60Y F WITH ALTEREDSENSORIUM 2 ?HYPOGLYCAEMIA (RESOLVED) CELLULITS OF BOTH LOWER LIMB


 PATIENT WAS APPARENTLY ASYMPTOMATIC YESTERDAY SHE GRADUALLY DEVELOPED ALTERED SENSORIUM SINCE MORNING AND NOT PASSING URINE SINCE MORNING.


 

NO H/O FEVER, COUGH, COLD, VOMITING. DIARRHOEA, SEIZURES.

PAST HISTORY: K/C/O DM, HTN ON MEDICATION.

NO H/O TB, ASTHMA, EPILEPSY

PERSONAL HISTORY:

BOWEL REGULAR

BLADDER- NOT PASSING URINE SINCE MORNING

SLEEP- ADEQUATE

APPETITE- NORMAL

NO KNOWN DRUG ALLERGY

NO ADDICTIONS.

GENERAL PHYSICAL EXAMINATION

NO SIGNS OF ICTERUS, CYAMNOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA

SIGNS OF PALLOR PRESENT

TEMP 98 F

PR 78 BPM

RR 19 CPM

BP 110/ 80 MM HG

SPO2 98 % AT RA

SYSTEMIC EXAMINATION

CVS S1 , S2 + , NO MURMURS

RS BAE + , NVBS

P/A SOFT , NON TENDER ,NO ORGANOMEGALY

CNS:

1. HIGHER MENTAL FUNCTION

MEMORY-

IMMEDIATE: NO

IMPLICE: NO

LONG TERM MEMORY: NO

2. GCS:

EYE RESPONSE

EYE OPENING- SPONTANEOUS- 4

MOTOR RESPONSE: OBEY COMMANDS- 6

VERBAL RESPONSE: ORIENTED- 5

TOTAL SCORE- 15

3. NECK RIGIDITY:

BRUDZISKI SIGN- NO

KERNIG SIGN- NO

4. CRANIAL NERVES: ALL CRANIAL NERVES INTACT

                   RIGHT                 LEFT

BULK: UL        N                         N

          LL        N                         N

TONE: UL        N                         N

          LL        N                         N

POWER:UL      4/5                     4/5

           LL       4/5                      4/5

REFLEXES:      RIGHT                 LEFT

          B          +                         +

          T          -                          -

          S          -                          -

          K       NOT ABLE TO ELICIT

          A       NOT ABLE TO ELICIT

  PLANTAR    EXTENSION             FLEXION

 SENSORY:  

FINE TOUCH: +                             +

   CRUDE:      +                            +

PRESSURE:     +                            +

PAIN:            INCREASED             INCREASED

VIBRATION:    +                            +

2 POINT DISCRIMINATION- NOT ABLE TO ELICIT

JOINT POSITION-NOT ABLE TO ELICIT

STEROGNOSIS-NOT ABLE TO ELICIT

COORDINATION:

1)FINGER NOSE-NOT ABLE TO ELICIT

2)KNEE HEAL-NOT ABLE TO ELICIT

3)DYSDIDOKOKINESIS:NOT ABLE TO ELICIT

JOINT-LOCAL RISE OF TEMPERATURE +

INCREASED PAIN SENSITIVITY BELOW THE HIP

INCREASING FROM HIP TO TOE IN SENSITIVITY

 

ON 26 /1/24 

 SHE WAS DEVELOPING REDNESS ALL OVER THE BOTH LOWER LIMBS 

SURGERY REFERAL IS DONE THEY ADVISED COMPRESSION AND DRESSING 

                                                                  |

 

ON 28/1/24 

SHE WAS DEVELOPING REDNESS IS SPREADING TO THE UPPER LIMB 

 





Treatment 

INJ PIPTAZ 2.25 mg IV TID

INJ TRAMADOL 1 amp in 100 mL NS  IV BD 

INJ LINAZOLID 6000MG IV OD

TAB CLINDAMYCIN 600 MG IV TID 

TAB AUGUMENTION 1.2G IV OD 

INJ HAI ACC TO GRBS 

TAB CHYMOROL FORTE TID 

INJ METROGYL 500 mg IV TID

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