70 Years old female with septic shock secondary to lt gluteal abscess HF r EF secondary to Ant lateral MI & inferior wall MI (involving left circumflex artery and Right coronary artery) ? AKI on CKD k/c/o Hypertension

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 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


Cheif complaints:
Patient came with complaints of sob  since 5 days 
Patient complaints of vomiting since morning
Complaints of loose stool 2- 3 episodes since morning
Complaints of lump over left back

History of present illness:

Patient apparently asymptomatic 3 years ago 

Patient went to regular check up diagnosed with Hypertension and on Regular medication 

Patient was able to do her work till Yesterday night ,since today she was unable to do her work with grade 2 sob which was progressed to grade 4 sob 

Vomitings Since today 3-4 episodes ,food particles as a content

Complaints of Loose stools, 2- 3 episodes 



C/0 lump over left back ,tenderness present and no local rise of temperature

No orthopnea ,No PND, no chest pain,no syncopal attack, palpation s present,

Complaints  of decreased urine output since 10 days

No complaints of burning micturition 

No complaints of fever ,cough ,cold
No pain abdomen
Past History:

History of Hypertension and on regular medication since 2 years 

No history Dm,Asthma,epilepsy ,TB,CAD,



Treatment history- 

Surgery done for fibriod uterus in 2006 

Family history - Not significant! 

General examination - 

Pallor - present

Icterus - absent 

Cyanosis - absent 

Clubbing- absent

Lymphedenopathy - absent

Edema - absent



Vitals : 

Temp - afebrile

Bp -90 /60 mmhg

Spo2- 95% at room air

RR - 32cpm

PR 114

Systemic examination : 



Cvs - S1S2 heard,no murmurs heard 

RS -

Wheeze - absent

Dysponea - present

Position of trachea - central 

Breath sounds - normal vesicular sound heard 
Adventitous sounds - basal crepts heard 
P/A : 
obese abdomen ,soft and non tender 
CNS : 
NAD 

Investigation- 
ECG admission 5/2/22 at 10: 50 pm
ECG on 6/2/22
ECG on 7/2/22 at 9: 15 am
USG Chest on 7/2 /22 at 12 pm

2D ECHO-




USG abdomen  

Chest X Ray
Treatment - 

Treatment - 
1.INJ MEROPENEM 500 MG IV BD
2.INJ CLINDAMYCIN 600 MG IV TID
3.INJ HYDROCOT 100 MG IV BD
4.NEBULISATION WITH DUOLIN AND BUDECORT 6HRLY
5.IVF NS @30 ML + OU 
6.INJ PAN 40 MG IV OD 
7 . INTERMITTENT CPAP 6TH HRLY 
8.INJ VANCOMYCIN 1 GM IN 100 ML NS OVER 1 HR  OD





Popular posts from this blog

A 26 YEAR OLD MALE WITH ? FEVER UNDER EVALUATION WITH AKI,ALI WITH SEVERE THROMBOCYTOPENIA

Image
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 series of inputs from 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 on the comment box" A 26 year old male farmer by occupation came with chief complaints of  Fever since 7 days Pedal edema since 7 days Loss of appetite since 5 days HOPI - Patient was apparently asymptomatic 1 week back ,then he had one episode of low grade fever,relieved with medication,associated with generalised body pains ,not associated with cough, burning micturition. Then developed pedal edema ,intially till ankle , gradually progressive ,pitting type. C/o loss of appetite since 4-5 days as...
Read more

A 41YEAR OLD MALE WITH CORPULMONALE SECONDARY TO COPD

Image
CHIEF COMPLAINTS: C/o B/L pedal edema since 20days C/o generalised swelling of body since 2days C/o scrotal edema since 10days HOPI: Patient was apparently asymptomatic 20days back then he developed B/L pedal edema which was gradual in onset, pitting type  Pt. also has h/o shortness of breath (on &off) Grade III, since 3years {10days back Pt. developed swelling of the scrotum 5x5cm in size, which is progressed to the present size 10x8cm, associated with pain; for which he got admitted in GENERAL SURGERY on 15/02/2022.  During course of management under the dept. of surgery, Pt. started developing generalised swelling of whole body since 2days and Mild SOB As the pt. requires no sudden surgical intervention(after evaluation by the surgery dept.), the case is transferred to GENERAL MEDICINE on 17/02/2022 i/v/o above complaints and falling saturation levels} Facial puffiness + No h/o othopnoea/ PND NO h/o fever/ headache/ vomitings No h/o burning micturition/ decreased urine...
Read more

40 Y/ M WITH CHRONIC LIVER DISEASE

Image
This is an onlineE log book to discuss our patients de- identified health data shared after taking his / her guardian' s signed informed consent . Here we discuss our individual patients problems through series of inputs from available global online community of experts with with an aim to solve those patients clinical problems with collective current best evidence based inputs . This E log book also reflects my patient my patient- centered online learning portfolio and your inputs are welcome.         40 year old male who is a fruit vendor , was brought to the casuality with generalised weakenss and fever since 2 days and excessive sleepiness since 2 days HOPI: patient was apparently asymptomatic 20  years back ,5 yrs back he was admitted in alcohol de addiction centre for 2 months and he stopped drinking alcohol for 4 months and then he again started drinking alchohol.  Now pt c/o generalised weakness and fever since 2 days and excessive sleepiness s...
Read more