General data T. E. 39 year old Male Catholic From Mandaluyong City Admitted last June 23, 2014

Chief Complaint Burn

History of Present Illness Few hours PTA, While fixing a defective LPG, patient accidentally lit up a candle causing explosion

Past Medical History (-) DM (-) Hypertension (-) Cardiac diseases (-) Pulmonary tuberculosis (-) Asthma (-) Cancer No allergies to food and drugs

Family Medical History (-) Cancer (-) DM (-) Hypertension (-) Pulmonary tuberculosis

Personal and Social History Smoker Occasional alcoholic drinker No illicit drug use

Physical Examination General: awake, conscious, coherent, in cardiorespiratory distress HEENT: anicteric sclera, pink palpebral conjunctiva, no cervical lymphadenopathy Thorax and lungs Symmetrical chest expansion, no retraction, no chest lag, clear breath sounds

Cardiovascular adynamic precordium, regular rate and rhythm, no murmur Abdomen Flat, normoactive bowel sounds, soft, non tender Extremities (+) flame burn

06/23/14 06/26/14 RBC count 6.5 4.6 Hemoglobin 1909 132 Hematocrit 0.61 0.40 Platelet count 237 194 WBC count 27.5 Neutrophil 0.84 0.83 Lymphocytes 0.10 Eosinophil 0.01 Monocytes 0.06 0.05 6/23/14 6/26/14 Na 142 148 K 4.70 3.20 Cl 112 114 BUN 5.60 4.40 Crea 88.90 92.80 Total Protein 29 31 Albumin 9.93 6.43 Globulin 19.1 24.6 A/G Ration 0.5 0.3

Chest Xray (06/23/14) Clear lungs Magnified cardiac silhouette

PT, PTT 06/23/14 (5am) (5pm) 06/26/14 Protime 15.1 20.6 15.7 % activity 77 46 72 INR 1.18 1.74 1.24 APTT 24.3 31.9 13.3

1st Hospital Day Patient admitted Intubated Therapeutics given: Paracetamol 600mg TIV Flammacerium cream Cefuroxime 750mg/ TIB q8 Omeprazole 40mg/tab Mebo ointment

2nd Hospital Day CVP inserted Monitor VS and recorded Seen by SICU rotator Started salbutamol nebulization

3nd Hospital Day ABG done Discontinued salbutamol nebulization Started heparin nebulization Anesthesia referral – was given midazolam for agitation

4th Hospital Day Medications were continued Repeat ABG done Started KCl drip Continued OF Feeding

5th Hospital Day Asystole CPR started Epinephrine DNR signed by relatives

Final Diagnosis Cardiopulmonary Arrest secondary to Acute Respiratory Distress Syndrome secondary to Smoke Inhalational Injury Flame Burn 70% TBSA superficial partial thickness to deep partial thickness