GENERAL MEDICINE
Greetings to one and all who are reading my blog.This is M.Yashwitha, a third semester student.
THIS LOG IS DONE UNDER THE GUIDANCE OF PRAKASH SIR .( INTERN).
This is Online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent .Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.
CASE SCENARIO :
45 year old female was brought to the casuality with chief complaints of involuntary movements of bilateral upper limb and lower limb yesterday night , one episode at 10:30pm . Subsidised in few minutes ,and other episodes in between 2am- 5am with intermittently regaining consciousness in between. Seizures were tonic type involving all four limbs with deviation of mouth and up rolling of eyes , frothing and involuntary micturition and defecation with post ictal confusion till today .
She presented to casuality with confused state .
She is a resident of beemavaram village and has with 2 children (lscs) , her husband left her 15 years ago , he was a chronic alcoholic . Since then she was in depression and has suicidal tendencies with history of starvation and forceful voluntary retching and inducing vomiting after food intake .
History of weight loss since 10 years with loss of appetite.
One PRBC transfused 4 years ago in view of anemia
3 years ago patient had one episode of tonic movement of all 4 Limbs with deviation of mouth, tonic type lasting for few minutes , and was started on Tab. LEVIPIL 500mg /OD
CT brain was done showed left frontal lobe edema.
Patient used to take her medication regularly but still has one episode of seizures every 3 months and which used to resolve with medication .
Menstrual history - once in 15 days / once in 2-3 months .
no history of fever , cough , sob , headache
On examination : patient is confused
GCS: E2V1M4
BP: 80mmhg on palpation after 4 pints of bolus 110/80mmhg
PR: 90bpm regular normal volume
CVS: S1S2 no murmurs
RS: NVBS no crepts
CNS: Pupils :NSRL
Tone : RT LT
N N
Reflexes : B T S A K P
RT: 2+ 2+ 2+ 2+ - F
LT: 2+ 2+ 2+ 2+ - F
Diagnosis : Status Epilepticus
seizure under evaluation
With ? anorexia nervosa.
INVESTIGATIONS:
Hemogram:
-LFT :
-RFT:
-MID BRAIN PLAN:
TREATMENT:
-Inj.LIVIPRIL 500mg /IV/VD.
-Inj.Optineuron in 500 ml NS /UV/OD.
-Inj.Pantop 40 mg /IV/OD.
-watch for any seizure episode.
-Inj.Lorazepam 2cc/IV/SOS.
-Monitor vitals 2nd hourly.
-IVF NS ,RL,DNS @100 ml/ hr.
-Inj.Zofer 4mg/IV/BD.
-Inj.Ceftriaxone 1gm/IV/BD.
-T.Plm 650 mg /PO/SOS.(if temperature is greater than 101 °F.
-T.Ecosprin /AV (7.5 /20mg /PO/HS).
-Protein X Powder 2 tablespoons in one glass milk /PO/TID.
6/09/2021:
-O/E patient is conscious, confused withdrawal to pain is positive.
-BP :90/160 mm Hg.
-PR: 88 Beats/min.
-CVS : S1 S2 +
-RS :BDE +.
-NVBS.
-P/A : soft ,NT .
-CNS : GCS -E2VM.
-Pupil NSRL.
-Tone of limbs normal.
Rx:
-IVF NS ,RL,DNS @150 ml/ hr.
-BP/ PR/Temperature 2nd hourly.
-W/F seizure activity.
-Inj.Ceftriaxone 1gm/IV/BD.
-Inj.Pantop 40 mg /IV/OD.
-Inj.Zofer 4mg/IV/BD.
-Inj.LIVIPRIL 500mg /IV/VD.
-Inj.Optineuron in 500 ml NS /UV/OD.
-Inj.Lorazepam 2cc/IV/SOS.
-Tab.PCM 650 mg /PO/SOS.
-Protein X Powder 2 tablespoons in one glass milk /PO/TID.
-GRBS charting 6th hourly.
-Monitor vitals 4th hourly.
7/09/2021.
-1 seizure episode at 12:30 AM lasting for 10 sec,tonic ,clonic with frothing.
-No fever spikes.
-patient is not responding to verbal commands (intentionally ?).
-O/E: patient is conscious,coherent and non cooperative.
-low ,unwilling to answer /perform activity.
-Afebrile.
-PS :86/min.
-BP :100/ 50 mm Hg.
-CVS: S1S2 +.
-RS :BAE (+ NVBS).
-P/A ,NT.
Rx:
-IVF NS ,RL,DNS @75ml/hr.
-Inj.Pantop 40 mg /IV/OD.
-inj.CEFTRIAXONE 1gm/IV/BD.
-inj.LIVIPRIL 500mg /IV/VD.
-BP/ PR/Temperature hourly.
-strict I/O charting.
-W/F seizure activity.
*2 to 3 episodes of seizures noted early morning.
-Inj.Phenytoin 600 mg/IV in 100 ml NS / STAT.
-Inj.Loraz 2 cc/IV/ STAT.
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