Case 42 – History


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Case 42

Death during rehab


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Brief History

The patient was an elderly Caucasian woman with history of mild hypertension, prior lower extremity deep venous thrombosis (status post inferior vena cava filter placement and on blood thinners), status post hysterectomy, gastric cancer (treated surgically) and status post splenectomy.

She was recently admitted to the hospital with a bleeding duodenal ulcer of undetermined etiology.

She was managed medically, stabilized, and transferred to a rehabilitation center.

Rehabilitation including physical therapy, which the family notes consisted of walking to the bathroom and back.


One day before death

On the day before death, during physical therapy, she was noted to be symptomatic (unspecified) with an oxygen saturation of 80%.

She was given supplemental oxygen (2 liters) and evaluated with unspecified blood work.

A chest x-ray was ordered for the following day.


Day of Death

On the day of death, the patient complained of abdominal pain.

At that time, her oxygen saturation was 85% while on 2 liters oxygen.

Oxygen was increased to 3 liters and 911 was called.

However, the patient collapsed, could not be revived and died.

There is no history of alcohol or cigarette use.

The history is provided by the family.


Next: Part 1

Discussion Questions

1. What is the differential diagnosis for this patient’s perimortem symptoms and cause of death?
2. What would you have done differently, if anything, as the patient’s clinician. Why?