feverprojr - Fungal 60/F 202357639

 fungal - 20231239265

ACUTE PULMONARY EDEMA SECONDARY TO ACS (RESOLVED )

CARDIOGENIC SHOCK (RESOLVED )

TYPE I RESPIRATORY FAILURE (RESOLVED)

HEART FAILURE WITH REDUCED EJECTION FRACTION (EF-38%)

SEVERE LV DYSFUNCTION

DIABETIC KETOACIDOSIS (RESOLVED )

LEFT LOWER LOBE OF LUNG FUNGAL BALL ( ASPERGILLOMA )

VT --> SINUS RHYTHM POST CPR STATUS

DM WITH LEFT FOOT ULCER ( PSEUDOMONAS )

ANAEMIA (NCNC)

GRADE II BEDSORE ON GLUTEAL REGION (RESOLVING)

POST EXTUBATED STATE DAY 7

Case History and Clinical Findings

PATIENT CAME WITH C/O PEDAL EDEMA SINCE 10 DAYS , BREATHLESSNESS SINCE 3 DAYS

HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS AGO THEN SHE DEVELOPED PEDAL EDEMA IN BOTH LIMBS WHICH WAS GRADUALLY PROGRESSING , PITTING TYPE , NOT RELIEVING . PATIENT ALSO COMPLAINTS OF BREATHLESSNESS SINCE 3 DAYS WHICH WAS MILD GRADUALLY PROGRESSIVE AND NOW CAME TO CASUALITY WITH SEVERE GRADE OF SOB WHICH IS AGGREVATING WITH CHANGE OF POSITION FROM SITTING TO SLEEP AND RELIEVING ON CHANGE OF POSITION TO SITTING . NO H/O SEASONAL EPISODES AND VARIATIONS

NO H/O GIDDINESS , VOMITINGS , DIARRHEA

NO H/O SEIZURES EPISODES

NO H/O FEVER , BLEEDING MANIFESTATIONS

PAST HISTORY :

K/C/O DM SINCE 12 YEARS , ON INSULIN SINCE 1 WEEK

N/K/C/O HTN,TB,THYROID DISORDERS,EPILEPSY,CVA,CAD

PERSONAL HISTORY:

APPETITE NORMAL

MIXED DIET

BOWEL AND BLADDER - REGULAR

ADDICTIONS -

ALCOHOL- TAKES TODDY OCCASSIONALLY ONCE IN A MONTH

GENERAL EXAMINATION:

AFEBRILE (98.7C/F)

BP:90/70 MMHG

PR:140 BPM

RR:22 CPM

SPO2: 98% @ 10 LITRES OF O2

GRBS:419 MG/DL

CVS:S1 S2 HEARD

NO MURMURS

CNS: NO FOCAL NEUROLOGICAL DEFICITS

P/A: SOFT AND NON TENDER

RS:BAE+ ,NORMAL VESICULAR BREATH SOUNDS PRESENT

ON 25/12/23 PULMONOLOGY REFERRAL WAS DONE I/V/O PT IS K/C/O LEFT UPPER LOBE FUNGAL BALL ?ASPERGILLOMA

ADVICE-

CONTINUE SAME TREATMENT

O2 INHALATION @6-8 LITRES WITH FAICAL MASK TO MAINTAIN SPO2 >94%

NEBULISATION WITH IPRAVENT 6TH HRLY AND BUDECORT 12TH HRLY

SYP.ASCORIL PO TID 2 TBSP

ON 26/12/23 SURGERY REFERRAL WAS DONE I/V/O DEBRIDEMENT AND DISARTICUALTION OF 3RD TOE OF LEFT FOOT 10 DAYS AGO

ADVICE -

REGULAR ASEPTIC DRESSING

CONTINUE SAME TREATMENT

ON 29/12/23 SURGERY ADVICE -

DEBRIDEMENT DONE

ASD AND LEFT LL ELEVATION

CONTINUE SAME TREATMENT

ON 3/1/24 ENT REFERRAL WAS DONE I/V/O DECREASING SECREATIONS FOR EXTUBATING THE PATIENT OR WHETHER TO PERFORM TRACHEOSTOMY

ADVICE -

PATIENT DOESNT NEED TRACHEOSTOMY

IF THERE ARE EXCESSIVE MUCOID SECRETIONS START ON SYP.AMBROXYL 10ML HS

HEAD ELEVATION BY 20-30 AFTER EXTUBATION

COURSE IN THE HOSPITAL:

A 60 YR OLD FEMALE WAS BROUGHT TO CASUALTY WITH THE ABOVE MENTIONED COMPLAINTS WITH VITALS AS PR:140BPM RR:22CPM BP:90/70 MM HG GRBS:419 MG/DL SPO2: 98% ON 10LIT O2;IN ER ECG MONITOR SHOWED PSVT, FOR WHICH INTRAVENOUS ADENOSINE WAS GIVEN IN DOSES OF 6MG, 12 MG AND 12 MG WAS GIVEN; AS RHYTHM WAS NOT REVERTED TO SINUS, PATIEWNT WAS STARTED ON INTRAVENOUS AMIADARONE INFUSION AFTER GIVING A STAT DOSE. ION VIEW OF IMPENDING RESPIRATORY FAILURE AND POOR GCS PATIENT WAS INTUBATED AND CONNECTED TO MECHANICAL VENTILATOR IN ACMV MODE. PATIENT AND SHIFTED TO ICU; BED SIDE SCREENING ECHO WAS DONE WHICH SHOWED EF OF 36%; SEVERE LV DYSFUNCTION, RCA AND LAD HYPOKINETIC; DILATED CHAMBERS AND IVC DILATED AND NON COLLAPSING. PATIENT HAD SUDDEN BRADYCARDIA AND TREATED ACCORDINGLY. IN VIEW OF HYPOTENSION PATIENT WAS STARTED ON INTRAVENOUS TRIPLE IONOTROPIC SUPPORT, ANTICOAGULANT AND ANTIBIOTICS; AND GIVEN CARDIAC LOADING DOSES. TRIPLE LUMEN INSERTION WAS DONE AT RIGHT IJV I/V/O MUTIPLE INOTROPIC SUPPORT AND FOLEYS CATHETERISATION WAS DONE.PATIENT WAS REFERRED TO SURGERY I/V/O LEFT 3RD TOE DISARTICULATION AND ULCER ON DORSUM OF LEFT FOOT 10 DAYS AGO. ALTERNATE DAY DEBRIDEMENT AND DRESSING DONE . PATIENT REFERRED TO PULMONOLOGY I/V/O LEFT UPPER LOBE FUNGAL BAL [? ASPERGILOMA] . PATIENT WAS REFERRED TO GENERAL SURGERY I/V/O GRADE II BEDSORES IN SACRAL REGION FOR WHICH DAILY DRESSING AND CHANGE OF POSTION 2ND HRLY WAS DONE.ON 3/01/24 PATIENT EXTUBATION CRITERIA WAS FULFILLED AND WAS EXTUBATED FOLLOWED BY OXYGEN SUPPORT . I/V/O LOW HB- 6.2GMS 2 PINT PRBC TRANSFUSION WAS DONE . AND PATIENT BEING HEMODYNAMICALLY STABLE IS DISCHARGED AND ADVISED FOR FURTHER FOLLOWUP.

Investigation

NameValue

Range

NameValueRangeSERUM CREATININE25-12-2023 03:51:PM0.9 mg/dl1.1-0.6 mg/dlSERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 25-12-2023 03:51:PMSODIUM133 mEq/L145-136 mEq/LPOTASSIUM3.8 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/LCALCIUM IONIZED1.10 mmol/Lmmol/LABG 25-12-2023 04:09:PMPH

6.95

PCO2

62.0

PO2

88

HCO3

13.0

St.HCO3

10.4

BEB

-18.4

BEecf

-17.0

TCO2

31.1

O2 Sat

85

O2 Count

9.6

Anti HCV Antibodies - RAPID25-12-2023 07:30:PMNon Reactive HBsAg-RAPID25-12-2023 07:30:PMNegative LIVER FUNCTION TEST (LFT) 25-12-2023 07:30:PMTotal Bilurubin0.97 mg/dl1-0 mg/dlDirect Bilurubin0.19 mg/dl0.2-0.0 mg/dlSGOT(AST)47 IU/L31-0 IU/LSGPT(ALT)14 IU/L34-0 IU/LALKALINE PHOSPHATE190 IU/L141-53 IU/LTOTAL PROTEINS6.0 gm/dl8.3-6.4 gm/dlALBUMIN2.85 gm/dl4.6-3.2 gm/dlA/G RATIO0.90RFT 25-12-2023 07:30:PMUREA27 mg/dl

42-12 mg/dl

CREATININE1.1 mg/dl

1.1-0.6 mg/dl

URIC ACID5.0 mg/dl

6-2.6 mg/dl

CALCIUM10.0 mg/dl

10.2-8.6 mg/dl

PHOSPHOROUS6.4 mg/dl

4.5-2.5 mg/dl

SODIUM135 mEq/L

145-136 mEq/L

POTASSIUM4.8 mEq/L

5.1-3.5 mEq/L

CHLORIDE105 mEq/L

98-107 mEq/L

ABG 25-12-2023 09:00:PMPH7.09PCO232.6PO284.0HCO39.6St.HCO310.4BEB-18.9BEecf- 18.2TCO221.5O2 Sat89.6O2 Count12.6

COMPLETE URINE EXAMINATION (CUE) 25-12-2023 10:07:PM

COLOUR

Pale yellow

APPEARANCE

Clear

REACTION

Acidic

SP.GRAVITY

1.010

ALBUMIN

Nil

SUGAR

Trace

BILE SALTS

Nil

BILE PIGMENTS

Nil

PUS CELLS

3-4

EPITHELIAL CELLS

2-3

RED BLOOD CELLS

Nil

CRYSTALS

Nil

CASTS

Nil

AMORPHOUS DEPOSITS

Absent

OTHERS

Nil

ABG 26-12-2023 12:01:AMPH7.09PCO242.4PO2103HCO312.4St.HCO312.1BEB-16.2BEecf- 15.4TCO228.1O2 Sat93.7O2 Count12.5

SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 26-12-2023 12:03:AM

SODIUM137 mEq/L

145-136 mEq/L

POTASSIUM3.3 mEq/L

5.1-3.5 mEq/L

CHLORIDE102 mEq/L

98-107 mEq/L

CALCIUM IONIZED1.14 mmol/Lmmol/LABG 26-12-2023 01:04:AMPH7.09PCO242.4PO2103HCO312.4St.HCO312.1BEB-16.2BEecf-15.4TCO228.1O2 Sat93.7O2 Count12.5

ABG 26-12-2023 02:05:AM

PH

7.56

PCO2

32.5

PO2

309

HCO3

29.1

St.HCO3

30.6

BEB

6.7

BEecf

6.4

TCO2

60.0

O2 Sat

99.1

O2 Count

13.0

ABG 26-12-2023 11:23:AMPH7.48PCO227.7PO283.0HCO320.6St.HCO322.7BEB-2.0BEecf- 2.4TCO243.9O2 Sat96.9O2 Count9.9

ABG 27-12-2023 01:24:AM

PH

7.48

PCO2

29.6

PO2

111

HCO3

21.8

St.HCO3

23.7

BEB

-0.9

BEecf

-1.2

TCO2

46.1

O2 Sat

98.2

O2 Count11.0RFT 27-12-2023 01:24:AMUREA34 mg/dl42-12 mg/dlCREATININE0.8 mg/dl1.1-0.6 mg/dlURIC ACID3.7 mg/dl6-2.6 mg/dlCALCIUM8.9 mg/dl10.2-8.6 mg/dlPHOSPHOROUS2.4 mg/dl4.5-2.5 mg/dlSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.4 mEq/L5.1-3.5 mEq/LCHLORIDE101 mEq/L98-107 mEq/LSERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 27-12-2023 03:07:PMSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.5 mEq/L5.1-3.5 mEq/LCHLORIDE99 mEq/L98-107 mEq/LCALCIUM IONIZED1.11 mmol/Lmmol/LABG 27-12-2023 07:02:PMPH7.46PCO234.3PO285.0HCO324.2St.HCO325.4BEB1.2BEecf0.8TCO249.0O2 Sat96.1O2 Count15.1ABG 27-12-2023 11:40:PMPH7.50PCO228.4PO245.4HCO322.4St.HCO324.0BEB-0.4BEecf-0.3TCO249.4O2 Sat86.1O2 Count5.5RFT 27-12-2023 11:40:PMUREA34 mg/dl42-12 mg/dlCREATININE1.1 mg/dl1.1- 0.6 mg/dlURIC ACID4.4 mg/dl6-2.6 mg/dlCALCIUM8.8 mg/dl10.2-8.6 mg/dlPHOSPHOROUS2.9 mg/dl4.5-2.5 mg/dlSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.0 mEq/L5.1-3.5 mEq/LCHLORIDE102 mEq/L98-107 mEq/LABG 28-12-2023 07:09:PMPH7.56PCO232.5PO2309HCO329.1St.HCO330.6BEB6.7BEecf6.4TCO260.0O2 Sat99.1O2 Count13.0SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 28- 12-2023 08:46:PMSODIUM135 mEq/L145-136 mEq/LPOTASSIUM3.1 mEq/L5.1-3.5 mEq/LCHLORIDE99 mEq/L98-107 mEq/LCALCIUM IONIZED1.11 mmol/Lmmol/LABG 29-12-2023 12:40:AMPH7.59PCO229.2PO2107HCO328.4St.HCO330.4BEB6.6BEecf6.1TCO258.7O2 Sat98.1O2 Count11.7LIVER FUNCTION TEST (LFT) 29-12-2023 12:40:AMTotal Bilurubin10.26 mg/dl1-0 mg/dlTotal Bilurubin0.68 mg/dl1-0 mg/dlDirect Bilurubin0.19 mg/dl0.2-0.0 mg/dlDirect Bilurubin0.25 mg/dl0.2-0.0 mg/dlSGOT(AST)21 IU/L31-0 IU/LSGOT(AST)23 IU/L31-0 IU/LSGPT(ALT)17 IU/L34-0 IU/LSGPT(ALT)20 IU/L34-0 IU/LALKALINE PHOSPHATE180 IU/L141- 53 IU/LALKALINE PHOSPHATE233 IU/L141-53 IU/LTOTAL PROTEINS6.7 gm/dl8.3-6.4 gm/dlTOTAL PROTEINS5.2 gm/dl8.3-6.4 gm/dlALBUMIN2.55 gm/dl4.6-3.2 gm/dlALBUMIN2.3 gm/dl4.6-3.2 gm/dlA/G RATIO0.61A/G RATIO0.80RFT 29-12-2023 12:40:AMUREA32 mg/dl42-12 mg/dlCREATININE1.0 mg/dl1.1-0.6 mg/dlURIC ACID4.1 mg/dl6-2.6 mg/dlCALCIUM10.1 mg/dl10.2-8

.6 mg/dlPHOSPHOROUS6.2 mg/dl4.5-2.5 mg/dlSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.4 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/LABG 29-12-2023 12:41:AMPH7.51PCO232.0PO2329HCO325.5St.HCO327.1BEB3.0BEecf2.68TCO252.2O2 Sat99.3O2 Count14.2SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 29- 12-2023 12:42:AMSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.4 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/LCALCIUM IONIZED1.20 mmol/Lmmol/LABG 29-12-2023 09:35:PMPH7.52PCO225.1PO2113HCO320.4St.HCO322.5BEB-2.3BEecf-2.1TCO245.1O2 Sat98.5O2 Count5.7SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 29-12- 2023 10:23:PMSODIUM133 mEq/L145-136 mEq/LPOTASSIUM3.2 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/LCALCIUM IONIZED1.22 mmol/Lmmol/LABG 29-12-2023 11:51:PMPH7.44PCO243.2PO235.9HCO329.0St.HCO327.8BEB4.7BEecf4.9TCO258.9O2 Sat58.1O2 Count9.7LIVER FUNCTION TEST (LFT) 29-12-2023 11:51:PMTotal Bilurubin1.01 mg/dl1- 0 mg/dlDirect Bilurubin0.18 mg/dl0.2-0.0 mg/dlSGOT(AST)26 IU/L31-0 IU/LSGPT(ALT)17 IU/L34-0 IU/LALKALINE PHOSPHATE225 IU/L141-53 IU/LTOTAL PROTEINS6.1 gm/dl8.3-6.4 gm/dlALBUMIN2.3 gm/dl4.6-3.2 gm/dlA/G RATIO0.61RFT 29-12-2023 11:51:PMUREA39 mg/dl42-12 mg/dlUREA139 mg/dl42-12 mg/dlCREATININE1.1 mg/dl1.1-0.6 mg/dlCREATININE1.1 mg/dl1.1-0.6 mg/dlURIC ACID3.1 mg/dl6-2.6 mg/dlURIC ACID3.1 mg/dl6-2.6 mg/dlCALCIUM10.2 mg/dl10.2-8.6 mg/dlCALCIUM10.2 mg/dl10.2-8.6 mg/dlPHOSPHOROUS6.8 mg/dl4.5-2.5 mg/dlPHOSPHOROUS6.8 mg/dl4.5-2.5 mg/dlSODIUM129 mEq/L145-136 mEq/LSODIUM129 mEq/L145-136 mEq/LPOTASSIUM2.5 mEq/L5.1-3.5 mEq/LPOTASSIUM2.4 mEq/L5.1-3.5 mEq/LCHLORIDE101 mEq/L98-107 mEq/LCHLORIDE101 mEq/L98-107 mEq/LSERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 30-12-2023 05:58:PMSODIUM136 mEq/L145-136 mEq/LPOTASSIUM3.4 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/LCALCIUM IONIZED1.09 mmol/Lmmol/LABG 30-12-2023 07:26:PMPH7.36PCO246.3PO279.6HCO325.7St.HCO324.8BEB0.6BEecf0.9TCO253.4O2 Sat94.0O2 Count14.1ABG 30-12-2023 11:05:PMPH7.44PCO215.9PO2147HCO310.7St.HCO315.0BEB-11.9BEecf-12 .9TCO222.2O2 Sat94.7O2 Count12.9SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 30-12-2023 11:05:PMSODIUM138 mEq/L145-136 mEq/LPOTASSIUM3.3 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/LCALCIUM IONIZED1.12 mmol/Lmmol/LABG 31-12-2023 11:51:PMPH7.45PCO226.1PO281.4HCO318.3St.HCO320.5BEB-4.6BEecf-4.9TCO239.3O2 Sat96.6O2 Count9.2RFT 31-12-2023 11:51:PMUREA37 mg/dl42-12 mg/dlCREATININE0.8 mg/dl1.1- 0.6 mg/dlURIC ACID2.5 mg/dl6-2.6 mg/dlCALCIUM8.1 mg/dl10.2-8.6 mg/dlPHOSPHOROUS3.3 mg/dl4.5-2.5 mg/dlSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.9 mEq/L5.1-3.5 mEq/LCHLORIDE104 mEq/L98-107 mEq/LABG 01-01-2024 10:08:PMPH7.38PCO232.4PO256.0HCO319.0St.HCO320.0BEB-5.2BEecf-5.1TCO242.9O2 Sat91.6O2 Count5.0SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 01-01- 2024 10:08:PMSODIUM132 mEq/L145-136 mEq/LPOTASSIUM3.4 mEq/L5.1-3.5 mEq/LCHLORIDE99 mEq/L98-107 mEq/LCALCIUM IONIZED0.99 mmol/Lmmol/LRFT 02-01-2024 09:56:AMUREA27 mg/dl42-12 mg/dlCREATININE0.7 mg/dl1.1-0.6 mg/dlURIC ACID3.0 mg/dl6-2.6 mg/dlCALCIUM8.2 mg/dl10.2-8.6 mg/dlPHOSPHOROUS3.0 mg/dl4.5-2.5 mg/dlSODIUM134 mEq/L145-136 mEq/LPOTASSIUM3.7 mEq/L5.1-3.5 mEq/LCHLORIDE96 mEq/L98-107 mEq/LABG 02-01-2024 06:57:PMPH7.37PCO229.6PO251.3HCO316.8St.HCO318.7BEB-7.0BEecf- 7.4TCO235.3O2 Sat94.1O2 Count13.1SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 02-01-2024 10:53:PMSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.5 mEq/L5.1-3.5 mEq/LCHLORIDE97 mEq/L98-107 mEq/LCALCIUM IONIZED1.17 mmol/Lmmol/LABG 03-01-2024 05:51:AMPH7.37PCO223.4PO2134HCO313.4St.HCO316.0BEB-10.5BEecf-10.9TCO228.8O2 Sat97.8O2 Count10.7ABG 03-01-2024 05:10:PMPH7.39PCO230.9PO2103HCO318.6St.HCO320.1BEB-5.2BEecf-5.4TCO240.1O2 Sat97.2O2 Count10.1ABG 03-01-2024 10:52:PMPH7.44PCO236.4PO285.0HCO324.3St.HCO325.1BEB0.8BEecf0.6TCO251.4O2 Sat96.6O2 Count11.5RFT 03-01-2024 10:52:PMUREA36 mg/dl42-12 mg/dlCREATININE0.9 mg/dl1.1-0.6 mg/dlURIC ACID6.7 mg/dl6-2.6 mg/dlCALCIUM8.7 mg/dl10.2-8.6 mg/dlPHOSPHOROUS2.4 mg/dl4.5-2.5 mg/dlSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.0 mEq/

L5.1-3.5 mEq/LCHLORIDE96 mEq/L98-107 mEq/LABG 04-01-2024 07:41:PMPH7.46PCO232.4PO284.9HCO323.2St.HCO324.6BEB0.2BEecf-0.0TCO249.7O2 Sat96.9O2 Count9.7SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 04-01- 2024 11:28:PMSODIUM135 mEq/L145-136 mEq/LPOTASSIUM3.1 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/LCALCIUM IONIZED1.17 mmol/Lmmol/LRFT 05-01-2024 11:30:PMUREA24 mg/dl42-12 mg/dlCREATININE0.8 mg/dl1.1-0.6 mg/dlURIC ACID5.5 mg/dl6-2.6 mg/dlCALCIUM8.9 mg/dl10.2-8.6 mg/dlPHOSPHOROUS2.0 mg/dl4.5-2.5 mg/dlSODIUM137 mEq/L145-136 mEq/LPOTASSIUM3.5 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/L

ON 6/1/24 ET FOR C/S WAS SENT

REPORT- PSEUDOMONAS AERUGINOSA ISOLATED

2D ECHO REPORT ON 26/12/23

RWMA PRESENT , LAD AKINETIC , RCA AND LCX HYPOKINESIA

MODERATE MR PRESENT , MODERATE TR WITH PAH , MILD AR +

SCLEROTIC AV, NO AS/MS . IAS INTACT

EF- 40%. RSVP- 52 MMHG

MODERATE LV DYSFUNCTION +

DIASTOLIC DYSFUNCTION + , NO PE

IVC SIZE - 1.73 CMS , DILATED

MAC +, THICKENED MV NON COLLAPSING

DILATED RA , LA

Treatment Given(Enter only Generic Name)

RT FEED 100ML WATER 4TH HRLY + IVF - NS +RL @75ML/HR

INJ.MIDAZOLAM 30MG + FENTANYL 200MG + 16ML NS IV INFUSION @ 6ML/HR

INJ.NORADRENALINE 4MG + 46ML NS IV INFUSION @ 24ML/HR INCREASE OR DECREASE ACC TO MAP

INJ. VASOPRESSIN 20U +49ML NS IV INFUSION @6ML/HR

INJ.DOBUTAMINE 10MCG/KG/MIN IV INFUSION @4ML/HR

INJ.HUMAN ACTRAPID INSULIN 0.1 U/KG/HR IV INFUSION TITRATE ACC TO GRBS

INJ.NPH S/C BD BEFORE MEALS

INJ.AMIODARONE 540 MG IN 300 ML NS @0.5MG/MIN OVER 18 HRS

INJ.HEPARIN 5000 IU /IV/TID

INJ.NEOMOL 1GM /IV/SOS IF TEMP IS >101.4 F

INJ.PIPTAZ 4.5 GM/IC/TID X 10 DAYS

INJ.METROGYL 100ML /IV/TID

INJ.ITRACONOZOLE 600 MG /RT/OD

INJ.5% DEXTROSE @20ML/HR IF GRBS <150 MG

ET SUCTIONING EVERY 3RD HRLY

POSTION CHANGE EVERY 2ND HRLY

NEB WITH IPRAVERT 6TH HRLY AND BUDECORT 12TH HRLY

T. AMIODARONE 200MG /PO/BD

T.ECOSPIRIN 150MG PO/OD

T.CLIPIDOGREL 75 MG PO/HD

T.ATORVASTATIN 80 MG OD / STAT -> 20 MG PO/OD

T.ITRACONOZOLE 100MG PO/BD

T.MET XL 25 MG PO/OD

INJ/LASIX 100MG + 40ML NS @ 4ML/HR

INJ.LINEZOLID 600MG IV /OD X 3 DAYS

INJ.KCL 2 AMP IN 200 ML NS IV OVER 6 HRS 33ML/HR

T.DAPAGLIFLOZIN 10MG PO/OD

T.IVABRAD 5MG /RT/SOS

INJ.CLEXANE 0.4MG SC/OD

INJ.MEROPENEM 1GM IV/BD

T.SPIRONOLACTONE 25MG RT/OD

INJ.TRAMADOL 1 AMP IN 100ML NS/IV/SOS

INJ.ZOFER 4 MG /IV/SOS

T.DYTOR 20MG RT/OD

T.SALBUTRIL + VALSARTAN 50 MG RT/OD

Advice at Discharge

1. FLUID RESTRICTION <1.5 L/DAY

2. SALT RESTRICTION 2-3 GM/DAY

3.TAB LINEZOLID 600MG PO BD FOR 6 DAYS

4. TAB SPIRANOLACTONE 25MG PO OD FOR CONTINUE

5. TAB DAPAGLIFOZIN 10MG PO OD CONTINUE

6. TAB ECOSPRIN GOLD 75/75/10 PO OD CONTINUE

7. TAB SACUBITRIL + VALSARTAN 50MG CONTINUE

8. TAB METFORMIN 500MG PO BD CONTINUE

9. TAB TENELIGLIPTIN 20MG PO OD AT 2 PM CONTINUE

10. TAB PAN 40MG PO OD AT 7AM

11. SYRUP POTCHLOR 15ML PO TID FOR 5 DAYS

12. REGULAR DRESSINGS FOR BEDSORE AND FOOT ULCER.