A 76 YEAR OLD FEMALE WITH COMPLAINTS OF CHEST PAIN AND SHORTNESS OF BREATH
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I have been given this case to solve in an attempt to understand the topic of "Patient clinical data analysis" to develop my competency i reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.
CASE DISCUSSION:
A 76years old female housewife by occupation brought with complaints of
- chest pain since yesterday
- SOB since morning
HOPI:
Patient was apparently asymptomatic 2yrs and was diagnosed with hypertension (is on medication not known). 2yrs back was admitted at a private hospital for liver problem- cholelithiasis -done cholecystectomy.
Presently- complained of chest pain since yesterday associated with 2 episodes of Vomiting,Sweating and 2 episodes of loose motions.
Was taken to RMP and was given 1 injection and tablet and brought back to home.
Since today morning she complained of discomfort and was brought to casualty .
PAST HISTORY:
Not a k/c/o - DM,TB,ASTHMA,EPILEPSY
PERSONAL HISTORY:
- Mixed diet
- sleep is adequate
- Appetite normal
- bowel and bladder movements are regular
MENSTRUAL HISTORY: attained menopause 15 years back
FAMILY HISTORY:
No similar complaints in family
GENERAL EXAMINATION:
At time of admission
Pt is drowsy,extremities were cool and clammy
PR-75bpm
Bp-60/40mmhg
Spo2-57% ON RA
CVS-S1,S2 +, no added sounds
RS- b/l diffuse crepts on inspiration
P/A-Soft,NT Scar present at the right hypochondriac region (kochers incision for cholecystectomy)
CLINICAL IMAGES:
INVESTIGATIONS:
2D ECHO: https://youtu.be/D3m0t9MIGxU
ABG:Day1 at 4:40pm
Serum lactate: 31
PROVISIONAL DIAGNOSIS: CARDIOGENIC SHOCK SECONDARY TO NSTEMI WITH CARDIOGENIC PULMONARY EDEMA.
TREATMENT:
PT WAS INTUBATED IN VIEW OF HYPOXIA AND CONNECTED TO MECHANICAL VENTILATOR
In view of cardiogenic shock pt was started on inotropic support
Post intubation vitals:
Bp:90/60MMHG
Pr:140BPM
Spo2:95%
Rr:crepts decreased
Post intubation investigations:
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