A 55 YEAR OLD MALE WITH PAIN ABDOMEN

C/C

ABDOMINAL PAIN SINCE 6.PM ON 8/12/2022

VOMITINGS - 5 EPISODES SINCE MORNING (NON PROJECTILE)

HOPI: 

PATIENT WAS APPARENTLY NORMAL TILL TODAY MORNING THEN HE DEVELOPED NAUSEA AND VOMITINGS 5 EPISODES,NON PROJECTILE,BILIOUS, NOT BLOOD STAINED.

LATER FROM EVENING 6.00 PM HE DEVELOPED DIFFUSE ABDOMINAL PAIN, NO GAURDING, NO TENDERNESS

NO RIGIDITY

PAST HISTORY: 

H/O SIMILAR COMPLAINTS 5 YEARS AGO.

AND HAD 3 HOSPITAL ADMISSIONS.

N/K/C/O 

HTN,DM,TB, EPILEPSY,CVA.

TREATMENT HISTORY:

NOT SIGNIFICANT

PERSONAL HISTORY: 

MARRIED, 

CAB DRIVER

APPETITE - DECREASED

DIET- MIXED

BOWEL- REGULAR

MICTURITION - NORMAL

ALLERGIES - NONE

HABITS - ALCOHOL since 20 years

                  180ML / DAY

FAMILY HISTORY: NOT SIGNIFICANT 

PHYSICAL EXAMINATION:

PATIENT IS C/C/C

NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, ODEMA.

VITALS: 

TEMPERATURE - 98.2 F

PR- 92 BPM

RR - 20 CPM

BP - 130 /90 MM OF HG

SPO2 - 97 %

GRBS - 128 MG /DL

SYSTEMIC EXAMINATION : 

CVS - S1 S2 + 

NO THRILLS , NO MURMURS

R/S : 

TRACHEA - CENTRAL

BAE + 

NVBS 

P/A : 

SCAPHOID IN SHAPE

NOT DISTENDED

NO PALPABLE MASSES

NO GAURDING

TENDERNESS IN R & L LUMBAR,ILIAC REGION AND UMBLICAL REGION.

BOWEL SOUNDS HEARD

CNS - NAD

9/12/2022

RYLES ASPIRATE 

DIAGNOSIS: ?ACUTE PANCREATITIS 

TREATMENT

1.IV FLUIDS 2 NS , 2 RL @100 ML / HR

2.NBM TILL FURTHER ORDERS

3.INJ.TRAMADOL IN 100 ML NS IV SOS

4.INJ.PAN 40 MG IV OD

5.INJ.ZOFER 4 MG IV /BD

9/12/2022

AMC BED - 5

55 M WITH PAIN ABDOMEN SINCE 1 DAY , VOMITINGS (5 EPISODES)

UNIT-4

PGY1: DR.KEERTHI

PGY3: DR.SHAILESH

SR: DR.SUSHMITHA

D.O.A : 8/12/2022 

C/C PAIN ABDOMEN SINCE 1 DAY

VOMITINGS (5 EPISODES) 

9/12/2022

S: 

PAIN SUBSIDED , NO VOMITINGS.

O:

PT IS C/C/C

BP- 150/80 MM OF HG

PR -74

SPO2 - 98% 

TEMPERATURE - AFEBRILE

GRBS- 121 MG /DL

CVS- S1,S2 + 

R/S - BAE + 

P/A - SOFT , TENDERNESS PRESENT IN R,L LUMBAR AND ILIAC REGION, UMBLICAL REGION.

CNS - NAD

I/O - 1000ML / 900 ML

A: ?ACUTE PANCREATITIS

P:

1.IV FLUIDS 2 NS, 2 RL , 1 DNS @ 100 ML /HR

2. NBM

3.INJ.TRAMADOL IN 100 ML NS IV /BD

4.INJ.PAN 4O MG IV/OD

5.INJ.ZOFER 4 MG IV SOS

10/12/2022

AMC BED - 5

55 M WITH PAIN ABDOMEN SINCE 1 DAY , VOMITINGS (5 EPISODES)

UNIT-4

PGY1: DR.KEERTHI

PGY3: DR.SHAILESH

SR: DR.SUSHMITHA

D.O.A : 8/12/2022 

C/C PAIN ABDOMEN SINCE 1 DAY

VOMITINGS (5 EPISODES) 

10/12/2022

S: 

PAIN SUBSIDED , NO VOMITINGS.

O:

PT IS C/C/C

BP- 160/90 MM OF HG

PR -64

SPO2 - 98% 

TEMPERATURE - 97.6 F

GRBS- 88 MG /DL

CVS- S1,S2 + 

R/S - BAE + 

P/A - SOFT , TENDERNESS PRESENT IN EPIGASTRIC REGION.

CNS - NAD

I/O - 2200ML / 1700 ML

A: ?ACUTE PANCREATITIS

P:

1.IV FLUIDS 2 NS, 2 RL , 1 DNS @ 100 ML /HR

2. NBM

3.INJ.TRAMADOL IN 100 ML NS IV /BD

4.INJ.PAN 4O MG IV/OD

5.INJ.ZOFER 4 MG IV SOS

17 year old female with seizures

BRIEF HISTORY: 

A 17 years old female,came to casuality at 2:28pm, with complaints of involuntary moments of both upper limbs and lower limbs since 12:00pm

She was apparantly assymptomatic ,till the age of 6 years and then she developed fever with chills for one day,and followed by which she developed involuntary moments of upper limbs and lower limbs,for about 5-10 minutes and associated with up rolling of eyeballs ,no micturition and no defecation and no frothing from mouth,and followed by which they have taken to local hospital followed by which,they received medication (no records available)and the seizures resolved,and they stayed in the hospital for 8 days and afterwards left home,they developed similar episodes frequently once in every 5-6days,followed by which they visited multiple hospitals,(no documents available ) and in 2018 they got a CT brain done and showed,Hemiatrophy of right cerebral hemisphere secondary to gliosis of right frontal and parietal lobes,and was diagnosed as post viral encephalitis,and was started on Tab valproate 300mg Po Bd

After which they visited to another hospital as she was micturiting following each seizure episode,and they’ve started on Tab.lamotrigine 50mg

She was on that medication since 5 years

She was born by FTNVD,and cried immediately after birth,her birth weight being 2.25kgs and no hospital admission immediately after birth,and achieved milestones according to her age .

And at 6years of age(studied till nursery and stopped,as mother is giving recurrent falls(due to decreased power in both limbs and due to recurrent seizures)

She stopped taking valproate since 2 months and lamotrigine since 15days

And since 15days her involuntary moments were increased,2-3times in a day,each episode(tonic and clonic) for every 5-10minutes followed by post ictal confusion ,and then she was taken to another hospital yesterday afternoon and adviced a scan but as the patient is not cooperative they kept her on iv drugs?sedation ,and the patient attenders have taken her home yesterday night.

And since today afternoon,she is having brief periods of involuntary moments of UL and LL ,one for every 5-10seconds,only tonic with up rolling of eye balls,and no tongue bite,and micturition and defecation.

She attained her menarche at the age of 13years,her cycles were irregular,once in every 2-3months.

She has an younger brother,who is studying 8th standard.

She has disturbed sleep since 1 month(used to sit in the bed at night times)

At the time of presentation ,she was in a confused state and 

BP: 100/80mmHg

PR:115bpm

CVS:s1 and S2

TEMP:98.8F

CNS:patient is confused 

Her tone and reflexes were normal.

Power wasn’t elicited

Metabolic profile was normal 

She developed 5-6 brief episodes of seizures since admission

(HISTORY ACKNOWLEDGEMENT - Dr.Haripriya ma'am) 

Presenting C/O:

 INVOLUNTARY MOVEMENTS of B/L 

UL & LL - 1 EPISODE 30 MINS AGO.(NO TONGUE BITE,FROTHING, INVOLUNTARY MICTURITION. POST ICTAL CONFUSION PRESENT)

HOPI: PATIENT WAS APPARENTLY NORMAL TILL THE AGE 6 YEARS ,THEN SHE  SUDDENLY DEVELOPED SEIZURES WHEN SHE HAD HIGH GRADE FEVER . LATER EPISODES OF SEIZURES WERE SUBSIDED AFTER TAKING MEDICATION. 1 EPISODE ONCE IN EVERY 10-15 DAYS. FROM LAST ONE WEEK SHE IS HAVING SEIZURES DAILY  EPISDOE LASTS FOR 10 - 15 MINS. NO TONGUE BITE ,NO FROTHING NO INVOLUNTARY BOWEL AND BLADDER MOVEMENTS.

PAST HISTORY: N/K/C/O DM,HTN,TB,ASTHMA.

H/O SIMILAR COMPLAINTS FROM THE AGE OF 6 YEARS.

TREATMENT HISTORY: 

PERSONAL HISTORY: SINGLE

APPETITE - NORMAL

DIET- MIXED

BOWELS- REGULAR

MICTURITION - NORMAL

NO KNOWN ALLERGIES

NO ADDICTIONS.

FAMILY HISTORY :  SIMILAR HISTORY IS SEEN IN HER GREAT GRAND FATHER.

PHYSICAL EXAMINATION: 

NO PALLOR, CYANOSIS, CLUBBING, LYMPHADENOPATHY, ODEMA

VITALS

TEMPERATURE - 98.8 F

RR- 19 CPM

PR- 119BPM

BP- 100/80 MM OF HG

SPO2 - 98%

GRBS- 116 MG/DL

CVS: S1,S2 +

NO THRILLS

NO MURMURS

RS: 

TRACHEA CENTRAL 

BAE+

NVBS

ABDOMEN: 

SCAPHOID 

NO TENDERNESS

NO ORGANIMEGALY

BOWEL SOUNDS HEARD

CNS: 

DROWSY

SPEECH - NO RESPONSE

NO SIGNS OF MENINGIAL IRRITATION

NO NECK STIFFNESS 

CNS-  

                               RIGHT                    LEFT 

TONE : 

UPPER LIMB:     NORMAL                 NORMAL

LOWER LIMB :   NORMAL                 NORMAL

REFLEXES: 

                   

BICEPS :               2+                           2+ 

TRICEPS:              2+                           2+  

SUPINATOR :       2+                           2+ 

KNEE :                   2+                           2+ 

ANKLE :                 2+                           2+ 

POWER: CANNOT BE ELICITED SINCE PATIENT WAS UNCONSCIOUS

                             

 DIAGNOSIS:

? STATUS EPILEPTICUS

KC/O EPILEPSY since 10 years.

TREATMENT : 

1.INJ.LEVIPIL 1 Gm IV STAT IN 100 ML NS F/B 500 MG BD

 INVESTIGATIONS

1/12/2022

 ECG 8.40 PM 

CHEST XRAY 

MRI 

2/12/2022

 ECG 7.40 AM

video of EEG during seizures

You can see the patient having seizures at 

1.11 seconds

2.34 seconds

3.56 seconds

5.24 seconds

6.52 seconds

8.15 seconds

9.45 seconds

10.51 seocnds

12.18 seocnds

13.50 seconds 

2/12/2022 

S: 1 episode of ?tonic seizure ? pseudoseizure

O: PT IS C/C/C 

TEMPERATURE -98.1 F

BP- 110/80 MM OF HG

PR- 91 BPM

SPO2- 98% 

GRBS-141 MG /DL

CVS- S1,S2+

R/S - BAE + 

P/A - SOFT ,NON TENDER

CNS-  

                   RIGHT LEFT 

TONE : 

UPPER LIMB: NORMAL NORMAL

LOWER LIMB :NORMAL NORMAL

REFLEXES: 

                   RIGHT LEFT

BICEPS : 2+ 2+ 

TRICEPS: 2+ 2+ 

SUPINATOR : 2+ 2+ 

KNEE : 2+ 2+ 

ANKLE : 2+ 2+ 

POWER: CANNOT BE ELICITED SINCE PATIENT WAS UNCONSCIOUS 

A: ?STATUS EPILEPTICUS

K/C/O EPILEPSY SINCE 10 YEARS 

P:

1. INJ. LEVIPIL 500 MG IV /BD

2.INJ. LORAZEPAM 2 CC IV /SOS

3.INJ.OPTINEURON 1 AMP IN 100 ML NS IV OVER 30 MINS.

4.INJ. SODIUM VALPROATE IV 500 MG BD.

A 75 year old female patient with shortness of breath ,Bilateral pedal edema

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Chief complaints:

75 year old female patient was brought to casualty with chief complaints of: C/o shortness of breath since 10 days Bilateral pedal edema since 10 days Facial puffiness since 10 days H/o of palpitation 10 days

HOPI:

Patient was apparently asymptomatic 15 days back & then she developed fever - low grade, intermittent, decreased with Rx

Shortness of breath since 10days which was insidious in onset, gradually progressed from class 2-4, Orthopnea present

C/o palpitations since 10 days B/I pedal edema since 10 days which was

pitting type extending upto knee Facial puffiness present. 

No history of chest pain, syncope attack. No history of decreased urine output, abdominal distention. No other complaints 

Personal history:

Diet:mixed

Appetite:normal

Bowel and bladder movements:normal

Appetite : decreased

Sleep : adequate 

No additions

On examination:-

Pt is C/C/C well oriented to Time ,place and person 

Pallor : present

B/I pedal edema - pitting type extending

upto knees

No cyanosis,clubbing,or generalised lymphadenopathy 

Temp: 99F

PR: 130 

Bp: 150/90mmhg

RR: 32 cpm

Spo2: 88-92% on RA

CVS:JVP raisedApex beat - diffuse Parasternal heave +Palpable P2 +

S1 S2 +

RS: Barrel shaped chest, Trachea central

BAE+, B/I crepts +

P/A: soft nontender

CNS: NFND

Inspection-

Shape of abdomen normal

Umbilicus -central and inverted

No visible scars,sinuses,dilated veins

Hernial orifices normal 

Palpation -no local rise of temperature 

No Tenderness present 

No guarding,rigidity,rebound tenderness 

No hepatomegaly,spleenomegaly

Percussion-

Resonant 

Auscultation-

Bowel sounds +

INVESTIGATION:

Serology: Negative 

Hemogram:

Serum electrolytes:

LFT:

ABG:

serum creatinine:

Serum urea:

RBS:

APTT:

:-

2D ECHO

ECG:

ECG at the time of presentation

After Inj. Metaprolol 5 mg IV/stat

26/11/2022

27/11/22 

7.00 am

10.00pm

28/11/2022

29/11/2022

30/11/2022

1/12/2022

X-ray:

27 /11/22 

28/11/2022

29/11/2022

25/11/22

NEW ADMISSION 

25/11/2022 

S:

75 year old female patient was brought to casualty with chief complaints of: C/o shortness of breath since 10 days Bilateral pedal edema since 10 days Facial puffiness since 10 days H/o of palpitation 10 days

O:PT IS C/C/C

BP-100/70 MM OF HG

PR: 116 BPM RS: BAE+ B/L BASAL CREPTS + IAA, IMA ++

CVS-S1,S2

P/A-SOFT

CNS-NAD

A- ATRIAL FEBRILLATION EITH HEART FAILURE

P:

1 PRBC TRANSFUSION DONE ON 25/11/2022

P:

1.FLUID (1.5 L) & SALT(<2GM) RESTRICTION

2.INJ.LASIX 40 MG IV /BD IF SBP >= 110 MM OF HG

3. T.METXL 25 MG PO/OD

4.T.PAN 40 MG PO/OD

 5. T.ECOSPRIN AV 75/10 MG PO/ HS

6. INJ.CLEXANE 40 MG OD / IV 

7. T.DOLO 650 MG PO/SOS

8.NEB WITH IPRAVEN 8TH HRLY

BUDECORT

  

Case uptake from Murali (INTERNEE) TO  ME 

26/11/2022

26/11/2022

 S: 75 year old female patient was brought to casualty with chief complaints of  shortness of breath since 10 days Bilateral pedal edema since 10 days Facial puffiness since 10 days H/o of palpitation 10 days

O:PT IS C/C/C

BP-130/70 MM OF HG

PR: 85 BPM

 RS:

BAE+

B/L BASAL DIFFUSE CREPTS + IAA, IMA ++

CVS-S1,S2

P/A-SOFT

CNS-NAD

A- ATRIAL FEBRILLATION WITH HEART FAILURE WITH BICYTOPENIA (ANEMIA+THROMBOCYTOPENIA )

P:

1.FLUID (1.5 L) & SALT(<2GM) RESTRICTION

2.INJ.LASIX 40 MG IV /BD IF SBP >= 110

MM OF HG

3. T.METXL 25 MG PO/OD

4.T.PAN 40 MG PO/OD

 5. T.ECOSPRIN AV 75/10 MG PO/ HS

6. INJ.CLEXANE 40 MG OD / IV 

7. T.DOLO 650 MG PO/SOS

8.NEB WITH IPRAVEN 8TH HRLY

BUDECORT 

27/11/2022

 S: 75 year old female patient was brought to casualty with chief complaints of  shortness of breath since 10 days Bilateral pedal edema since 10 days Facial puffiness since 10 days

PEDAL EDEMA SUBSIDED

SOB DECREASED

FACIAL PUFFINESS DECREASED 

O:PT IS C/C/C

BP-110/70 MM OF HG

PR: 120 BPM

RS:BAE+

B/L BASAL DIFFUSE CREPTS + IAA, IMA ++

CVS-S1,S2

P/A-SOFT

CNS-NAD

A- ATRIAL FEBRILLATION WITH HEART FAILURE WITH BICYTOPENIA( ANEMIA+THROMBOCYTOPENIA ) WITH COPD

P:

1.FLUID (1.5 L) & SALT(<2GM) RESTRICTION

2.INJ.LASIX 40 MG IV /BD IF SBP >= 110 MM OF HG

3. T.METXL 25 MG PO/OD

4.T.PAN 40 MG PO/OD

 5. T.ECOSPRIN AV 75/10 MG PO/ HS

6. INJ.CLEXANE 40 MG OD / IV 

7. T.DOLO 650 MG PO/SOS

8.NEB WITH IPRAVEN 8TH HRLY

BUDECORT 

28/11/2022

 S: 75 year old female patient was brought to casualty with chief complaints of  shortness of breath since 10 days Bilateral pedal edema since 10 days Facial puffiness since 10 days

PEDAL EDEMA SUBSIDED

SOB DECREASED

FACIAL PUFFINESS DECREASED 

O:PT IS C/C/C

BP-80/50 MM OF HG

PR: 141 BPM

RS:

BAE+

B/L BASAL DIFFUSE CREPTS + 

CVS-S1,S2

P/A-SOFT ,NIN TENDER

CNS-NAD

A- ATRIAL FEBRILLATION WITH HEART FAILURE WITH BICYTOPENIA(ANEMIA+THROMBOCYTOPENIA ) WITH VOPD

1 PRBC TRANSFUSION DONE ON 25/11/2022

P:

1.FLUID (1.5 L) & SALT(<2GM) RESTRICTION

2.INJ.LASIX 40 MG IV /BD IF SBP >= 110 MM OF HG

3. T.METXL 25 MG PO/OD

4.T.PAN 40 MG PO/OD

 5. T.ECOSPRIN AV 75/10 MG PO/ HS

6. INJ.CLEXANE 40 MG OD / IV 

7. T.DOLO 650 MG PO/SOS

8.NEB WITH IPRAVEN 8TH HRLY

BUDECORT

29/11/2022

75/F with PEDAL EDEMA & SOB

D.O.A: 24/11/11

S:

PEDAL EDEMA SUBSIDED

SOB DECREASED

O:

PT IS C/C/C

BP-110/70 MM OF HG

PR: 100 - 130 BPM IRREGULARLY IRREGULAR 

RS:

BAE+

B/L BASAL CREPTS + 

CVS-S1,S2

P/A-SOFT ,NON TENDER

CNS-NAD

A- ATRIAL FIBRILLATION WITH HEART FAILURE 

COPD 

BICYTOPENIA (ANEMIA+THROMBOCYTOPENIA) ?B12 DEFICIENCY

1 PRBC TRANSFUSION DONE ON 25/11/2022

P:

1.FLUID (1.5 L) & SALT(<2GM) RESTRICTION

2.INJ.LASIX 40 MG IV /BD IF SBP >= 110 MM OF HG

3. T.METXL 25 MG PO/BD

4. T.ECOSPRIN AV 75/10 MG PO/ HS

6. INJ.CLEXANE 40 MG SC/OD

7. T.WARFARIN 2 MG PO/OD @ 6.00 PM 

8. T.DOLO 650 MG PO/SOS

9.NEB WITH IPRAVEN 8TH HRLY

BUDECORT