Pre-final practical examination 1/4/2022

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through a series of inputs from an available global online community of experts with an aim to solve those patient's clinical problems with collective,current,best evidence based inputs.

This e-log book also reflects my patient centered online learning portfolio and your valuable inputs in the comment box is welcome

Prasuna Reddy

Roll no. 49

9th semester

My case is of a 75 year old lady, a homemaker in Miryalguda, who was brought to casuality in an unresponsive state with no recordable blood pressure and no pulse.


 

Post CPR vitals:
Afebrile
BP 170/100
PR 110 BPM

CVS S1,S2 +
RS BAE+, Decreased air entry in rt mammary area

There were myclonic movements noted on 29th march and 30th march. They were not seen before by the attenders.

https://youtube.com/shorts/KpNRO6Ri_PI?feature=share

PERSONAL HISTORY:

*Diet - Vegetarian 
* Appetite - Normal 
* Bowel and Bladder - Regular
* Sleep - Adequate 
* Allergy- None
* Addition- None

FAMILY HISTORY:
There is no significant family history.

GENERAL EXAMINATION : 

The patient is unconscious.
Well built and nourished.

Pedal edema present - upto the knee - pitting type.
Palor is present
No- icterus, clubbing, cyanosis, lymphoedenopathy.

















Vitals : 

On 30 March 2022 : 

*Temperature - 98 degree F
* Pulse - 90 bpm
* Respiratory rate - 18cpm
*BP - 160/90 mm of Hg
* SpO2 - 98(on ventilator) - 35 on admission.

On 31 March 2022 : 

Temperature - 102F 
Pulse 118 bpm 
RR- 12 cpm 
BP - 160/80 mmHg
Spo2 - 98(on ventilator) 
GRBS - 146 mg/dl

Systematic examination:

CNS: 
Corneal, conjunctival reflexes absent
Dolls eye movement is absent
Babinskis reflex is mute
Hypotonia is seen in all limbs
Areflexia seen

Myoclonic jerks occured for 2 days and stopped










CVS: JVP NORMAL, Apex beat 5th Intercostal  space Mid Clavicular line s1s2 +

RS: BAE + , decreased air entry on right side IMA, IAA 

P/A: soft, non tender , BS + 

Provisional diagnosis: 

Acute type 2 respiratory failure secondary to Obstructive Sleep Apnea and Hypertension following a Cardiac arrest.



INVESTIGATIONS : 
29/03/2022 :

* Hemogram- of 29 and 30th of march
HB 8.5 to 8.6
TLC 13,600 to 15,200
PCV 27.4
MCH 26.6
MCHC 31
PLT 2.0 to 1.4
P.S NORMOCYTIC, NORMOCHROMIC with neutrophilic leucocytosis
Serum iron : 45ug/dl

RBS: 211mg/dl
HbA1c : 6.8%

*Liver Function Tests- 
TB 0.57
DB 0.16
AST 148
ALT 123
ALP 180
TP 4.7
ALB 2.2

* Renal Function tests :
Blood Urea: 49mg/dl 
S. Creatinine: 1.9mg/dl
Na 142
K 4.7
Cl 98

* CUE: 
ALB ++
Sugars nil
Pus cells 4-5
Epithelial cells 1-2

*ABG : 
ABG post CPR fio2 100%
pH 6.88
PCo2 107
PaO2 77.4
HCO3 11.8
SpO2 82.5

Interpretation : Metabolic and respiratory acidosis 

ABG day 0 evening fio2 80%
pH 7.46
PCo2 32.8
PaO2 146
HCO3 23.1
SpO2 96.8

ABG day 1 morning fio2 40%
pH 7.4
PCo2 31.9
PaO2 80
HCO3 21.5
SpO2 94.7

On 30/3/22
Renal function tests:
Serum creatitnine : 2.8
Uric acid: 11.8
Urea: 89
Na: 143
K: 4.2
Cl: 102
Phosphorus: 5.1
Ca: 8.7

RBS: 221

CUE:
Alb: 2+
Pus cells: 4 to 5
RBCs : 6 to 8

Chest x ray: on 29th

Expiratory field, PA view showing cardiomegaly and prominent bronchiovascular , hazziness, effusion

30/3/22


On 31/3/22



ECG: 

Post CPR:

Day 1: 



2D echo
Concentric LVH
Sclerotic AV
EF 58%
RVSP 35 mmHg
Diastolic dysfunction +







Treatment

Ventilatory support
IVF NS/RL @50ML/HR
Inj. Pan 40 mg IV OD
Inj. Zofer 4 mg IV SOS
Inj. Midazolem titrate B/W 0.1 - 3 mg/Kg 
Inj. Atracurium @ 0.8ml/hr (10mcq/hr)
Inj. Levipil 1gm IV STAT
Inj. Levipil 500 mg IV TID
Inj. Clexane 60mg sc OD
Inj. Ceftriaxone
RT feeds milk+protein 100ml, water 100ml q4hrly
Propped up position
Air bed with position change 2nd hourly










 





















Comments

Post a Comment

Popular posts from this blog

60/F C/O HEADACHE SINCE 6YRS, FRONTAL, RELIEVED ON TAKING PCM, NOT ASSOCIATED WITH NAUSEA, VOMITINGS, ASSOCIATED WITH FEVER AND DIZZINESS  BURNING SENSATION, TINGLING, NUMBNESS IN BOTH LEGS AND HANDS SINCE 2 MONTHS TWITCHING OF HANDS WITH CRAMPS CHEST PAIN IN MID STERNUM WHICH RESOLVES AUTOMATICALLY  BURPS +, HOARSENESS OF VOICE +, CONSTIPATION + POLYURIA +, POLYDYPSIA+, NOCTURIA +, SOB GRADE 2, DRY MOUTH + K/C/O EPILEPSY SINCE 20YRS H/O RT TIBIA FRACTURE SURGERY  H/O RIGHT EYE SX 5 YRS AGO, LEFT EYE SX 3 YRS AGO DM SINCE 8YRS, ON OHAS, CHANGED TO INSULIN SINCE 2 MONTHS H/O TYPHOID FEVER 2 MONTHS AGO H/O HYSTERECTOMY 8YRS AGO PT IS C/C/C NO PALOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA  BP: 120/70 MMHG PR: 86BPM GRBS: 181MG/DL CVS: S1,S2 HEARD RS: BAE +, NVBS P/A: SOFT, NT CNS: HMF INTACT SENSORY INTACT PROPRIOCEPTION: RT AN LT SIDE ON BOTH UL AND LL IS 10/10 POWER IN B/L UL IS 5/5 AND LL IS 4+/5 TONE IN B/L UL AND LL IS NORMAL GRAPHESTHESIA AND STEREOGNOSIS IS NORMAL
Read more

35yr old female

Image
This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome. I’ve been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan.  AN 38 YEAR OLD FEMALE BROUGHT TO THE HOSPITAL WITH FEVER, CHILLS AND BODY PAINS FOR 1 WEEK  CASE: CHIEF COMPLAINTS:  A 38 year old female patient came with the complaints of fever, chills, and body pains for the past
Read more