Gm final Practical short case
Final practical examination-short case
February 08, 2022
FINAL PRACTICAL EXAMINATION-SHORT CASE
Feb 8,2022
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CHIEF COMPLAINTS:
A 50 year male farmer ,manual labourer,brought to casualty with h/o altered sensorium since 1 day
H/o fever since 4 days.
HISTORY OF PRESENTING ILLNESS -
Patient was apparently asymptomatic 4 days ago,then he developed fever which is high grade,No diurnal variation, associated with chills.
No h/o cough and GE symptoms.
Attenders tells h/o stoppage of oral hypoglycemic agents for 3days, h/o decreased intake of food as he has fever.
H/o altered sensorium since 1 day.
Irrelevant talk,not recognising attenders since this morning .
Able to move all four limbs,No h/o vomitings, head ache, seizures.
Took him to nalgonda hospital, TLC-13,000:POT-5.0:CREATININE:2.9
SHIFTED HERE FOR FURTHUR MANAGEMENT.
PAST HISTORY -
H/o TB 2YRS back used Anti Tubercular Therapy for 6 months.
Diagnosed as Type -2 Diabetes mellitus on Oral hypoglycemic agents 1 YR back.
No H/O Hypertension,asthma,Cerebro vascular accident
PERSONAL HISTORY :
DIET - MIXED,
APPETITE -NORMAL ,
BOWEL MOVEMENT - REGULAR ,
BLADDER MOVEMENTS - REGULAR, ADDICTIONS-H/O
ALCOHOL-REGULAR INTAKE OF 180ML SINCE 30YRS,STOPPED SINCE 2YRS AFTER DIAGNOSIS OF TB.
RECENTLY ALCOHOL INTAKE ON JAN 15,2022.
FAMILY HISTORY:
Non-significant.
TREATMENT HISTORY:
on oral hypoglycemic agents since 1 year
ON Anti Tubercular Therapy for 6 months
ON EXAMINATION -
PATIENT IS CONCIOUS , INCOHERENT, NON COOPERATIVE
NO ICTRUS
NO PALLOR
CLUBBING:present.
NO CYANOSIS , NO LYMPHADENOPATHY, NO EDEMA
VITALS -
TEMPERATURE - 97' F
PULSE RATE - 126BPM
BLOOD PRESSURE - 190/80 MM OF HG
RESPIRATORY RATE - 28
SPO2 - 97 % AT ROOM AIR
GRBS-HIGH.
SYSTEMIC EXAMINATION -
CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS
RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS
DYSPNOEA PRESENT.
P/A - soft,non tenderness, no organomegaly
CNS: Pt is conscious, inorientation ,non cooperative
Motor system:unable to move right LL against gravity.
Tone - Rt Lt
U/L N N
L/L ?HYPO N
Reflexes:
Biceps,triceps,supinator,knee,ankle:can't be elicited.
B/L PLANTAR EXTENSION PRESENT.
O/E NECK STIFFNESS PRESENT,APPEARS TO BE ?SPONDYLOARTHROPATHY.
INVESTIGATIONS:
PROVISIONAL DIAGNOSIS:
CASE OF ALTERED SENSORIUM SECONDARY TO DKA.
TREATMENT :
1.IVF 2 UNITS NS IV_BOLUS/STAT.
AND THEN IVF NS@100ML/HR
2.INJ.HAI 6U/IV/STAT
3.INJ.HUMAN ACTRAPID 1ML(40U)
4.INJ.THIAMINE 1AMP IN 100ML NS/IV/OD
5.INJ.OPTINEURON 1 AMP IN 100ML NS/IV/OD
6.GRBS MONITORING-EVERY HOURLY.
7.INJ.MONOCEF 2GM/IV/BD.
Goji Berries... yes... I tried those too.For my health conditions, Those sweet, red berries seemed to help, but only during the time when I consumed them. I don't want to take a drug for the rest of my life, so why would I want to take a natural supplement everyday for the rest of my life (although Goji berries are very tasty and are highly nourishing). To me this was not a cure either (and I'm LOOKING for the CURE).
ReplyDeleteUp to that point, I hadn't found a cure. I felt like a young jumbled mess. I continued to have extreme pain, but continued on my path to healing. I started to focus on myself and not everyone else. When I was a young adult, I took on too much responsibility out of a sense of obligation. This was no longer healthy for me, so I resigned from all my projects and groups. Those days to come were the best [and worst] days. I took a lot of time off work, yet began to feel so extremely exhausted. Many health professionals "diagnosed" me with adrenal fatigue & Hiv,Prostate Cancer so my situation was annoying then I keep searching for permanent cure online that's when I came to know of Dr Itua herbal center hands whom god has blessed with ancestral herbs and a gift to heal people with diseaseSo I made a purchase of his herbal medicines and I have been watching my health for 6 years now and I actually confirmed that his herbal medicines are a permanent cure and I'm so happy that I came to know of his herbal healings.You can contact Dr Itua herbal center Email: drituaherbalcenter@gmail.com www.drituaherbalcenter.com if you went through exactly what I go through in terms of health conditions because to be honest there is more to learn about natural herbs than medical drugs.