A 75YR OLD MALE, CARPENTER CAME TO THE CASUALITY WITH C/O BREATHLESSNESS SINCE 3 DAYS AND BOTH LOWER LIMB SWELLING SINCE 2 MONTHS

PATIENT WAS APPARENTLY ASYMPTOMATIC 15 YRS BACK THEN HAD SOB WORSENED OVER DAYS, ATTENDED TO A MEDICAL FACILITY AND DIAGNOSED WITH ? HEART PROBLEM AND HYPERTENSION 

SINCE 5 YEARS, PATIENT HAD EASY FATIGUABILITY, SOB ON EXERTION WHICH INTERFERES WITH HIS WORK SINCE THEN HE STOPPED WORKING AND STAYS AT HOME.

SINCE 1 MONTH, PATIENT HAD SOB AND COUGH ON EXERTION WHICH HAD WORSENED IN LAST 3 TO 4 DAYS TO SOB AT REST. 

NO H/O FEVER, NO CHEST PAIN, NO PALPITATIONS, ADMITTED ONE MONTH BACK FOR HEART FAILURE AND AKI ON CKD 

K/C/O HTN SINCE 15 YRS, CURRENTLY ON T. AMLONG 10 MG BD
? CAD +, EF 40% 
K/C/O CKD SINCE 1 TO 2 YRS ON CONSERVATIVE MANAGEMENT 
K/C/O ? COPD ON ASTHALIN INHALER SINCE 1 YR

PERSONAL H/O:
SLEEP IS ADEQUATE
APPETITE IS NORMAL
BOWEL AND BLADDER MOVEMENTS ARE REGULAR
NO KNOWN ALLERGIES 
SMOKES 1 PACK BEEDI SINCE 50 YRS

FAMILY H/O:
NO SIGNIFICANT FAMILY HISTORY 

GENERAL EXAMINATION:
PALOR +, EDEMA +
NO ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY 

VITALS AT ADMISSION:
TEMP: AFEBRILE
PR: 122 BPM
RR: 28 CPM
BP: 200/110 MM HG
SPO2: 89 % AT RA, 97% WITH 2L O2
GRBS: 114 MG/DL

SYSTEMIC EXAMINATION:

CVS: S1,S2 HEARD

RS: 
BAE + , DYSPNEA +
WHEEZE + , B/L MID AND END EXPIRATORY WHEEZE
INSPIRATORY COARSE CREPTS IN B/L ISA, IAA
NO BRONCHOPHONY, NO EGOPHONY

P/A: SOFT, NON TENDER, BOWEL SOUNDS HEARD

CNS: NFND

DIAGNOSIS: ? ACUTE EXACERBATION OF COPD WITH CKD AND HYPERTENSION , HFREF SECONDARY TO ? CAD / HYPERTENSION 

TREATMENT:
27/1
T. LASIX 40MG PO BD
T METXL 25MG PO OD
T CINOD 10MG PO OD
T OROFER XT 1 TAB PO BD
T NODOSIS 500MG PO BD
T SHELCAL 500MG PO OD
NEB BUDECORT 12TH HRLY, IPRAVENT, MUCOMIX 8TH HRLY

28/1
T. LASIX 40MG PO BD
T CINOD 10MG PO OD
T OROFER XT 1 TAB PO BD
T NODOSIS 500MG PO BD
T SHELCAL 500MG PO OD
NEB BUDECORT 12TH HRLY, IPRAVENT, MUCOMIX 8TH HRLY
T CARVEDILOL 3.125MG PO OD
INHALER FORACORT

29/1
T. LASIX 40MG PO BD
T CINOD 10MG PO OD
T OROFER XT 1 TAB PO BD
T NODOSIS 500MG PO BD
T SHELCAL 500MG PO OD
NEB BUDECORT 12TH HRLY, IPRAVENT, MUCOMIX 8TH HRLY
T CARVEDILOL 3.125MG PO BD
INHALER FORACORT




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