202211019

 60 YEARS OLD FEMALE WITH SOB


CASE DETAILS

60 year old female patient came with c/o SOB  since 3 days
SOB ( grade III  progressed to grade IV ) over 3 days
Aggravated while lying down (orthopnea )

HISTORY OF PRESENT ILLNESS 

Pt. was apparently asymptomatic 3 days back then developed SOB  ( grade III  progressed to grade IV ) over 3 days
Aggravated while lying down (orthopnea )
No c/o cough, fever, vomiting, loose stools
No c/o pedal edema 

PAST HISTORY 
 
K/c/o HTN SINCE 10 YEARS and on medication ( metoprolol & Amlodipine tab. )

DM since 5 years and on medication ( metformin & glimiperide tab.)

Not k/c/o CAD, TB, EPILEPSY

PERSONAL HISTORY 
DIET - MIXED
APPETITE - NORMAL
SLEEP - INADEQUATE
BOWEL & BLADDER - REGULAR
NO ADDICTIONS 

GENERAL EXAMINATION 

VITALS 
Pt. Is c/ c/ c
Temp - Afebrile 
B.P. - 160/ 80 mm Hg
P.R - 102 bpm
R.R - 15 cpm
GRBS - 340 mg /dl
Spo2 - 95 % @ 5 lt o2

PHYSICAL EXAMINATION 
PALLOR  -
ICTERUS - 
CYANOSIS -
KOILONYCHIA - 
LYMPHADENOPATHY -
PEDAL EDEMA  -

SYSTEMIC EXAMINATION 
CVS - s1 + , s2 +
RS - BILATERAL CREPTS PRESENT
CNS - NAD
P/A - SOFT , NON TENDER

INVESTIGATIONS :

CBP :
HB - 10.4 
TLC - 14400
PCV - 31.0
PLT - 3.25

RBS - 332
HBA1C - 7.2

RFT :
S.urea - 50
S. Creatinine - 2.2
Na - 139
K - 4.5
Cl - 99

LFT :
T.B - 1.31
D.B - 0.20
AST - 13
ALT - 10
ALP - 184
T.P - 6.7



20/03/2022


UREA - 96
S. CREATININE- 2.5
Na - 137
K - 3.6
Cl - 98


23 /03/2022

UREA - 142
S. CREATININE - 3.2
Na - 133
K - 3.8
Cl - 99

ABG

20/03/2022 

23 /03/2022


USG


2D ECHO


2D ECHO VEDIO


ECG
17/3/2022



19/3/2022


21/03/2022


23/03/2022


CHEST X RAY 

17/3/2022


19 /3/2022

23/03/2022


Provisional diagnosis:

HFrEF 2° TO ?CAD ( EVOLVING MI) - CARDIOGENIC SHOCK  
GLOBAL HYPOKINESIA WITH ALL CHAMBERS DILATED.   SEVERE  MR +/ TR+ 
HTN +, DM + , CKD +(Mod. Lv dysfunction , EF 40 % )

TREATMENT: 

18/03/2022

1.  INJ. LASIX 20 mg IV TID
2. TAB. ECOSPIRIN -AV (75/20) PO / H/S
3. TAB. AMLONG 5MG PO /OD
4. Inj. HUMAN ACTRAPID S/C ACC TO GRBS /TID
5. TAB. PANTOP 40 MG PO /OD
6. TAB. ISOLAZINE 20 MG PO /BD
7. INJ. MONOCEF 1 GM IV/BD
8. TAB. NODOSIS 500 MG PO/TID
9. NEBULISATION ( DUOLIN , BUDECORT ) /TID
10. MONITOR BP , GRBS, INFORM SOS
11.  Fluid RESTICTION ( < 1 LT /DAY)
12. SALT RESTRICTION (< 2GM/ DAY)


19/03/2022

1.  INJ. LASIX 80 mg IV TID ( 80 ---- 40---- 40)
2. TAB. ECOSPIRIN -AV (75/20) PO / H/S
3. TAB. AMLONG 5MG PO /OD
4. Inj. HUMAN ACTRAPID S/C ACC TO GRBS / TID
5. TAB. PANTOP 40 MG PO /OD
6. TAB. ISOLAZINE 20 MG PO /BD
7. INJ. MONOCEF 1 GM IV/BD
8. TAB. NODOSIS 500 MG PO/TID
9. INJ. CLEXANE 60 MG SC /BD
10. NEBULISATION ( DUOLIN , BUDECORT ) /TID
11.  O2 INHALATION - SOS
12. INTERMITTENT NIV SUPPORT 
13. MONITOR BP , GRBS, INFORM SOS

20/03/2022

1.  INJ. LASIX 80 mg IV TID ( 80 ---- 40---- 40)
2. TAB. ECOSPIRIN -AV (75/20) PO / H/S
3. TAB. AMLONG 5MG PO /OD
4. Inj. HUMAN ACTRAPID S/C ACC TO GRBS / TID
5. TAB. PANTOP 40 MG PO /OD
6. TAB. ISOLAZINE 20 MG PO /BD
7. INJ. MONOCEF 1 GM IV/BD
8. TAB. NODOSIS 500 MG PO/TID
9. TAB. MET XL 25 MG PO / OD
10. INJ. CLEXANE 60 MG SC /BD
11. NEBULISATION ( DUOLIN , BUDECORT ) /TID
12.  O2 INHALATION - SOS
13. INTERMITTENT NIV SUPPORT 
14. MONITOR BP , GRBS, INFORM SOS

21/03/2022

1.INJ. NORADRENALINE @10 ML/HR
2. INJ. DOBUTAMINE 1 AMP + 50 ML NS @ 3 ML/HR
3. INJ. LASIX 40 mg IV TID 
4. TAB. ECOSPIRIN -AV (75/20) PO / H/S
5. Inj. HUMAN ACTRAPID S/C ACC TO GRBS / TID
6. TAB. PANTOP 40 MG PO /OD
7. INJ. MONOCEF 1 GM IV/BD
8. TAB. NODOSIS 500 MG PO/TID
9. INJ. CLEXANE 60 MG SC /BD
10. NEBULISATION ( DUOLIN , BUDECORT ) /TID
11.  O2 INHALATION - SOS
12. INTERMITTENT NIV SUPPORT 
13. MONITOR BP , GRBS, INFORM SOS

22/03/2022

1.INJ. NORADRENALINE @20 ML/HR
2. INJ. DOBUTAMINE 250 MG + 50 ML NS @ 4 ML/HR
3. INJ. VASOPRESSIN 1 AMP+ 50 ML NS @ 1 ML / HR
4. INJ. LASIX 40 mg IV TID 
5. TAB. ECOSPIRIN -AV (75/20) PO / H/S
6. Inj. HUMAN ACTRAPID S/C ACC TO GRBS / TID
7. TAB. PANTOP 40 MG PO /OD
8. INJ. MONOCEF 1 GM IV/BD
9. TAB. NODOSIS 500 MG PO/TID
10. INJ. CLEXANE 60 MG SC /BD
11. NEBULISATION ( DUOLIN , BUDECORT ) / BD
12.  O2 INHALATION - SOS
13. INTERMITTENT  CPAP 
14. MONITOR BP , GRBS, INFORM SOS

23/03/2022

1.INJ. NORADRENALINE @20 ML/HR
2. INJ. DOBUTAMINE 250 MG + 50 ML NS @ 4 ML/HR
3. INJ. VASOPRESSIN 1 AMP+ 50 ML NS @ 1 ML / HR
4. INJ. LASIX 40 mg IV TID 
5. TAB. ECOSPIRIN -AV (75/20) PO / H/S
6. Inj. HUMAN ACTRAPID S/C ACC TO GRBS / TID
7. TAB. PANTOP 40 MG PO /OD
8. INJ. MONOCEF 1 GM IV/BD
9. TAB. NODOSIS 500 MG PO/TID
10. INJ. CLEXANE 60 MG SC /BD
11. NEBULISATION ( DUOLIN , BUDECORT ) / BD
12.  O2 INHALATION - SOS
13. INTERMITTENT  CPAP 
14. MONITOR BP , GRBS, INFORM SOS

• Severe resp distress  & pt was intubated on 24/3/22 at 2:45 am

• And had sudden cardiac arrest at 3:15 am

• Cpr 8cycles given

• Death time 3:52 am on 24/3/22

CAUSE OF DEATH :

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