GUIDE QUESTIONS:

1. What pertinent pieces of information in the history and clinical

course of the patient will give you an idea on what happened to the
patient?
2. Based from the history of the patient, give the possible
pathophysiology(pathogenesis) of pulmonary edema in this patient.
3. What clinical manifestations are expected in a patient with pulmonary
edema? Are they manifested by the patient?
4. If X-ray will reveal pleural effusion, what type of effusion will this
patient have, exudative or transudative or both?
5. The clinical diagnosis on admission is Disseminated Intravascular
Coagulopathy(DIC). What is DIC? Is it logical for the attending ER
physicians to assume this is a case of DIC? Why or why not?
6. As a medical technologist, what other laboratory examinations do you
think will help the clinicians explain what happened to the patient?
7. What laboratory test will confirm sepsis?
AUTOPSY CASE OF J.D.

▪ 35 y/o G1P1 (1-0-0-1) who underwent non-

institutional delivery assisted by a hilot 3
days prior to consult
▪ was brought for consult on June 1, 2003 at JP-
ER with a chief complaint of vomiting
▪ Patient’s immediate postpartum condition
was said to be unremarkable but she was,
noted to lose appetite, with decreased
urination and no bowel movement.
▪ Twelve hours prior to consult, the
patient started having bouts of profuse
vomiting, accompanied by dysuria.
▪ No fever, headache or body malaise
noted.
▪ The patient already had more than ten
episodes of vomiting when she was
noted to be weak and incoherent by her
husband, hence consult.
At the E.R.
▪ Patient was noted to be dehydrated, disoriented
and incoherent, with globular abdomen and the
following vital signs: BP=120/80, HR=140, RR=32
and T=36°C
▪ The CBC done, revealed leukocytosis with
predominance of segmenters (96%), while
urnalysis result showed pyuria of 18-20 WBC.
▪ The admitting resident noted vaginal discharge and
ordered for gram stain of the discharge. The result
revealed +2 Gram(-) bacilli, and +1 Gram (+) cocci
▪ Patient was then admitted, hydrated and given
antibiotics.
 Day 1
▪ Two hours after admission, patient was noted to
be dyspneic and in respiratory distress.
▪ She was then intubated and hooked to continuous
ambubagging.
▪ Progressive rise in temperature and decrease in
blood pressure was noted after intubation.
▪ Fifteen and a half hours after admission, the
patient succumbed to cardiopulmonary arrest.
▪ CPR was done but to no avail, patient was
pronounced dead sixteen hours after admission.
CLINICAL IMPRESSION:

▪ DISSEMINATED INTRAVASCULAR
COAGULOPATHY SECONDARY TO SEPSIS
PROBABLY SECONDARY TO POSTPARTUM
INFECTION.
Initial Autopsy result

PROVISIONAL ANATOMIC DIAGNOSIS:

DIFFUSE ALVEOLAR DAMAGE WITH PULMONARY
EDEMA, BILATERAL.
SEMI-SOLID MUCOID MATERIAL, TRACHEA AND
BOTH PRIMARY BRONCHI.
RETAINED PLACENTAL TISSUE, UTERUS.
MUCOSAL EROSIONS, STOMACH.
FOCAL MURAL HEMORRHAGES, LEFT VENTRICLE.
PETECHIAL HEMORRHAGES, BOTH KIDNEYS.