Tuesday, supposedly i start at 8am sharp...but had to wait for my patient to be available... the first 1 patient had ESWL procedure.. So had to change patient from AGE to Diabetic case..
So the case
62 year old Malay lady... have loss of conscious (LOC ) with shortness of breath...with underlying HPTN and DM
Well the flop is... LOC came for ICU then later developed SOB soon after warded to the general ward after the ICU...
Silly me i put SOB for the chief complaint..because i forgot to change to LOC because the main main complaint why she came was LOC.. but i clerked SOB then later after digging more, the complaint was LOC...super silly didn't change it...hamagad..
When you fail your chief complaint... you fail everything...
So... again.. another flop...my diet history for the DM underlying patient was detailed...... had to know breakfast lunch and dinner what the patient had...
In what particular.. well the sugar intake...and did she inject her insulin before or after food?...
as she have loss of conscious probably due to inadequate energy... daaa....means the mediation was not correctly follow...
Another clue is that this patient had multiple addmission for diabetic problem...silly me again i DIDNT ask further on this under Past Medical History!!! hamagaddd how silly...
as she have loss of conscious probably due to inadequate energy... daaa....means the mediation was not correctly follow...
Another clue is that this patient had multiple addmission for diabetic problem...silly me again i DIDNT ask further on this under Past Medical History!!! hamagaddd how silly...
From here, i have to keep reminding my self... FULL HISTORY IS ALWAYS THE BEST...
Well.. thats that .. thats my long case issue with this one... its going to be a hard ball to save this one.... my theory have to be tip top
Physical Examination ( PE )
Positive Findings
- Swelling of right dorsum of hand with puritus
- Reduce Vocal Fremitus & Vocal Resonance
- Bronchial Breathing
- Reduce Breath sound both side on lower zone of lung
- Bibasal Crepitations lower zone best head anterior chest
- Corse Crepitation
DDx ( differential diagnosis )
1. Hypoglycemic Shock
2. TIA <24 hours Transient Ischemic Shock
3. Stroke - Ischemic Stroke
4. CVA - Cerebro Vascular Accident
Management :
1. ABC - Maintain Airway, Assist breathing , Check Circulation
- Chest Physiotheryapy
- Oxygen Therapy
- IV Access for Fluid Resusscitation
2. FBC
3. Blood sugar profile - Glucometer
4. Lipid Profile
5. ABG - Pulse oximetry & Blood drawing
6. ECG
7. Chest X-Ray - Pleural Effusion, Pulomary Edema, Pneumothorax
8. CT/MRI - Stroke
9.RFT - Creatinine & Urea
10. LFT - ALP
11. Angiography
12. Spirometry?
Stroke Mx
- Confrim by ECG , BNA, ECG , CT
- TpA fibrinolytics
- Aspirin 300mg
- Admit to stroke unit
Further,
Reperfusion Stratergy - Fibrinolytics & PCI
Pace Maker / Heart Transplant
