Narrative Review: Death
|
Narrative Review |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
| Site | Patient | AE | Complication | Event date | AE code |
|---|---|---|---|---|---|
| xxx | xxx | x | mm/dd/YYYY | xxx |
Demographic / Medical history
- Demographic: [age] year old [gender]
- Past Medical History: [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
- Past Surgical History: [including date]
- Medications: [relevant to the event not all]
Procedure
- Index Procedure Date/Time:
- mm/dd/YYYY at xx:xx [insert date and time]
- Index Procedure Detail:
- On mm/dd/YYYY at xx:xx [insert date and time] the subject underwent a [select surgical correction] for [select etiology].
- Access site details
- The site reported that there were/were not procedural complication(s).
Event(s)
Event (1):
- Site Reported Event Onset Date: mm/dd/YYYY
- Event summary:
- Symptoms and sign: Subject presented with [sign and symptom] on mm/dd/YYYY.
- Important characteristics of the chief complaint such as severity, site, and duration.
- Other important symptoms related to the chief complaint.
- Physical assessment:
- Vital signs
- Positive physical examinations or related negative examinations.
Event (2):
- Site Reported Event Onset Date: mm/dd/YYYY
- Event summary:
- Symptoms and sign: Subject presented with [sign and symptom] on mm/dd/YYYY.
- Important characteristics of the chief complaint such as severity, site, and duration.
- Other important symptoms related to the chief compliant.
- Physical assessment:
- Vital signs
- Positive physical examinations or related negative examinations.
Laboratory data, Imaging and tests
- Lab studies:
- Date/ name/ value
- ECG / date:
- ECHO / date:
- CXR / date:
- Ultrasound
- Endoscopy
- Colonoscopy
- Other imaging and diagnostic tests / date:
Consults
- Date and time of consult
- Suggested treatments
Clinical course
- Date and time of events,
- Patient condition got worse or better.
Treatment and outcome
- List of relevant medical treatments
- Outcome [Discharge / Hospice / Death]