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A 75years old female from muthyalammagudem came with c/o pain and swelling at left hip region due fall from bed while sleeping at around 12:00 AM on 18/11/2020
No h/o head injury
No h/o fever
No h/o headache / dizziness / LOC / blurring of vision / diplopia
Not a k/c/o DM / HTN / Asthma / Epilepsy / CAD / TB
GENERAL EXAMINATION:
Patient is coherent cooperative moderately built and moderately nourished
There is no pallor,Icterus,cyanosis,clubbing, lymphadenopathy
LOCAL EXAMINATION:
There is swelling on the left side of hip
skin over the swelling is normal
Tenderness over lateral side of left hip
Movement- restricted and pain full
Shorting of leg
Attitude- externally rotated
Distal pluses are present
SYSTEMIC EXAMINATION:
CVS : S1 S2 heard
RS : BAE + , NVBS
P/A : soft , NT
18/11/2020
 |
1 unit PRBC transfusion was done on 19/11/2020
During transfusion she had Fever with chills and 1 episode vomiting.
No h/o chest pain / palpitations / SOB
No h/o cold /cough
No h/o burning micturition
No h/o pain abdomen / loose stools
No h/o headache / dizziness / LOC / blurring of vision / diplopia
CVS : S1 S2 heard
RS : BAE + , NVBS
P/A : soft , NT
20/11/2020
Transfusion had been stopped and symptomatic treatment was given
AVIL
HYDROCORTISONE
NEOMOL
ZOFER
She had surgery on 21/11/2020 (POD - 0)
Next day (POD - 1)she complaints of burning micturition
No h/o fever / loin pain / hematuria
22/11/2020
Following day (POD - 2) she developed hypotension which recovered with IV fluids
23/11/2020
On 24/11/2020 (POD-3) she had another blood transfusion which was uneventful at that time.
Next day (POD - 4) she had fever with chill and 2 episodes of vomiting which is non Projectile , non bilious , associated with food particles
No h/o cold /cough
No h/o burning micturition
No h/o pain abdomen / loose stools
No h/o headache / dizziness / LOC / blurring of vision / diplopia
PAST HISTORY
Not a known cases of diabetes, hypertension , Asthama , epilepsy , CAD , TB
PERSONAL HISTORY
Diet : mixed
Sleep : adequate
B&B : regular
Addictions : nil
ON EXAMINATION
Patient c/c/c
Pallor +
Icterus +
No cyanosis / clubbing / koilonychia / lymphadenopathy
CVS : S1 S2 heard
RS : BAE + , NVBS
Expiratory wheez is present at- B/L supra scapular and infra clavicular area
End expiratory crepts- B/L infra scapular and infra axillary area
P/A : soft , NT
25/11/2020
8am
11:51am
Ultrasound abdomen
6pm
10:16 pm
26/11/2020
28/11/2020
29/11/2020
k30/11/2020
DIAGNOSIS :-
Post op case of PFN for left IT facture with
?Delayed haemolytic reaction
?ischemic hepatitis
mixed hyperbilirubinemia with hypoalbuminemia
TREATMENT -:
1)IVF -NS ,RL- U.O+30ml/hr2)Neb- DUOLIN- 8th hourly
BUDECORT-12th hourly
MUCOMIST-12th hourly
MUCOMIST-12th hourly
3)Inj. LASIX 20mg IV/BD
4)Tab UDILIV 300mg BD
5)Tab. AGUMENTIN 625mg Bd for 5days
6) Tab. PAN 40mg od
7)Inj. ZOFER 4mg IV /BD
8) Inj. vit K 10mg IV/OD for 3 days
9) Syp-LACTULOSE 15ml H/S
10) strict I/O charting
11) Tab. ULTRACET 1/2 QID
12) Temp/bp/pr/spo2/rr - monitoring 4th hourly
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