Case 1
PC :
48 yr old male
Being managed as
hypertensive emergency
?acute coronary syndrome
r/o: pulmonary embolism
tab exforge hct 10/160/12.5mg stat
tab aspirin 300mg stat, 75mg daily
tab atorvastatin 40mg nocte
iv pmol 1g stat
sc clexane 40mg bd x 24hrs
Background
Pt is a known hypertensive client presented with sudden onset left sided chest pain, of severity (10/10), non radiating, sharp and piercing in nature.
client had not taken his medications today
bps were not recordable on arrival
ODQ :
fever-, chills-, headache-, dyspnoea-, orthopnoea-, calf pains-, limb weakness-,chest pain-
looks generally stable, in no obvious pain or resp distress, febrile, anicteric, not pale, acyanosed, hydration satisfactory
hs s1 s2 m0
lz clinically clear
ns grossly intact, no focal neurologic deficit
BP(this morning-141/93),p-79bpm
Labs
ECG: abnormal t wave
BUE: unremarkable
Lipid profile: T. Chol-5.6(high)
TFT: unremarkable
PLAN
To take samples for cardiac enzymes ,D-Dimer
To do CTPA / Echocardiogram
To continue current medication
Case 2
PC :
33 yr old female
Known HPT with
– Infarctive Stroke with left parapareisis from stroke
– G6PD Defect
-Asthma
Being managed
Hysteria
HPC :
Client was in her usual state of health until this afternoon when he got involved in a heated argument with her husband. Her husband witnessed sudden onset of screaming and unresponsiveness. She was rushed to the hospital for further management.
Current medications
1. IV Paracetamol 1g tds x 1/7
2. IV Metronidazole 400 mg tds x 1/7
3. IV Labetalol 40 mg in 100 mls NS – to run slowly
4. IV Somazina 1g stat
ODQ :
Chest pain-, cough- , vomit- , nausea-
stable, not pale, anicteric, afebrile, hydration is fair, no bipedal edema
cns- Conscious and alert , OTPP
Has power of 3/5 in the left upper limb and 3/5 in the left lower limb
tone is normal, with increased reflexes
right limbs normal
Plan
To complete current medications
To discharge home on orals
Case 3
PC :
2 yr old male
Client being managed as a case of
Sepsis 2′ to tonsilitis complicated by febrile seizure(resolved)
Malaria(No mps)
Mesenteric lymphadenitis
Current medication
Syr Brufen 5 mls bd x 7/7
iv pmol 250mg stat, then qid x 24hrs
iv rocephin 1g stat, then bd x 24hrs
iv omeprazole 20mg stat
iv pabiovite 1 n 2 in 500ml of 5% DNS,
start iv artesunate 40mg at 0hr, 12hr then 24hr
Background
Pt presented in the company of his parents with fever+ (started yesterday), abdominal pain+, and one episode of seizure which self aborted after about a minute
ODQ :
poor feeding-, vomiting+ (resolved), headache+, sore throat+, cough-, chest pain-, lethargy-, irritability-,
looks well, afebrile, in no obvious pain or resp distress, not pale, acyanosed, hydration satisfactory
active, conscious alert and well oriented to time place and person, no signs of meningeal irritation elicited
bs vesicular, adequate a/e bilaterally, no added sounds
ent: tonsils are slightly hyperemic
hs s1 s2 m0, tachycardic
abd: unremarkable
Labs
bf-unremarkable
fbc:hb-9.4,wbc-12.02(differential neutrophilia)
Abd. pelvic ultrasound
USG features suggestive of mesenteric lymph adenitis
PLAN + DR Ansong
To continue current medication
To do blood culture
Keep on seizure monitoring chart
To extend current medications
