A 75 year old male, Farmer by occupation (stopped working 5 years ago) from Nalgonda was brought to casualty by his son in an unresponsive state and altered sensorium since 3 days.
Daily routine and lifestyle:
He initially used to work in band ( plays music during the functions) 15 years back
His routine is active lifestyle
With all his works being done by him and rides his bike
And switched his job to farmer as he's getting aged and has to look after their farm
During this period he had increased consumption of alcohol ( frequency- 3-4times/week)
He was asked to stop working by his sons 2 years back as he is aging
He started staying at his sons house but used to maintain his active lifestyle by doing household chores ,getting groceries,cleans and maintains nearby dargah
HISTORY OF PRESENT ILLNESS -
Patient was apparently asymptomatic 10 years ago, when he had a h/o fall and had an IT fracture for which he was managed conservatively.
Patient had SOB ? Asthma 2 years ago for which he was managed conservatively and was advised to stopped smoking and alcohol intake
14/6/23-
Patient was drowsy and was not having food
After 2- 3hours patient developed left upper and lower limb weakness with deviation of mouth
But was able to move his limbs and recognise attenders
Later was taken to gollagudem hospital was given symptomatic management
Patient is conscious ,irritable
And was referred to nalgonda hospital
18/6/23 - patient had increased drowsiness and altered sensorium with decreased responsiveness to commands
( patient was given librium )
19/6/23 -
In view of persisting altered sensorium ct brain was done In the next two days, patient showed slight improvement in his symptoms
Recognising attenders ,movement of limbs +
On Friday 24.6.23 night patient had tachepnoeaa and decreased saturations and increased drowsiness, and hence later he came to our hospital on 24.6.23 as they were advised that the patient is in need of mechanical ventilation
Patient presently has a history of alcohol intake 8 days ago, and he developed craving for alcohol 3 days ago and was in agitated state, irritable and also self talk.
Patient has no H/O cough, cold, loose stools, vomitings, burning micturition.
PAST HISTORY:
No similar complaints in the past
No H/o Type II DM , Hypertension, TB, CAD , Epilepsy and Thyroid disorders
PERSONAL HISTORY:-
Diet: Mixed
Appetite: Normal
Sleep: Adequate
Bowel & bladder: Regular
Patient has h/o beedi smoking for about 10 years (2-3 beedis/ day), stopped 2 years ago and presently has on and off history of beedi smoking since 2 years
Patient was a chronic alcoholic for about 10 years. Stopped 2 years ago but has a h/o on and off alcohol consumption.
Last intake - 8 days ago
No allergies
FAMILY HISTORY:
No significant family history
GENERAL EXAMINATION:
Patient is in altered sensorium
Moderately built, well nourished
No pallor/icterus/cyanosis/clubbing/Generalized lymphadenopathy/pedal edema
VITALS:
Temp: 99.4 F
PR: 93 bpm
RR: 34cpm
BP: 130/80mmHg
Spo2: 99%@RA
GRBS: 127mg/dl
SYSTEMIC EXAMINATION:
CVS: S1 S2 heard, No murmurs
RS: BAE+
P/A: soft, non tender
A soft palpable mass is present over epigastrium
No engorged veins, scars or sinuses
1. Autonomic function: Normal
2. CNS examination:
GCS- E1V1M5
Pupils -B/L NSRL
MOTOR SYSTEM :
Right Left
Bulk: N. N
Tone: Right Left
UL. N N
LL. N. N
Deep tendon reflexes:
Biceps: +2 +2
Triceps: +2 +2
Supinator:. +2 +2
Knee: - -
Ankle: +1 +1
Plantar: - -
Sensory:
CRANIAL NERVES : Couldn't be assessed as the patient is in altered sensorium.
Pulmonology referral-
1. Consider intubation i/v/o low GCS
2. CST
PROVISIONAL DIAGNOSIS -
Altered sensorium secondary to ? Acute ischemic stroke ? Alcohol withdrawal with Type II Respiratory failure secondary to ? Pulmonary edema ? Aspiration Pneumonia with B/L Hydrocele with Right LL IT fracture 10 years ago.
Investigations -24/6/23
ABG -
pH- 7.44
PO2- 65.9
PCO2- 28.6
HCO3- 19.1
Hb: 15.1 gm/dl
TLC: 15,200
Platelets :2.91
PBS:NC/NC with WBC leukocytosis
RBS - 132 mg/dl
Urea: 57
Creatinine: 1.1
Na: 138
K:4.8
Cl:98
Total bilirubin 0.89
Direct bilirubin 0.19
AST 27
ALT. 19
ALP. 128
Total protein 6.6
Albumin 3.58
A/G: 1.19
CUE: Albumin +
Sugar- nil
Ep cells - 2-3
Pus cells -2-4
HBsAG - negative
HCV- negative
HIV 1/2 -negative
ECG -
Chest X-Ray
USG abdomen -
USG - B/L INGUINO-SCROTAL REGION -
CT Brain - plain
Impression-
1. Hypodensity involving right temporo parietal region - P/O infarct
2. White matter and periventricular changes are noted
3. SVIC -1
4. Age related atrophy
2D ECHO -
Concetric LVH (1.42 cms)
No RWMA
Paradoxical IVS
Trivial AR +/PR+
NO MR
Sclerotic AV , No AS/MS
EF - 60%
RSVP - 36 mm hg
Good IV systolic function, diastolic dysfunction+
No PA/ PAE
IVC - 0.9 cms (collapsing)
Treatment -
1. IVF NS , 5D AT 50ML / HR
2. Head end elevation
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. PIPTAZ 4.5 g IV/ Stat f/b Inj. PIPTAZ 4.5 g IV/ TID
6. Inj. Clindamycin 600 mg IV / BD
7. Inj. Pantop IV/OD/ BBF
8. Inj. Thiamine 200 mg + 100ml NS IV/OD
9. Tab. Ecosprin - AV 75/20/ RT/ HS
10. Tab PCM 650 mg RT/ SOS (>100F)
11. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
12. Chest physiotherapy, postural drainage
13. Suctioning 4th hourly
14. DVT stockings and position change 2nd hourly
15. Strict I/O charting
26/06/2023
S:
Patient is in altered sensorium
O:
Pt is conscious
pallor present
No icterus,cyanosis,clubbing,
lymphadenopathy,edema
Bp-100/60mmHg
Pr- 98 bpm
Temperature -99 F
Rr- 41 cpm
Grbs- 131 mg/dl @8am
I/o-1700/1600
CVS-S1,S2 heard ,no murmurs
RS- BAE present, Breath sounds reduced in left mammary and infra axillary areas
Right - fine basal crepts present
Wheeze present
CNS-
GCS - E2V2M5
Right Left
Bulk: N. N
Tone: Right Left
UL. N decreased
LL. N. Decreased
Deep tendon reflexes:
Biceps: +2 +3
Triceps: +2 +3
Supinator:. + +
Knee: - +
Ankle: - +
Plantar: - -
P/A- soft ,non tender
A:
Altered sensorium secondary to ? Acute ischemic stroke ? (Infarct at Right temporo parietal region)Alcohol withdrawal with Type II Respiratory failure secondary to ? Pulmonary edema ? Aspiration Pneumonia with ?B/L Hydrocele with LL IT FRACTURE 10 years ago
P:
1. IVF NS , 5D AT 50ML / HR
2. Head end elevation
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. PIPTAZ 4.5 g IV/ TID - D2
6. Inj. Clindamycin 600 mg IV / BD - D2
7. Inj. Pantop IV/OD/ BBF
8. Inj. Thiamine 200 mg + 100ml NS IV/OD
9. Tab. Ecosprin - AV 75/20/ RT/ HS
10. Tab PCM 650 mg RT/ SOS (>100F)
11. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
12.Chest physiotherapy, postural drainage
13. Suctioning 4th hourly
14. DVT stockings and position change 2nd hourly
15. Strict I/O charting.Chest physiotherapy, postural drainage
Investigations- 26/6/23
ABG -
pH- 7.437
PO2- 49.9
PCO2- 26.7
HCO3- 17.7
Hb: 14 gm/dl
TLC: 17,500
L - 14
Platelets :2.78
PBS:NC/NC with WBC leukocytosis
Urea: 63
Creatinine: 1.1
Na: 141
K: 5
Cl: 99
Ca -1.11
CUE-
Albumin +++
Sugar Nil
Pus cells 4-5
Epithelial cells 1-2
Reaction - Acidic
Surgery referral done for swelling in INGUINO-SCROTAL REGION
- No active surgical intervention needed
- Plan for Jaboulays procedure under SA once patient is stable
- Scrotal support
Ophthalmology referral- Fundoscopy
1. Right eye fundus not visible due to thick posterior capsular opacification
2. Left eye fundus details not seen due to Brown cataract
ECG-
27/06/2023:
S:
Sensorium improved
O:
Pt is conscious
pallor present
No icterus,cyanosis,clubbing,
lymphadenopathy,edema
Bp-120/70mmHg
Pr- 99 bpm
Temperature -97.4F
Rr- 34 cpm
Grbs- 118 mg/dl @8am
I/o-3300/2050 ml
CVS-S1,S2 heard ,no murmurs
RS- BAE present, NVBS
CNS-
GCS - E1V3M6
Right. Left
Bulk: N. N
Tone: Right Left
UL. N N
LL. decreased decreased
Deep tendon reflexes: R/L
Biceps: +2 +2
Triceps: +2 +2
Supinator:. + +
Knee: - +
Ankle: + +
Plantar: M M
P/A- soft ,non tender
A:
Altered sensorium secondary to ? Acute ischemic stroke ? (Infarct at Right temporo parietal region)Alcohol withdrawal with Type II Respiratory failure secondary to ? Pulmonary edema ? Aspiration Pneumonia with Right Hydrocele
with Right LL IT fracture 10 years ago
P:
1. IVF NS , RL AT 50ML / HR
2. Head end elevation
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. PIPTAZ 4.5 g IV/ TID - D3
6. Inj. Clindamycin 600 mg IV / BD - D3
7. Inj. Pantop IV/OD/ BBF
8. Inj. Thiamine 200 mg + 100ml NS IV/OD
9. Tab. Ecosprin - AV 75/20/ RT/ HS
10. Tab PCM 650 mg RT/ SOS (>100F)
11. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
12.Chest physiotherapy, postural drainage
13. Suctioning 4th hourly
14. DVT stockings and position change 2nd hourly
15. Strict I/O charting
ABG -
pH- 7.43
PO2- 63.8
PCO2- 33.9
HCO3- 22.3
Hb: 13.9 gm/dl
TLC: 12,700
N - 73
L - 16
RBC - 5.15
PBS:NC/NC with WBC leukocytosis
S. Urea - 55
S. Creatinine - 1.0
PT - 17 sec
INR - 1.23
APTT - 34 sec
CT- 4 mins
BT - 2 mins
Culture and sensitivity -URINE
28/06/2023
S:
Sensorium improved
O:
Pt is conscious
pallor present
No icterus,cyanosis,clubbing,
lymphadenopathy,edema
Bp-120/80mmHg
Pr- 97 bpm
Temperature -97.2F
Rr- 26 cpm
Grbs- 120mg/dl @8am
I/o-3200/2200 ml
CVS-S1,S2 heard ,no murmurs
RS- BAE present
NVBS
CNS-
GCS - E4V3M6
Right Left
Bulk: N. N
Tone: Right Left
UL. N decreased
LL. N. decreased
Deep tendon reflexes:
Biceps: + +3
Triceps: + +3
Supinator:. + +2
Knee: - +
Ankle: - +
Plantar: flexor extensor
P/A- soft ,non tender , bowel sounds heard
A:
Altered sensorium secondary to ? Acute ischemic stroke ? (Infarct at Right temporo parietal region)Alcohol withdrawal with Type I Respiratory failure secondary to ? Aspiration Pneumonia with Right Hydrocele
with Right LL IT FRACTURE 10 years ago
P:
1. IVF NS , RL AT 50ML / HR
2. Head end elevation
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. PIPTAZ 4.5 g IV/ TID - D4
6. Inj. Clindamycin 600 mg IV / BD - D4
7. Inj. Pantop IV/OD/ BBF
8. Inj. Thiamine 200 mg + 100ml NS IV/OD
9. Tab. Ecosprin - AV 75/20/ RT/ HS
10. Tab PCM 650 mg RT/ SOS (>100F)
11. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
12.Chest physiotherapy, postural drainage
13. Suctioning 4th hourly
14. DVT stockings and position change 2nd hourly
15. Strict I/O charting
ABG -
pH- 7.377
PO2- 78.7
PCO2- 43.9
HCO3- 25.2
Na: 138
K: 4.1
Cl: 102
Ca - 1.1
S. Creat- 1.0
S. Urea- 47
Psychiatry referral i/v/o alcohol dependence
Impression -
Delirium due to general medical condition
Tobacco dependence syndrome
Currently abstinent in protected environment
Advice -
1. Tab Olanzepine 2.5 mg PO/MD
2. Continue Inj. Thiamine as per general physician
3. Orientation cues
4. Soft restraints to be followed
29/06/2023
S:
Sensorium improved
O:
Pt is conscious
pallor present
No icterus,cyanosis,clubbing,
lymphadenopathy,edema
Bp-120/80mmHg
Pr- 120 bpm
Temperature -101.3 F
Rr- 26 cpm
Grbs- 99 mg/dl @8am
I/o-2000/1850 ml
CVS-S1,S2 heard ,no murmurs
RS- BAE present
NVBS
CNS-
GCS - E4V3M6
Right Left
Bulk: N. N
Tone: Right Left
UL. N N
LL. decreased decreased
Deep tendon reflexes:
Biceps: + +2
Triceps: + +2
Supinator:. + +2
Knee: - +
Ankle: - +
Plantar: flexor extensor
P/A- soft ,non tender , bowel sounds heard
A:
Altered sensorium secondary to ? Acute ischemic stroke ? (Infarct at Right temporo parietal region)Alcohol withdrawal with Type I Respiratory failure secondary to ? Exacerbation of COPD ?Aspiration Pneumonia with Right Hydrocele
with Right LL IT FRACTURE 10 years ago
P:
1. IVF NS , RL AT 50ML / HR
2. Head end elevation
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. PIPTAZ 4.5 g IV/ TID - D5
6. Inj. Clindamycin 600 mg IV / BD - D5
7. Inj. Pantop IV/OD/ BBF
8. Inj. Thiamine 200 mg + 100ml NS IV/OD
9. Tab. Ecosprin - AV 75/20/ RT/ HS
10. Tab PCM 650 mg RT/ SOS (>100F)
11. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
12.Chest physiotherapy, postural drainage
13. Suctioning 4th hourly
14. DVT stockings and position change 2nd hourly
15. Strict I/O charting
ABG -
pH- 7.43
PO2- 63.8
PCO2- 33.9
HCO3- 22.3
Hb: 13.3 gm/dl
TLC: 14,900
N -83
L - 6
RBC - 4.98
PBS:NC/NC with WBC leukocytosis
Na: 136
K: 4.8
Cl: 99
Ca - 1.14
28.6.23 ECG
29.6.23 ECG
Chest xray - 29.6.23
30/06/2023
S:
Sensorium improved
O:
Pt is conscious
pallor present
No icterus,cyanosis,clubbing,
lymphadenopathy,edema
Bp-120/80mmHg
Pr- 120 bpm
Temperature -99.3 F
Rr- 28 cpm
Grbs- 111 mg/dl @8am
I/o-1600/1450 ml
CVS-S1,S2 heard ,no murmurs
RS- BAE present
NVBS
CNS-
GCS - E4V3M6
Right Left
Bulk: N. N
Tone: Right Left
UL. N decreased
LL. N. Decreased
Power. Rt. Lft
5/5. 2/5
5/5. 3/5
Deep tendon reflexes:
Biceps: +2 +2
Triceps: + +
Supinator:. + +
Knee: -+ +
Ankle: + +
Plantar: flexor extensor
P/A- soft ,non tender , bowel sounds heard
A:
Altered sensorium secondary to ? Acute ischemic stroke ? (Infarct at Right temporo parietal region)Alcohol withdrawal with Type I Respiratory failure secondary to ? Exacerbation of COPD ?Aspiration Pneumonia with Right Hydrocele
with Right LL IT FRACTURE 10 years ago
P:
1. IVF NS , RL AT 50ML / HR
2. Head end elevation
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. PIPTAZ 4.5 g IV/ TID - D6
6. Inj. Clindamycin 600 mg IV / BD - D6
7. Inj. Pantop IV/OD/ BBF
8. Inj. Thiamine 200 mg + 100ml NS IV/OD
9. Tab. Ecosprin - AV 75/20/ RT/ HS
10. Tab PCM 650 mg RT/ SOS (>100F)
11. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
12.Chest physiotherapy, postural drainage
13. Suctioning 4th hourly
14. DVT stockings and position change 2nd hourly
15. Strict I/O charting
Investigations
ABG-
pH- 7.40
PO2- 52.5
PCO2- 37.9
HCO3- 23.4
Hb: 13.9 gm/dl
TLC: 8,200
N -72
L - 13
RBC - 5.05
Platelets :
PBS:NC/NC
Urea: 72
Creatinine: 1.0
Na: 136
K: 4.5
Cl: 98
Ca -1.02
LFT-
AST- 78
ALT- 74
TB - 0.88
DB- 0.2
TP - 6.2
ALB- 3.26
A/G RATIO- 1.1
1/07/23
S:
Sensorium improved
O:
Pt is conscious
No pallor, icterus,cyanosis,clubbing,
lymphadenopathy,edema
Bp-140/90mmHg
Pr- 108 bpm
Temperature -99.4 F
Rr- 30 cpm
Grbs- 85 mg/dl @8am
I/o-3200/1550 ml
CVS-S1,S2 heard ,no murmurs
RS- BAE present
NVBS
CNS-
GCS - E4V4M6
Right Left
Bulk: N. N
Tone: Right Left
UL. N decreased
LL. N. Decreased
Power. Rt. Lft
5/5. 2/5
5/5. 3/5
Deep tendon reflexes:
Biceps: +2 +2
Triceps: + +
Supinator:. + +
Knee: -+ +
Ankle: + +
Plantar: flexor extensor
P/A- soft ,non tender , bowel sounds heard
A:
Altered sensorium secondary to ? Acute ischemic stroke ? (Infarct at Right temporo parietal region)Alcohol withdrawal with Type I Respiratory failure secondary to ? Exacerbation of COPD ?Aspiration Pneumonia with Right Hydrocele
with Right LL IT FRACTURE 10 years ago
P:
1. IVF NS , RL AT 50ML / HR
2. Head end elevation
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. PIPTAZ 4.5 g IV/ TID - D7
6. Inj. Clindamycin 600 mg IV / BD - D7
7. Inj. Pantop IV/OD/ BBF
8. Inj. Thiamine 200 mg + 100ml NS IV/OD
9. Tab. Ecosprin - AV 75/20/ RT/ HS
10. Tab PCM 650 mg RT/ SOS (>100F)
11. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
12.Chest physiotherapy, postural drainage
13. Suctioning 4th hourly
14. DVT stockings and position change 2nd hourly
15. Strict I/O charting
pH- 7.405
PO2- 47.1
PCO2- 26.7
HCO3- 16.4
Hb: 12.8 gm/dl
TLC: 8,600
N - 71
L - 14
RBC - 4.05
Platelets - 3.08
PBS:NC/NC
Urea: 55
Creatinine: 0.9
Na: 135
K: 4.4
Cl: 102
Ca - 1.09
Chest X-Ray - 1/7/23
2/07/2023
S:
Sensorium improved
O:
Pt is conscious
Not oriented to time, place and person.
No icterus,cyanosis,clubbing,
lymphadenopathy,edema
Bp-130/90mmHg
Pr- 94 bpm
Temperature -98.4 F
Rr- 22 cpm
Grbs- 94 mg/dl @8am
I/o-3000/1400 ml
CVS-S1,S2 heard ,no murmurs
RS- BAE present
NVBS, B/L diffuse grunting present
CNS-
GCS - E4V4M5
Right Left
Bulk: N. N
Tone: Right Left
UL. N decreased
LL. N. Decreased
Power. Can't be assessed
Deep tendon reflexes:
Biceps: +2 +2
Triceps: + +
Supinator:. + +
Knee: -+ +
Ankle: + +
Plantar: flexor extensor
P/A- soft ,non tender , bowel sounds heard
A:
Altered sensorium secondary to ? Acute ischemic stroke ? (Infarct at Right temporo parietal region)Alcohol withdrawal with Type I Respiratory failure secondary to ? Exacerbation of COPD ?Aspiration Pneumonia with Right Hydrocele and Grade II Bed sore
with Right LL IT FRACTURE 10 years ago
P:
1. IVF NS , RL AT 50ML / HR
2. Head end elevation
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. Pantop IV/OD/ BBF
6. Inj. Thiamine 200 mg + 100ml NS IV/OD
7. Tab. Ecosprin - AV 75/20/ RT/ HS
8. Tab PCM 650 mg RT/ SOS (>100F)
9. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
10.Chest physiotherapy, postural drainage
11. Suctioning 4th hourly
12. DVT stockings and position change 2nd hourly
13. Strict I/O charting
Investigations:
ABG -
pH- 7.4
PO2- 49.3
PCO2- 32.3
HCO3- 19.6
Hb: 13.5 gm/dl
TLC:7,200
N - 62
L - 18
RBC - 5.16
Platelets - 3.31
PBS:NC/NC
Urea: 51
Creatinine: 1.0
Na: 139
K: 4.3
Cl: 101
Ca - 1.14
3/07/2023
S:
Sensorium improved
O:
Pt is conscious
Not oriented to time, place and person.
No icterus,cyanosis,clubbing,
lymphadenopathy,edema
Bp-130/80mmHg
Pr- 84 bpm
Temperature -100.1 F
Rr- 30 cpm
Spo2- 92% on RA
Grbs- 121 mg/dl @8am
I/o-3300/1900 ml
CVS-S1,S2 heard ,no murmurs
RS- BAE present
NVBS
CNS-
Pupils- B/L NSRL
GCS - E4V4M5
Right Left
Bulk: N. N
Tone: Right Left
UL. N decreased
LL. N. Decreased
Power. Can't be assessed
Deep tendon reflexes:
Biceps: +2 +2
Triceps: + +
Supinator:. + +
Knee: -+ +
Ankle: + +
Plantar: flexor extensor
P/A- soft ,non tender , bowel sounds heard
A:
Altered sensorium secondary to ? Acute ischemic stroke ? (Infarct at Right temporo parietal region)Alcohol withdrawal (resolving) with Type I Respiratory failure secondary to ? Exacerbation of COPD ?Aspiration Pneumonia with Right Hydrocele and Grade II Bed sore
with Right LL IT FRACTURE 10 years ago
P:
1. IVF NS , RL AT 50ML / HR
2. Head end elevation 30 degrees
3. Ryles feed 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
4. O2 support to maintain saturation above 92%
5. Inj. Pantop IV/OD/ BBF
6. Inj. Thiamine 200 mg + 100ml NS IV/OD
7. Tab. Ecosprin - AV 75/20/ RT/ HS
8. Tab PCM 650 mg RT/ SOS (>100F)
9. Nebulization Budecort and Ipravent 6th hourly. Mucomist - 4th hourly
10.Chest physiotherapy, postural drainage
11. Suctioning 4th hourly
12. DVT stockings and position change 2nd hourly
13. Strict I/O charting
Investigations:
ABG -
pH- 7.45
PO2- 53.2
PCO2- 32.3
HCO3- 19.6
Urea: 34
Creatinine: 0.8
Na: 139
K: 4.2
Cl: 101
Ca - 1.2
On 3/7/23
Patient has been discharged and advised the following:
-Plenty of oral fluids
-RT FEEDS 200ml milk + protein powder 4th hourly and 100 ml water 2nd hourly
-Tab Ecosprin - AV 75/20/ RT/ HS
-Tab. DOLO 650 Mg RT/SOS If >100F
-Tab. PANTOP 40 mg PO/OD/ BBF
-Position change 2nd hourly.
-Chest physiotherapy
-Daily dressing for Bed sore
Follow up -
Follow up after 1 week to General medicine OP
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