathing
- Relax and expand the airways
Recommendations
- The hospital should ensure that drugs with high DDI should not be administered together
- In diagnosis, a person with breath shortness a CT scan should always be applicable to prevent to diagnose the correct underlying condition.
- The medication record should warn the pharmacist on drugs that have high DDI.
Work cited