70 year old female with chest pain and SOB

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CONSENT WAS GIVEN BY BOTH PATIENT AND ATTENDERS 

CASE DISCUSSION:

A 76years old female housewife by occupation brought with complaints of 

• chest pain since yesterday 
• SOB since morning 

HOPI:

Patient was apparently asymptomatic 2yrs and was diagnosed with hypertension (is on medication not known). 2yrs back was admitted at a private hospital for liver problem- cholelithiasis -done cholecystectomy.

Presently- complained of chest pain since yesterday associated with 2 episodes of Vomiting,Sweating and 2 episodes of loose motions.

Was taken to RMP and was given 1 injection and tablet and brought back to home.

Since today morning she complained of discomfort and was brought to casualty .

PAST HISTORY:

Not a k/c/o - DM,TB,ASTHMA,EPILEPSY

PERSONAL HISTORY:

She is Married

She consumes 

• Mixed diet 
• sleep is adequate 
• Appetite normal
• bowel and bladder movements are regular

MENSTRUAL HISTORY: attained menopause 15 years back

FAMILY HISTORY:

No similar complaints in family 

GENERAL EXAMINATION:

At time of admission 

Pt is drowsy,extremities were cool and clamy

PR-75bpm

Bp-60/40mmhg

Spo2-57% ON RA

CVS-S1,S2 +, no added sounds 

RS- b/l diffuse crepts on inspiration 

P/A-Soft,NT Scar present at the right hypochondriac region (kochers incision for cholecystectomy)

CLINICAL IMAGES:

INVESTIGATIONS

DIAGNOSES: CARDIOGENIC SHOCK SECONDARY TO NSTEMI WITH CARDIOGENIC PULMONARY EDEMA.

TREATMENT:

PT WAS INTUBATED IN VIEW OF HYPOXIA AND CONNECTED TO MECHANICAL VENTILATOR 

In view of cardiogenic shock pt was started on inotropic support

Post intubation vitals:

Bp:90/60MMHG

Pr:140BPM

Spo2:95%

Rr:crepts decreased

Post intubation investigations:

MEDICATION:

RT FEEDS 100ml milk 4th hrly, 50ml water 2nd hrly

Inj.PAN 40mg/IV/OD

Inj.Zofer 4mg/IV/SOS

Inj.NA 2 AMP IN 40ml NS @ 14ml/hr

Inj.doubutamine 1 amp in 45ml NS @ 15ml/he

Inj.Atracurium

Inj.Lasix 40mg iv/b

Tab Ecosprin AV 75/10 OD

Inj.Clexane 60 mg sc bd

inj.KCL 1amp in 200ml NS over 4 hrs

Vitals are monitored

Day 2

S: Pt is on mechanical ventilation and sedation

O:

Pt ACMV VC MODE

GCS: E1VTM1

RR TOTAL:23

RR:14

Fio2:100

TV:400

PEEP:5

VITALS:

BP: 110/60mmhg

PR: 138bpm

RR: 21cpm

Temp: 100.4f

GRBS: 193mg/dl at 7:00am 

SYSTEMIC EXAMINATION:

CVS: s1,s2 no added sounds

P/A: not tender,Soft

RS:BAE+

K/c/o - HTN since 2 yrs

A: CARDIOGENIC SHOCK SECONDARY TO NSTEMI WITH CARDIOGENIC PULMONARY EDEMA.

P:

RT FEEDS 100ml milk 4th hrly, 50ml water 2nd hrly

Inj.PAN 40mg/IV/OD

Inj.Zofer 4mg/IV/SOS

Inj.NA 2 AMP IN 40ml NS @ 14ml/hr

Inj.doubutamine 1 amp in 45ml NS @ 15ml/he

Inj.Atracurium

Inj.Lasix 40mg iv/b

Tab Ecosprin AV 75/10 OD

Inj.Clexane 60 mg sc bd

inj.KCL 1amp in 200ml NS over 4 hrs

Vitals are monitored