case presentaion dr widad
DESCRIPTION
Fen 23rdTRANSCRIPT
DR.Widad Al-Shukaili
Admitted in Rustaq hospital for 1 day with Dx of pancreatitis ,amylase >2000 ,, discharge LAMA
58 yrs , F , 1 day h/o abdo. Pain and loose motion
At 01:00 AM
A patent
B Spo2 96 %
C HR 105,,BP 84/46
D GCS 15,reflo. 1.5
E 38C,dehydrated
KCO DM on insulin,HTN,IHD with EF 30 % , AF ( aspirin , digoxin , frusimide , simva. ,cavidelol)
6 D h/o constipation ,, followed by 1 D of diarrhea (?? Bloody ?? Mucus) after orange juice
1 D of colicky abdo. Pain mainly upper abdo. radiating to the back ,relieved by leaning forward
5 times vomiting (food particle) ,no heamatemesisAbdo. Distention --- difficulty in breathing
No h/o fever, no previous episode, no similar FHNo genitourinary symptomsNo chest complains or neuro.
Dehydrated , not jaundice , not pale, JVP not raised , no pedal edema , no clubbing
Chest ----- b/l equal air entry , no added sound
CVS------ s1s2
PA distended , gen. tenderness mainly upper abdo. , BS sluggish , hyperesonance
PR no melena
CNS intact
CBC HB 15,WBC 8.9,PLT 332
U/E ur. 17 , cr 200 ,K+ 4.8 , Na 143
LFT AST 899
LDH 583
Lipid profile WNL
Coag. WNL
Lactate 2.6
ABG heamolysed
Amylase 2000 ( high)
Chest XRAY ----- normal
CT abdomen ---verbal report : plain CT done as the pt with RF ,,,, acute pancreatitis with ascitis
58 yrs lady , KCO HTN,DM,AF,IHD on x6 D h/o constipation followed by 1 D diarrhea,rt lumber pain after orange juiceNo feverLAMA from Rust. Hosp. ,,,, amylase > 2000O/e : dehydrated , hypotensive,hypoglycemic ,distended abdo.Inx : amylase 2000 , AST 899 , LDH 583 , lactate 2.6 with derange UECT ------ acute pancrititis with ascitis
Pt admitted under medical word at 6 AM ------ Acute pancreatitis
Pt continue to be hypotensive and febrile
At 9 AM senior radiologist seen CT abdomen ??????
From 9 AM to 11 AM surgeon awaited final CT report
At 11 AM the CT report finalized
At 12 AM surgeon review the pt and decided to operate on her but family refused
At 1 :30 pt arrested ---------------- cleared dead
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