75/F - TRAHI

A 75years old female from muthyalammagudem came with c/o pain and swelling at left hip region due fall from bed while sleeping at around 12:00 AM on 18/11/2020 

No h/o head injury
No h/o fever
No h/o headache / dizziness / LOC / blurring of vision / diplopia 

Not a k/c/o DM / HTN / Asthma / Epilepsy / CAD / TB

GENERAL EXAMINATION:
Patient is coherent cooperative moderately built and moderately nourished

There is no pallor,Icterus,cyanosis,clubbing, lymphadenopathy 

LOCAL EXAMINATION:
There is swelling on the left side of hip 
skin over the swelling is normal 
Tenderness over lateral side of left hip 
Movement- restricted and pain full 
Shorting of leg 
Attitude- externally rotated 
Distal pluses are present  

SYSTEMIC EXAMINATION:
CVS : S1 S2 heard 
RS : BAE + , NVBS
P/A : soft , NT

18/11/2020














 


 
 














1 unit PRBC transfusion was done on 19/11/2020
During transfusion she had Fever with chills and 1 episode vomiting.

No h/o chest pain / palpitations / SOB
No h/o cold /cough
No h/o burning micturition
No h/o pain abdomen / loose stools
No h/o headache / dizziness / LOC / blurring of vision / diplopia 

CVS : S1 S2 heard 
RS : BAE + , NVBS
P/A : soft , NT

20/11/2020






Transfusion had been stopped and symptomatic treatment was given
AVIL
HYDROCORTISONE 
NEOMOL
ZOFER

She had surgery on 21/11/2020 (POD - 0)





Next day (POD - 1)she complaints of burning micturition
No h/o fever / loin pain / hematuria

22/11/2020





Following day (POD - 2) she developed hypotension which recovered with IV fluids
23/11/2020





On 24/11/2020 (POD-3) she had another blood transfusion which was uneventful at that time.

 Next day (POD - 4) she had fever with chill and 2 episodes of vomiting which is non Projectile , non bilious , associated with food particles

No h/o cold /cough
No h/o burning micturition
No h/o pain abdomen / loose stools
No h/o headache / dizziness / LOC / blurring of vision / diplopia 

PAST HISTORY 
 Not a known cases of diabetes, hypertension , Asthama , epilepsy , CAD , TB

PERSONAL HISTORY
Diet : mixed
Sleep : adequate
B&B : regular 
Addictions : nil

ON EXAMINATION 
Patient c/c/c
Pallor +
Icterus +
No cyanosis / clubbing / koilonychia / lymphadenopathy 

CVS : S1 S2 heard 
RS : BAE + , NVBS
Expiratory wheez is present at- B/L supra scapular and infra clavicular area
End expiratory crepts- B/L infra scapular and infra axillary area
P/A : soft , NT


25/11/2020

8am

11:51am








Ultrasound abdomen

6pm

10:16 pm




26/11/2020




















28/11/2020



29/11/2020

  k


30/11/2020










DIAGNOSIS :- 

Post op case of PFN for left IT facture with
?Delayed haemolytic reaction
?ischemic hepatitis 
mixed hyperbilirubinemia with hypoalbuminemia 


TREATMENT -:
1)IVF -NS ,RL- U.O+30ml/hr
2)Neb- DUOLIN- 8th hourly
BUDECORT-12th hourly 
MUCOMIST-12th hourly 
3)Inj. LASIX 20mg IV/BD
4)Tab UDILIV 300mg BD
5)Tab. AGUMENTIN 625mg Bd for 5days 
6) Tab. PAN 40mg od
7)Inj. ZOFER 4mg IV /BD
8) Inj. vit K 10mg IV/OD for 3 days 
9) Syp-LACTULOSE 15ml H/S
10) strict I/O charting 
11) Tab. ULTRACET 1/2 QID
12) Temp/bp/pr/spo2/rr - monitoring 4th hourly 



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