Skip to main content

75 year old female with RESPIRATORY FAILURE secondary to PULMONARY EDEMA

Introduction: This is an online E-log Entry Blog to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs. 

Note: The cases have been shared after taking consent from the patient/guardian. All names and other identifiers have been removed to secure and respect the privacy of the patient and the family.

Chief complaints:
Patient came to casualty in an unresponsive state with blood pressure not recordable, spo2 35% on 15 liters of o2 and no pulse with electrical activity. 

History of Presenting illness:

  • 25 yrs ago patient had sudden onset chest pain, radiating to neck, and palpitations and was taken to hospital and diagnosed to have occlusion myocardial infarct and percutaneous coronary angioplasty was done
  • 2017 - Patient had complaints of shortness of breath since 2-3 weeks and increased snoring with  daytime sleeping, which is aggravated - Drowsiness since 4 days - Pedal edema since 5 days. 
Patient was put on Bipap support.
2d Echo showed mild concentric lVH, normal LV function, grade-iii diastolic dysfunction. 
after stabilization patient was shifted to stepdown ward and treated with sartans (AR 2 blockers), bipap support, antacids nebulization and other supportive care. 
During the hospital stay, patient was treated with diuretics, antiplatelets, statins, antibiotics, PPI, oxygen support, niv support and other supportive care.
2022
- CPR was started according to 2020 American heart association guidelines and intubated with 7.5 cm et and bilateral air entry checked cycles of CPR was done with one milligram adrenaline after each cycle.
Patient was admitted here for further evaluation and management.

Past History
Patient has been diagnosed with hypertension, diabetes mellitus, obstructive sleep apnea.

EXAMINATION
  • post cpr vitals:
afebrile
bp 170/100
pr 110 bpm
  • cvs - s1,s2 +
  • rs - bae+, decreased air entry in left mammary area





REFLEXES:
Babinski - https://youtu.be/ClVeP-iX594
Pupillary reflex - https://youtu.be/JNsX-jaApQU

Comments

Post a Comment

Popular posts from this blog

General Medicine Internship Real Patient OSCEs Towards Optimizing Clinical Complexity

Image
Introduction:   This  online  E-log Entry Blog  is an  objectively structured clinical examination method to assess the clinical competence during the course of my General Medicine Internship rotation (June'2023-August'2023) by reviewing the case reports shared below and  to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs for questions surrounding the clinical vignettes borrowed from the E Log Book. Note:   The  cases have been shared after taking consent from the patient/guardian. All  names and other identifiers have been removed to secure and respect the privacy of the patient and the family .   CASE REPORT 1: A 30-year-male, pharmacist by occupation, presented with the chief complaint of  Fever  since 1 week  and difficulty in swallowing since 1 week.  Patient was apparen...
Read more

BIMONTHLY ASSIGNMENT - MAY 2021

Image
  Note:   I have been assigned the following cases to solve the related questions 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, diagnosis and the treatment regimen. Note: The information in this assignment has also been obtained from various sources that I have referenced and acknowledged with their online links and I have paraphrased them further. However the images I have borrowed may have copyright issues as they may not be certified through a creative commons license in which case, I hope the original authors will get in touch with me and I shall remove them if they wish. CARDIOLOGY Case 1 https://muskaangoyal.blogspot. com/2021/05/a-78year-old-male- with-shortness-of.html . Complete details regarding the case are in the mentioned link above. ANSWERS TO CASE 1 1.What is the difference between heart failure with preserved ejec...
Read more

32Y Male with FEVER and DYSPHAGIA since 1 WEEK

Image
  Introduction:   This is an online  E-log Entry Blog to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs.  Note:   The  cases have been shared after taking consent from the patient/guardian. All  names and other identifiers have been removed to secure and respect the privacy of the patient and the family . Consent:   An informed consent has been taken from the patient in the presence of the family attenders and other witnesses as well and the document has been conserved securely for future references.  A 32-year-old  man, pharmacist by occupation presented to the outpatient department with the, CHIEF COMPLAINTS: 1. Fever  since 1 week. 2. Difficulty in swallowing since 1 week. HISTORY OF PRESENTING ILLNESS:   Patient was apparently asymptomatic 6 years back when he met with an accident...
Read more