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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

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