Dr Ambika Prasad Dash Consultant – Laparoscopic and General Surgeon Apollo Hospitals, Bhubaneswar

Laxman Pradhan 48 years, Male, from Janla, Khurda Sustained Blunt Trauma Abdomen due to RTA when car collided with a parked truck from back on 16 th at 2 AM. He Reported to our Hospital – Emergency at around 12 PM – Admitted to MICU at 1:00 PM At arrival: Patient was restless with profuse sweating, heart rate:134/m, RR: 44/m Abdominal Distension - + Mild to moderate diffuse abdominal pain CBG > 500mg/dl Sustained a bout of hypotension, responded to fluid resuscitation History of DM - since long

Lab Investigations and Imaging FAST Minimal Pleural Collection Peritoneal Collection CECT Pneumoperitonium Peritoneal Collection Lab Parameters: TLC – 2.1 x 10 3 µL pH – 7.24 Lactate – 6.2 mmol/l Glucose – 571 mg/dl SGOT – 124 U/dl SGPT – 130 U/dl Sr Amylase – 601 U/l

Emergency Exploratory Laparotomy Findings 2-3 liters of peritonial collection with food particles Ileal disruption at about 1 ft from I-C junction Mesenteric tear with focal hemorrhagic collections

Post Operative Period Extubation not possible Patient sent to ICU with ET tube Patient required pressure support to maintain BP Glycemia control achieved by insulin infusion

POD - 1 Patient quite irritable Heart rate – 144 /m, BP: 124/66 mm Hg with vasopressors TLC count: 2000/µl At around 9PM patient had bradycardia and reccurrent VT(Heart Rate 260/m, Pulseless) CPR done, VT controlled, BP Low Gasping.

1 AM: Patient had AF Cardioversion done with 300 J Planned for urgent dialysis for presistent Lactacidosis and dialysis done at 1:40 AM Patient got VT again at 9:30 AM ( ), DC Cardioversion (200 J) given. Gasping, BP:80/60 with high dose pressor agents, Temp: F Poor prognosis explained to patient attendants. 1:40 PM: Patient had cardiac arrest, CPR done Declared dead at 2 PM.

Conclusion Patient died of Cardiac Arrest due to repeated VT Attributable causes may be: Late presentation to Hospital Uncontrolled diabetes for which patient was taking irregular treatment. Severe Sepsis and Lactacidosis which could not be reverted back with adequate interventions.