75Y/F WITH C/O SOB AND FEVER

CBBLE UDHC SIMILAR CASES

 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

PATIENT C/O SOB AND FEVER SINCE 3 DAYS

HOPI:

PT WAS AA 3 DAYS BACK THEN HE PRESENTED WITH SOB SINCE 3 DAYS [MMRC GR-II] , INCREASED ON EXERTION AND RELIEVED ON REST

NO ORTHOPNEA , NO PND AND NOT ASSOCIATED WITH WHEEZE

C/O FEVER SINCE 3 DAYS, LOW GRADE, INTERMITTENT AND NOT ASSOCIATED WITH CHILLS AND RIGOR , SWEATING AND NOT ASSOCIATED WITH DIURNAL VARIATION

LOSS OF APPETITE +

NO H/O COUGH,CHEST PAIN, CHEST TIGHTNESS ,HEMOPTYSIS,LOSS OF WEIGHT.

PAST H/O:

H/O SIMILAR COMPLAINTS IN THE PAST 2YRS AGO FOR WHICH SHE WAS ADMITTED AND POST DISCHARGE NEBULIZATION ,

K/C/O DM-2 SINCE 8Y AND ON MEDICATION 

H/O BIOMASS EXPOSURE + FOR 40 YRS

NOT K/C/O HTN, BA,CAD,THYROID, TB.

NO H/O COVID

PERSONAL H/O:

HOMEMAKER BY OCCUPATION

DIET - MIXED,

APPETITE -DECREASED

BOWEL MOVEMENT - REGULAR

BLADDER MOVEMENTS - NORMAL

NO ADDICTIONS

NO KNOWN DRUG ALLERGIES

FAMILY HISTORY: NOT SIGNIFICANT

ON EXAMINATION 

PATIENT IS CONSCIOUS , COHERENT, COOPERATIVE , THIN BUILT AND MODERATELY NOURISHED

NO SIGNS OF PALLOR ,ICTERUS, CLUBBING, CYANOSIS, LYMPHADENOPATHY, PEDAL EDEMA.

VITALS:

TEMP: AFEBRILE

PR: 110 BPM

BP:130/70 MMHG

SPO2: 84% ON RA

GRBS: 95mg%

RR: 25CPM

 

SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD, NO MURMURS HEARD

PER ABDOMEN: SOFT, NONTENDER

CNS : NAD

RESPIRATORY SYSTEM : 

INSPECTION: SHAPE OF THE CHEST- ELLIPTICAL 

B/L SYMMETRICAL CHEST 

TRACHEA APPEARS TO BE CENTRAL

EXPANSION OF CEHST : EQUAL ON BOTH SIDES

ACCESSORY MUSCLES REPIRATION +

NO DROPPNG OF SHOULDER

NO CROWDING OF RIBS

WASTING OF MUSCLES +

SPINOSCAPULAR DISTANCE EQUAL ON BOTH SIDES

PALPATION:

ALL INSPECTORY FINDINGS CONFIRMED

NO LOCLAL RISE OF TEMPERATURE

NO TENDERNESS

 TRACHEA SLIGHTLY DVIATED TO RIGHT

CHEST MOVEMENTS EQUAL ON BOTH SIDES

AEPX BEAT @ LEFT 5TH ICS MEDIAL TO MIDCLAVICULAR LINE

TVF EQUAL IN BOTH AREAS

PERCUSSION:

DIRECT: RESONANT

INDIRECT:RESONANT

AUSCULTATION:

BAE+ 

VBS: HEARD

CREPTS + @ RIGHT INFRA SA , IAA

INVESTIGATIONS

2D ECHO

ECG

ROUTINE INVESTIGATIONS

FBS 83

PLBS

CXR

HRCT CHEST 

HRCT

HRCT

HRCt

Multiple focal area of bronchiectatic changes seen in both lung mainly in apical segment of left upper lobe ,right middle lobe ,lingular segment and left lower lobe with few area of mucoid impaction.

Multiple centrilobular nodules in both lung mainly in right middle lobe and left lower lobe.

Above features are suggestive of infective bronchiolitis likely secondary to Koch's disease.

DIAGNOSIS :- ACUTE EXACERBATION OF BRONCHIECTASIS WITH TYPE 2 DM

TREATMENT GIVEN :- 

1]INJ.AUGMENTIN 1.2 G /IV/TID

2]INJ.PAN 40MG OD [BBF]

3]INJ.HYDROCORT 100MG IV OD 

4]O2 INHALATION WITH NASAL PRONGS @ 2-3L/MIN

5]NEB BUDECORT TID ; MUCOMIST 4TH HRLY

6]T.MUCINAC LC/HS/TID

7]TAB.MONTAC LC HS/OD

8]SYP.ASCORIL 2 TSP TID X 1 WEEK

9]TAB.PCM 650MG SOS

60Y/M WITH C/O BREATHLESSNESS

CBBLE UDHC SIMILAR CASES 

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 

PATIENT C/O BREATHLESSNESS AND CHEST PAIN SINCE 4 DAYS , DRY COUGH SINCE 3 DAYS [OCCASSIONALLY].

HOPI:-

PT WAS APPARENTLY ASYMPTOMATIC 4 DAYS BACK THEN HE PRESENTED WITH BREATHLESSNESS WHICH IS SUDDEN IN ONSET[MMRC GR-III] ASSOCIATED WITH WHEEZE AND INCREASED ON LYING DOWN.

BREATHLESSNESS RELIEVED ON SITTING POSITION.

H/O COUGH + SINCE 3 DAYS , WITHOUT EXPECTORATION. DIURNAL VARIATION 

CHEST PAIN SINCE 4 DAYS, NOT ASSOCITED WITH SWEATING, NONRADIATING. DRAGGING TYPE. NO POSTURAL VARIATION. 

LOSS OF APPETITE +

NO H/O FEVER, CHEST TIGHTNESS ,  HEMOPTYSIS.

PAST H/O:

H/O SIMILAR COMPLAINTS IN THE PAST FOR WHICH HE USED ORAL MEDICATION AND INHALERS [ROTAHEALER WITH ROTACAP] FOR A WEEK.

H/O TB 20YRS BACK. USED ATT IRREGULARLY. 

H/O ASTHMA 10 YRS BACK

NOT A K/C/O HTN ,DN,CAD

NO H/O COVID 19

DRUG H/O:

USED ATT 20 YRS BACK IRREGULARLY. 

USED INJ.PIPTAZ BD FOR 5 DAYS

PERSONAL H/O:

MARRIED

DIET - MIXED,

APPETITE -DECREASED ,

BOWEL MOVEMENT - REGULAR

BLADDER MOVEMENTS - NORMAL

NO ADDICTIONS

NO KNOWN DRUG ALLERGIES

FAMILY HISTORY: NOT SIGNIFICANT

ON EXAMINATION 

PEDAL EDEMA PRESENT

NO SIGNS OF PALLOR ,ICTERUS, CLUBBING, CYANOSIS, LYMPHADENOPATHY, 

VITALS AT ADMISSION

TEMP: AFEBRILE

PR: 92 BPM

BP:100/70 MMHG

SPO2: 95% ON RA

GRBS: 110mg%

RR: 42CPM

 

SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD, NO MURMURS HEARD

PER ABDOMEN: SOFT, NONTENDER

CNS : NAD

RESPIRATORY SYSTEM : 

INSPECTION: SHAPE OF THE CHEST- ELLIPTICAL 

TRACHEA APPEARS TO BE CENTRAL

RR 42 CPM

ACCESSORY MUSCLES REPIRATION +

NO DROPPING OF SHOULDER

SPINOSCAPULAR DISTANCE EQUAL ON BOTH SIDES

PALPATION:

ALL INSPECTORY FINDINGS CONFIRMED

NO LOCLAL RISE OF TEMP

NO TENDERNESS

TRACHEA CENTRAL IN POSITION

PERCUSSION:

DIRECT: RESONANT

INDIRECT:RESONANT

AUSCULTATION:

BAE+ 

VBS: HEARD

B/L RONCHI +

INVESTIGATIONS :-

ABG 22-04-2022 08:07:AM

 PH 7.43 

 PCO2 42.2 

 PO2 75.4 

 HCO3 27.9 

 St.HCO3 27.7 

 BEB 3.8 

 BEecf 3.9 

 TCO2 56.3 

 O2 Sat 94.2 

 O2 Count 15.7

ABG 22-04-2022 06:01:PM

 PH 7.43 

 PCO2 34.9 

 PO2 64.0 

 HCO3 23.1 

 St.HCO3 24.1 

 BEB -0.3 

 BEecf -0.6 

 TCO2 47.7 

 O2 Sat 91.9 

 O2 Count 13.1

ABG 22-04-2022 09:40:PM

 PH 7.41 

 PCO2 39.3 

 PO2 65.9 

 HCO3 24.4 

 St.HCO3 24.7 

 BEB 0.4 

 BEecf 0.3 

 TCO2 51.3 

 O2 Sat 92.6 

 O2 Count 12.0

ABG 23-04-2022 03:25:PM

 PH 7.32 

 PCO2 44.5 

 PO2 139 

 HCO3 22.5 

 St.HCO3 21.9 

 BEB -3.0 

 BEecf -2.6 

 TCO2 46.0 

 O2 Sat 97.4 

 O2 Count 17.3

 ABG 24-04-2022 06:25:AM

 PH 7.35 

 PCO2 39.3 

 PO2 83.5 

 HCO3 21.3 

 St.HCO3 21.6 

 BEB -3.4 

 BEecf -3.3 

 TCO2 45.2 

 O2 Sat 95.5 

 O2 Count 12.5 

 ABG 24-04-2022 07:17:PM

 PH 7.37 

 PCO2 42.3 

 PO2 68.3 

 HCO3 24.0 

 St.HCO3 23.8 

 BEB -0.7 

 BEecf -0.5 

 TCO2 50.5 

 O2 Sat 93.8 

 O2 Count 12.7 

 ABG 25-04-2022 07:05:AM

 PH 7.37 

 PCO2 44.8 

 PO2 61.7 

 HCO3 25.5 

 St.HCO3 24.8 

 BEB 0.6 

 BEecf 0.8 

 TCO2 53.3 

 O2 Sat 92.6 

 O2 Count 13.0

ABG 25/4/22 5PM

ABG 26/4/22 10AM

RFT 22-04-2022 

 UREA 35 mg/dl 

 CREATININE 1.0 mg/dl

 URIC ACID 2.4 mg/dl 

 CALCIUM 10.0 mg/dl

 PHOSPHOROUS 3.3 mg/dl 

 SODIUM 141 mEq/L 

 POTASSIUM 3.9 mEq/L 

 CHLORIDE 102 mEq/L 

 LIVER FUNCTION TEST (LFT) 22-04-2022 

 Total Bilurubin 0.65 mg/dl 

 Direct Bilurubin 0.20 mg/dl 

 SGOT(AST) 14 IU/L

 SGPT(ALT) 11 IU/L 

 ALKALINE PHOSPHATE 101 IU/L 

 TOTAL PROTEINS 5.8 gm/dl 

 ALBUMIN 2.8 gm/dl

 A/G RATIO 0.93 

 COMPLETE BLOOD PICTURE (CBP) 22-04-2022

 HAEMOGLOBIN 11.0 gm/dl 

 TOTAL COUNT 10900 cells/cumm 

 NEUTROPHILS 76 % 

 LYMPHOCYTES 15 % 

 EOSINOPHILS 02 % 

 MONOCYTES 07 % 

 BASOPHILS 00 % 

 PLATELET COUNT 6.10 

 SMEAR Normocytic normochromic with thrombocytosis 

HBsAg-RAPID  Negative   

Anti HCV Antibodies - RAPID Non Reactive

23-04-2022

SERUM CREATININE 1.0 mg/dl 

 SERUM ELECTROLYTES

 SODIUM 146 mEq/L 

 POTASSIUM 3.5 mEq/L 

 CHLORIDE 103 mEq/L 

 COMPLETE BLOOD PICTURE (CBP)

 HAEMOGLOBIN 8.7 gm/dl 

 TOTAL COUNT 10800 cells/cumm 

 NEUTROPHILS 89 % 

 LYMPHOCYTES 07 %

 EOSINOPHILS 01 % 

 MONOCYTES 03 % 

 BASOPHILS 00 %

 PLATELET COUNT 5.05 

 SMEAR Normocytic normochromic anemia with reactive neutrophilia

25/4/22

SERUM ELECTROLYTES (26-4-22):-

SODIUM 148 mEq/L 

 POTASSIUM 3.7 mEq/L 

 CHLORIDE 101 mEq/L 

D DIMER 970 MCG/ML(22/4/22)

TROPONIN I: NEGATIVE

PT:16S

APTT:32S

INR:1.11

BT:2 MIN

CT: 4MIN 30SEC

CXR

2D ECHO

MIXED TR+ : TRIVIAL AR + ; NO MR

GOOD LV SYSTOLIC FUNCTION + 

SCLEROTIC AV, NO MS/AS ; NO RWMA

DIASTOLIC DYSFUNCTION ; MILD PAH +

USG ABDOMEN

USG LEG

E/O DIFFUSE SUBCUTANEOUS EDEMA NOTED OVER ANKLE AND UPTO 5 CMS ABOVE TO IT

ATA , PTA AND DPA SHOWS MONOPHASIC WAVEFORM WITH DAMPENED FLOW.

ANTERIOR AND POSTERIOR TIBIAL VEINS ARE NORMAL

POPLITEAL ARETRY AND VEIN NORMAL

XRAY ANKLE AND KNEE RIGHT

ECG 

SPUTUM C/S:- 

TREATMENT GIVEN:- 

1] IVF 1 NS @ 50ML/HR

2]INJ.PAN 40MG OD [BBF]

3]INJ.SLIDENAFIL 25MG BD

4]INJ.DERIPHYLLINE IV BD

5]INJ.HYDROCORT 100MG IV BD 

6]INJ.PIPTAZ 4.5G IV TID

7]O2 INHALATION WITH NASAL PRONGS                    @ 2-3L/MIN

8]CPAP INTERMITTENTLY WITH SETTING  

FIO2-30, PEEP-5

9]NEB DUOLIN QID ; BUDECORT TID ;              MUCOMIST 4TH HRLY

10]TAB.MONTAC LC HS/OD

11]TAB AZEE 500MG PO OD

12]TAB.PCM 650MG SOS