42 years old female with complaints of SOB since 3 months

 42 years old female came to the causality with chief complaints of:

- SOB since 3 months

- Cough since 10 days

- Fever since 7 days

- Decreased urine output since 2 days.

History of present illness: The patient was apparently asymptomatic 3 months ago. Then she developed SOB which was insidious in onset, progressive in nature, associated with wheeze and orthopnea. SOB was of Grade II-III.

Then she developed cough 10 days ago which was associated with exacerbation - mucoid, minimal, non blood stained, non foul smelling. Aggravated on lying down and relieved on sitting position.

Then she developed fever 7 days ago- insidious in onset, high grade, non progressive, relieved with medication. 

She developed decreased urine output in the last 2 days.

- No c/o chest pain.

- No h/o myalgias.

- No h/o loss of taste or smell sensation.

- No c/o burning micturition, loose stools, vomitings.

Past h/o: H/O TB 10 years back. She took ATT for 6 months. 

H/o similar complaints for the last 6 months. She is on inhalation since 10 days SOS.

H/o exposure to biogas since the last 25 years. 

Not a k/c/o DM, HTN, Asthma, Epilepsy, CAD, CVA.

Family h/o- Not significant 

Personal h/o-

Diet- Mixed

Sleep- Adequate

Appetite- Normal

Bowel and Bladder habits- Oliguria since last 2 days.

Normal bowel habits.

No addictions.

General Examination: She is conscious, coherent, cooperative well oriented to time, place and person. She is moderately built and moderately nourished.

Pallor- present

No icterus, cyanosis, clubbing, lymphadenopathy, Edema.

Vitals:

Temperature- 99.5 F

PR- 120 bpm

BP- 140/90 mm Hg

RR- 39 cpm

SpO2- 99% @ RA

GRBS- 141 mg/dl

Systemic Examination:

RS- BAE+, NVBS heard

CVS- S1, S2 sounds heard. No murmurs.

GIT- Soft, non tender, Bowel sounds heard.

CNS- NAD

Provisional Diagnosis- ACUTE EXACERBATION OF COPD SECONDARY TO ?CAP

WITH TYPE -II RESPIRATORY FAILURE

WITH SEVERE PAH-II

WITH POST TB SEQUALAE

WITH DENOVO HTN

WITH ?TIA

WITH MODS (DIC)

Investigations:

1) Summary of all investigations done from 15/12/21 to 18/12/21

2) CXR- PA View (20/12/21)

3) CT Scan Brain 

4) HRCT Thorax

5) ABG- 19/12/21 and 20/12/21

6) ECG- 15/12/21

ECG- 20/12/21

7) 2D ECHO- 18/12/21

8) Coagulation profile:

PT- 18 s

                                     INR- 1.3

APTT- 35 s

Treatment given:

A) On the day of admission i.e. 15/1//21:

1. INJ. PIPTAZ 4.5 gm I.V. TID

2. INJ. HYDROCORTISONE 200 mg I.V. STAT

3.INJ. LASIX 80 mg I.V. STAT

4.Nebulisation with DUOLIN - 4th hourly, BUDECORT- 8th hourly, MUCOMIST- 4th hourly

5. Oxygen inhalation @6-8 L/min with face mask

6. NIV with BIPAP continuously with 2 hours gap following meals 

7. SYP. ARISTOZYME 2 tsp- TID

8. SYP. ASCORIL 2 tsp- TID

9. TAB. PCM 650 mg PO/SOS

10. Monitor vitals

B) GM referral taken I/V/O ECG changes (17/12/21)

C) Ophthalmology referral taken i/v/o increasing ICP (17/12/21)