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80 Y/M with Shortness of breath

 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 CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT.    

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan 

9-March-2022

A 80 year old male came to OPD with

Shortness of breath since 15 days 



HISTORY OF PRESENT ILLNESS 

Patient was apparently asymptomatic 10 days back and then he developed Shortness of breath grade II, which was insidious in onset, not associated with Orthopnea or paroxysmal nocturnal dyspnea. It was relieved on taking bronchodilators. 

From 7:00pm, patient developed sudden onset of Shortness of Breath (grade IV) and was brought to our hospital. He stopped taking bronchodilators 2 days back. 

No history of fever, chest pain, palpitations or pedal edema.  

PAST HISTORY

Patient had similar episodes 2 to 3 times a month since past 3 years.

Medication being taken- 

*Ipratropium bromide and levosalbutamol 200 MDF ( 3 times a week)

*Theophylline(23 mg)  and etophylline (77 mg) BD

* Montek(10 mg) - LC (5 mg) BD  

No H/o Diabetes, Hypertension, Leprosy, Tuberculosis, Coronary heart disease, Epilepsy. 

PERSONAL HISTORY:

Diet : Mixed 

Appetite : Normal 

Sleep : Disturbed

Bowel and Bladder moments : Regular

Micturition : Normal 

FAMILY HISTORY:

Not significant 





GENERAL EXAMINATION

Patient is conscious ,coherent and cooperative. Well oriented to time , place and person 
No signs Pallor , Icterus , cyanosis , clubbing , Lymphadenopathy, edema of feet.
 Vitals

BP -220 /140 mm Hg
PR - 119/ min
Temp - Afebrile
RR -41
Spo2 - 98
GRBS -126 mg%
 
SYSTEMIC EXAMINATION
 
CVS: S1 S2 PRESENT 
RS: BAE +
Inspiratory wheeze present in inframammary, infra axillary and infra scapular area. R> L
CNS: NAD 
P/A: soft 

 

INVESTIGATIONS

Hameogram

 

Chest X RAY
 
9-03-2022


10-03-2022











PROVISIONAL DIAGNOSIS 
Chronic renal failure
Acute exacerbation of COPD
Hypertensive emergency

TREATMENT
Head end elevation. 
Inj. LASIX 40mg IV TID
Nebulization with Ipratropium and budecort every 6th hourly. 
O2 inhalation to manautiyan SpO2 >90%
Vitals monitoring 
Strict I/O charting 
Fluid retention
Salt restriction
Tab WODOSIS 
 Tab Biv D 
Tab OROFER IV / BD 500 mg BD 0.25
ERYTHROPOIETIN 4000 IU X SLX and week
Patient had been instructed to go for dialysis as soon as possible.

11-05-2022, 14-05-2022 , 17-05-2022
Three dialysis sessions were conducted and patient got discharged.
Advised for dialysis for twice a month.

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