67 year old male with sob since 10 days,pedal and facial edema since 8 days
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A 67 year old Male R/O Devarakonda , came to the casualty on 2nd December 2023 with complaints of Shortness of breath since 10 days and pedal & facial edema since 8 days
HISTORY OF PRESENT ILLNESS:
Patient came in drowsy but arousable state to the casualty . He was apparently asymptomatic 10 days back , then he developed Shortness of breath which is insidious in onset, gradually progressive in nature, aggravating on exertion and relieved on taking rest, progressed from grade II to grade III- IV (Modified MRC)
Orthopnea, Paroxysmal nocturnal dyspnea present
C/O Bilateral pedal edema below knees , facial puffiness and periorbital edema since 8 days , insidious onset, gradually progressive in nature , no diurnal variation, pitting type I.
C/o decreased urine output and decreased appetite since 5days
No C/o chest pain, palpitations, profuse sweating,
No c/o fever, cold, cough, nausea, vomiting, loose stools.
His daily routine is waking up at 6: 00 am, breakfast as idli/upma at 8:00 am . He used to have his lunch as rice and curry , sambhar/rasam at 1: 00 pm .He usually haves his dinner as chapati/upma/rice and curry at 8:00pm and goes to bed by 9:00 pm.
The patient used to lead a normal life before this 15days .
HISTORY OF PAST ILLNESS:
K/c/o asthma since 10yrs -on medication
N/K/C/O DM, CAD, CVD, Thyroid, epilepsy
K/C/O HTN 6 yrs ago and used medication for 3 yrs and stopped as BP was under control
H/O TB 30 yrs ago
FAMILY HISTORY:
Not significant
PERSONAL HISTORY:
Married
Shop keeper by occupation
Diet: Mixed
Appetite: decreased
Sleep: adequate
Urine output decreased
Bowel movements: Regular
Addictions: Alcohol occasionally
Allergies: no known
GENERAL EXAMINATION:
Patient is drowsy due to sedation, coherent to time , place, person.
Ht: 155cm Wt: 58 kg
Pallor: present
Icterus: absent
Clubbing: absent
Cyanosis: absent
Koilonychia: absent
Lymphadenopathy: absent
Post intubation vitals: Vitals: Temp: 98 F
BP: 90/60 mmHg
PR: 102 bpm
RR: 15 cpm ACMV mode
SpO2: 100% at 5 litre O2
GRBS: 126 mg%
SYSTEMIC EXAMINATION:
RS:
Orthopnea +
Paroxysmal nocturnal dyspnoea +
wheeze +
Central position of trachea
NVBS +
CVS:
S1 S2 heard
No murmurs
No thrills
ABDOMEN:
Shape of abdomen: mildly distended
No tenderness
No palpable mass
No bruits
Liver and spleen- not palpable
Bowel sounds heard
CNS:
drowsy but arousable
no neck stiffness
kernig's sign negative
cranial nerves: normal
motor - intact
sensory - intact
Glasgow scale E2V2M2 = 6/15
MUSCULOSKELETAL SYSTEM: normal
SKIN: normal
ENT: normal
TOOTH & ORAL CAVITY: normal
PHYSICAL EXAMINATION:
IVF NS 100ml IV 100ml/hr
Inj.noradrenalin @2mcg/min to maintain MAP >65mmhg
Inj.midazolam 2400mcg/hr
Ryles feeds 50 ml 2nd hourly
Inj.piptaz 2.25 gm IV TID
Inj.linezolid 600mg IV BD
Et tube suction 2nd hourly
Chest physiotherapy
Patient vitals remained same until 7/12/23
Midazolam IV stopped to try to extubate the patient,patient didn't regain the consciousness and passed away after few days even after performing quality CPR and giving the all necessary drugs
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