fever projr 202249038 46/m

 Diagnosis

RIGHT UPPERLIMB GAS GANGRENE(ECOLI ISOLATED)

S/P INCISION AND DRAINAGE

REFRACTORY HYPOKELEMIA SECONDARY TO ?DIURETICS, INSULIN ,? RENAL TUBULAR ACIDOSIS

REFRACTORY METABOLIC ACIDOSIS (NAGMA)

THROMBOCYTOPENIA DUE TO ? UREMIA,?HUS,?DIC

AKI ON CKD

K/C/O DIABETES MELLITUS SINCE 2 YEARS

COMPENSATED GRADE II BED SORE

Case History and Clinical Findings

C/O PUS DISCHARGE FROM RT SHOULDER REGION SINCE 1DAY

SWELLING OF RT UPPERLIMB SINCE 1DAY

NO HISTORY OF TRAUMA ,INFECTIONS

HISTORY OF PRESENT ILLNESS-PT WAS APPARENTLY ASYMPTOMATIC 1DAY BACK THEN HE DEVELOPED SWELLING OF RT UPPERLIMB NEAR SHOULDER REGION,HISTORY OF PUS DISCHARGE OF SEROUS TYPE.

NO HISTORY OF TRAUMA OR ANY INFECTIONS.

HISTORY OF SWELLING OF RT UPPERLIMB EXTENDING TO THE RT HAND

PAST HISTORY-H/O ACUTE KIDNEY INJURY ON HD

K/C/O DM 2YRS

H/O PREVIOUS UROSEPSIS AND PNEUMONIA

H/O HD PROLONGED HOSPITAL STAY

LOCAL EXAMINATION-

ON INSPECTION SWELLING NEAR RT SHOULDER REGION 5X4CM OVOID IN SHAPE,SKIN INDURATION PRESENT

VISIBLE PUS POINT PRESENT ,SEROUS DISCHARGE PRESENT

PALPATION-LOCAL RISE OF TEMPERATURE PRESENT,TENDERNESS PRESENT, ALL INSPECTORY FINDINGS CONFIRMED

SKIN INDURATION PRESENT

SWELLING EXTENT OVER LATERAL ASPECT OF RT SHOULDER

ON POD -7 PATIENT WAS REFERRED TO GENERAL MEDICINE I/V/O HYPOKALEMIA AND DERANGED RFT AND HYPO TENSION

Investigation

USG ABDOMEN DONE ON 23/11/22: MINIMAL ASCITES AND RAISED ECHOGENECITY OF B/L KIDNEYS

USG OF RT UPPER LIMB ON 23/11/22:

FEATURES SUGGESTIVE OF CELLULITIS OR NECRPTIZING FASCITIS

EXAMINED VESSELS SHOW NORMAL COLOUR FLOW

2D ECHO ON 24/11/22:

SCLEROTIC AV ,NO AS/MS

NO RWMA,MILD LVH

TRIVIAL AR+, NO MR

EF 62% GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION +,NO PE

IVC SIZE 0.6 CM

REVIEW 2DECHO ON 25/11/22

NO RWMA MILD LVH

TR+ WITH PAH

TRIVIAL AR+/MR+

SCLEROTIC AV ,NO AS/MS

EF 62% GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION +,NO PE


IVC SIZE 0.7CM

BLOOD C/S REPORT:

E.COLI ISOLATED

URINE C/S:

E.COLI> 10 TO THE POWER 4 CFU/ML OF URINE ISOLATED

PUS C/S :

PUS FROM WOUND RT SHOULDER UPPER INCISION AND FROM ABSCESS E.COLI ISOLATED

PUS FROM LOWER VERTICAL INCISION :E.COLI ISOLATED

USG OF ABDOMEN AND CHEST ON 28/11/22:

B/L MILD PLEURAL EFFUSION NOTED

B/L GRADE 1 RPD

MODERATE ASCITES

2D ECHO ON 28/11/22:

MILD TR+ WITH PAH

TRIVIAL TR+ MR+

GLOBAL HYPOKINESIA

NO AS/MS

FAIR LV FUNCTION

DIASTOLIC DYSFUNCTION PRESENT NO PE

Treatment Given(Enter only Generic Name)

1)HIGH PROTEIN DIET + 3 EGG WHITES

2)INJ.MEROPENAM 1 GM/IV/BD

4)INJ CLINDAMYCIN 60PO/BD

5)INJ ASTYMINE FORTE IV/BD

6)TAB PAN 40 MG PO/OD

7)TAB CHYMERAL FORTE PO/TID

8)TAB DOLO 650 PO/TID

9)TAB NODOSIS 500MG

10)TAB OROFER XT PO/BD

11)TAB VIT C PO/OD0 MG IV/TID

12)SYRUP POTCLOR 20ML PO/BD

13)GRBS 7 POINT PROFILE

14)INJ HAI/SC TID

15)PROTEIN X POWDER IN 1 GLASS OF WATER/MILK/PO/BD


16)RIGHT UPPE LIMB ELEVATION,RIGHT SHOULDER MOVEMENTS

BLOOD TRANSFUSIONS DONE ON

PRBC TRANSFUSION 1 UNIT ON 23/11/22

PLATELET TRANSFUSION 1 UNIT ON 24/11/22

PRBC TRANSFUSED 1 UNIT ON 25/11/22

WHOLE BLOOD TRANSFUSION DON ON 28/11/22

17)REGULARDRESSINGS

18)AIR BED

19)PHYSIOTHERAPY TO RT UPPPER LIMB

ORTHO ,NEOHROLOGY, PULMONOLGY ADVICE TAKEN AND FOLLOWED

Advice at Discharge

1)HIGH PROTEIN DIET + 3 EGG WHITES

2)TAB PAN 40 MG PO/OD

3)TAB CHYMERAL FORTE PO/TID

4)TAB DOLO 650 PO/TID

5)TAB NODOSIS 500MG

6)TAB OROFER XT PO/BD

7)TAB VIT C PO/OD0 MG IV/TID

8)TAB.AUGMENTIN625MG PO BD

9)SYRUP POTCLOR 20ML PO/BD

10)PROTEIN X POWDER IN 1 GLASS OF WATER/MILK/PO/BD

11)RIGHT UPPE LIMB ELEVATION,RIGHT SHOULDER MOVEMENTS NBH

12)REGULARDRESSINGS

13)AIR BED

14)PHYSIOTHERAPY TO RT UPPPER LIMB

15) ONITMENT THROMBOPHOBE FOR LOCAL APPLICATION

PATIENT AND ATTENDERS HAVE BEEN EXPLAINED ABOUT THE CONDITION OF THE PATIENT IN THEIR OWN UNDERSTANDABLE LANGUAGE BUT WANTS TO LEAVE AGAINTS MEDICAL ADVICE AS THE PATIENT DOESNT WANT TO STAY AND TAKE TREATMENT AND REFUSED FOR ANY TREATMENT SINCE 1/12/22 FROM 2PM.

HOSPITAL STAFF AND DOCTORS ARE NOT RESPONSIBLE FOR ANY FURTHER DETORIORATION OF THE PATIENT CONDITION

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