2) Evidence based date wise workflow logs collated by the intern with clickable and verifiable links

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome."I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

Case 1

Pajr group

https://chat.whatsapp.com/D0NgFHIdkWw6l1oETClPxF

Blog

http://bhargavimalothu84.blogspot.com/2023/09/cheif-complaints-patient-was-brought-to.html

[8/29, 12:44 PM] Bhargavi: Admission : 27/8/23

Dr.susmitha sr

Dr.navya pgy1

Dr.nishitha PGY2

S:

Patient is in altered sensorium since 2 days

O:

Vitals:

Patient is oriented to time , person but not to place

Bp : 140/70mmhg

Pr : 110bpm

Rr : 24 cpm

Grbs: 189 at 8am

Temp : 98.7 f

Cvs :. S1 s2 heard no murmurs

Rs : b/l AE present

P/A : soft. Non tender

A: 

Altered sensorium secondary to hypoglycemia secondary to OHA's

Pyrexia under evaluation

K/c/o cva since 2 months

K/c/o DM type 2 since 2 years

HTN AND CKD and cks since 2months

P:

Inj.neomol 1gm iv

Inj.25percent dextrose 40 ml/hr increase or decrease acc to grbs

T.tenofovir 300 mg po od

T. Amlong 5mg rt/od

T.ecosprin av gold 75/75/20 Rt/HS

T.PCM 650 mg RT/TID

SYP.potchlor 15 ml RT/TID

GRBS AND BP amd temperature monitering

[8/29, 4:31 PM] Rakesh Biswas sir: Was he in altered sensorium today morning? 

Saw him walking in the corridors yesterday 

Also is he in ward or AmC with his altered sensorium?

[8/29, 4:34 PM] Bhargavi: Amc sir

[8/29, 4:34 PM] Navya Maam Gm: No sir he is not in altered sensorium today

[8/30, 2:11 PM] Rakesh Biswas sir: @⁨Bhargavi⁩ Update the vital sugar chart for @⁨Navya Maam Gm⁩ and team to understand how they were the cause of his current persistent brain damage and altered sensorium so that @⁨Haripriya Mam⁩ can add it as one important iatrogenic cause for brain damage

[8/30, 2:12 PM] Bhargavi: Ok sir

[8/30, 3:15 PM] Bhargavi: Admission : 27/8/23

Dr.susmitha sr

Dr.navya pgy1

Dr.nishitha PGY2

S:

Patient is conscious coherent and cooperative but he unable to remember us today, we spoke to him yesterday for half an hour

O:

Vitals:

Patient is oriented to time , person but not to place

Bp : 130/90mmhg

Pr : 102bpm

Rr : 24 cpm

Grbs: 305 mg/dl 6 units hai given

Temp : 98.7 f

Cvs :. S1 s2 heard no murmurs

Rs : b/l AE present

P/A : soft. Non tender

A: 

Altered sensorium secondary to hypoglycemia secondary to OHA's ( resolved)

Pyrexia resolved

K/c/o cva since 2 months

K/c/o DM type 2 since 2 years

HTN AND CKD and ckd since 2months

P:

Inj.neomol 1gm iv

T.tenofovir 300 mg po od

T. Amlong 5mg rt/od

T.ecosprin av gold 75/75/20 Rt/HS

GRBS AND BP amd temperature monitering

[8/30, 3:16 PM] Bhargavi: Sir since the admission he is in altered sensorium and his grbs at admission is 35 mg/dl

[8/30, 3:18 PM] Rakesh Biswas sir: Share all the sugar charts and our intervention incompetence since admission asap and put them in the case report

[8/30, 3:19 PM] Rakesh Biswas sir: Duration of tenofovir? When was HBV first detected? 

Was this Glimeperide induced hypoglycemia?

[8/30, 3:21 PM] Rakesh Biswas sir: Next two pages as well. I want to see this in his case report

[8/30, 3:21 PM] Bhargavi: Ok sir

[8/30, 3:22 PM] Rakesh Biswas sir: Take the right hand part of this page properly to show the interventions

[8/30, 3:23 PM] Bhargavi: Ok sir

[8/30, 3:23 PM] Rakesh Biswas sir: What about other interventions at the same times such as food? Was he not eating? Mention the food times in the chart and what was given

[8/30, 3:23 PM] Navya Maam Gm: 2 months back he was detected with hbsag ..since 2 months he is using tenofovir

Yes sir glimiperide induced hypoglycemia

[8/30, 3:58 PM] Bhargavi: 27/8

8.30 am He had soup made with jowar

 At 1pm he took a cup of rice with cucumber curry

 And since 4pm he went into altered sensorium

 He got admitted at 9.30 pm night

And he didn't take any food that night

Next day 28/8

 At 11am and 5pm he has milk through ryles tube

 

29/8

He had 2 idly at 8 am

And at afternoon 1.30 he had rice with dal , and at night at 8.30 he had cup of rice with dal 

30/8

 Mrng at 8.30 he had 3 idly 

Afternoon 1.30pm cup of rice with dal

Night 8.30 pm cup of rice with dal

[8/30, 4:05 PM] Rakesh Biswas sir : Mention the sugar values around that time and two hours after that

[8/30, 4:48 PM] Rakesh Biswa sir: Remove the institutional identifiers before you share all the above in his case report

[8/30, 5:09 PM] Rakesh Biswas sir: 👆share all the above in the case report link

[8/30, 5:22 PM] Bhargavi: Ok sir

[8/31, 12:39 PM] Bhargavi: Admission : 27/8/23

Dr.susmitha sr

Dr.navya pgy1

Dr.nishitha PGY2

S:

Patient is conscious coherent and cooperative and drowsy

O:

Vitals:

Patient is oriented to time , place and person

Bp : 110/60mmhg

Pr : 112bpm

Rr : 22 cpm

Grbs: 248 mg/dl 8 units hai given

Temp : 98.7 f

Cvs :. S1 s2 heard no murmurs

Rs : b/l AE present

P/A : soft. Non tender

 

Cns tone RT LT

             Ul. N. N

             Ll. N.        

 

Power RT LT

            UL. 5/5 5/5

            LL. 5/5

Reflex:

            B +3 +3    

            T +3 +3

             S +3 +3

             K +3       

             A +3

             P F F

A: 

Altered sensorium secondary to hypoglycemia secondary to OHA's ( resolved)

K/c/o cva since 2 months

K/c/o DM type 2 since 2 years

HTN AND CKD and ckd since 2months

P:

Inj.hai sc/tid acc yo grbs 

T.tenofovir 300 mg po od

T. Amlong 5mg rt/od

T.ecosprin av gold 75/75/20 Rt/HS

T.cinod 10mg po bd

GRBS AND BP amd temperature monitering

[8/31, 5:04 PM] Rakesh Biswas sir : Share his blood sugar values since yesterday

Case 2

Pajr group

https://chat.whatsapp.com/BiZ72Am76Qd5a0VcGTC2BT

Blog

http://bhargavimalothu84.blogspot.com/2023/09/60f-diabetes-10-days-fever-weakness.html

[8/29, 4:34 PM] Rakesh Biswas: Fever chart?

[8/29, 9:42 PM] Rakesh Biswas: Clinical image DP of lateral abdomen and biceps

[8/30, 11:38 AM] Bhargavi: Admission: 29/8/23

Dr.susmitha sr

Dr.nishitha pgy2

De navya pgy1

S: 

fever spike 101 f at night 2am

Constipation+

O

Pt is c/c/c

Bp: 110/70

Pr: 78

Spo2: 97 percent

Temp: 97.5f

Grbs : 88 mg/dl

Cvs s1s2 heard

Rs : b/a ae +

crepts + at right ISA IAA

P/a : soft non tender

Cns : no fnd

A

Diabetic acidosis

K/c/o dm 2 since 15 years

P

Iv fluids @ 100 ml /hr

Inj.monocef 1gm iv bd

Inj.pan 40 iv od

Rt feeds milk 4th hrly 200ml

Inj.hai sc/tid acc to grbs

Grbs, pr, bp, temp monitoring

[8/30, 2:20 PM] Rakesh Biswas sir: Standing

[8/30, 2:21 PM] Rakesh Biswas sir: Sugar Chart since admission?

[8/30, 2:22 PM] Bhargavi: She could only stand by support sir because she is weak

[8/30, 2:22 PM] Bhargavi: So it is difficult to get a picture of it

[8/30, 2:56 PM] Rakesh Biswas sir: What is the reason for her weakness?

[8/31, 12:22 PM] Bhargavi: Admission: 29/8/23

Dr.susmitha sr

Dr.nishitha pgy2

De navya pgy1

S: 

2 spikes fever one at 12 am 100 f 

At 7am : 101 f

O

Pt is c/c/c and drowsy

Bp: 110/80

Pr: 85

Spo2: 95 percent

Temp: 101.1f

Cvs s1s2 heard

Rs : b/a ae +

P/a : soft non tender

Cns : no fnd

A

Diabetic acidosis( resolved)

K/c/o dm 2 since 15 years

Iv fluids @ 100 ml /hr

Inj.monocef 1gm iv bd

Inj.pan 40 iv od

Rt feeds milk 4th hrly 200ml

Inj.hai sc/tid acc to grbs

Syp.potchlor 15ml rt/bd

Grbs, pr, bp, temp monitoring

[9/2, 3:05 PM] Bhargavi: Admission: 29/8/23

Dr.susmitha sr

Dr.nishitha pgy2

De navya pgy1

S: 

1 spikes fever one at 6pm 101 f 

1 episode of vomiting

O

Pt is c/c/c and drowsy

Bp: 120/80

Pr: 90

Rr: 21cpm

Spo2: 95 percent

Temp: 97.5

Cvs s1s2 heard

Rs : b/a ae +

P/a : soft non tender

Cns : no fnd

Diabetic acidosis ( resolved)

A:

Aki on ckd

Anemia secondary to ckd

Dengue igm positive

P

Inj.pan 40 iv od

Rt feeds milk 4th hrly 200ml

Inj.hai sc/tid acc to grbs

Inj.epo 4000 iu sc/od

T.proferxt po od

Inj.piptaz 2.26 iv/bd

Protein powder 2 spoons in one glass of water

Grbs, pr, bp, temp monitoring

[9/2, 7:56 PM] Rakesh Biswas: What brought her to the hospital? 

[8/29, 4:34 PM] Rakesh Biswas sir: Fever chart?

[8/29, 9:42 PM] Rakesh Biswas sir: Clinical image DP of lateral abdomen and biceps

[8/30, 11:38 AM] Bhargavi: Admission: 29/8/23

Dr.susmitha sr

Dr.nishitha pgy2

De navya pgy1

S: 

fever spike 101 f at night 2am

Constipation+

O

Pt is c/c/c

Bp: 110/70

Pr: 78

Spo2: 97 percent

Temp: 97.5f

Grbs : 88 mg/dl

Cvs s1s2 heard

Rs : b/a ae +

crepts + at right ISA IAA

P/a : soft non tender

Cns : no fnd

A

Diabetic acidosis

K/c/o dm 2 since 15 years

P

Iv fluids @ 100 ml /hr

Inj.monocef 1gm iv bd

Inj.pan 40 iv od

Rt feeds milk 4th hrly 200ml

Inj.hai sc/tid acc to grbs

Grbs, pr, bp, temp monitoring

[8/30, 2:20 PM] Rakesh Biswas sir: Standing

[8/30, 2:22 PM] Bhargavi: She could only stand by support sir because she is weak

[8/30, 2:22 PM] Bhargavi: So it is difficult to get a picture of it

[8/30, 2:56 PM] Rakesh Biswas sir: What is the reason for her weakness?

[8/31, 12:22 PM] Bhargavi: Admission: 29/8/23

Dr.susmitha sr

Dr.nishitha pgy2

De navya pgy1

S: 

2 spikes fever one at 12 am 100 f 

At 7am : 101 f

O

Pt is c/c/c and drowsy

Bp: 110/80

Pr: 85

Spo2: 95 percent

Temp: 101.1f

Cvs s1s2 heard

Rs : b/a ae +

P/a : soft non tender

Cns : no fnd

A

Diabetic acidosis( resolved)

K/c/o dm 2 since 15 years

Iv fluids @ 100 ml /hr

Inj.monocef 1gm iv bd

Inj.pan 40 iv od

Rt feeds milk 4th hrly 200ml

Inj.hai sc/tid acc to grbs

Syp.potchlor 15ml rt/bd

Grbs, pr, bp, temp monitoring

[9/2, 3:05 PM] Bhargavi: Admission: 29/8/23

Dr.susmitha sr

Dr.nishitha pgy2

De navya pgy1

S: 

1 spikes fever one at 6pm 101 f 

1 episode of vomiting

O

Pt is c/c/c and drowsy

Bp: 120/80

Pr: 90

Rr: 21cpm

Spo2: 95 percent

Temp: 97.5

Cvs s1s2 heard

Rs : b/a ae +

P/a : soft non tender

Cns : no fnd

Diabetic acidosis ( resolved)

A:

Aki on ckd

Anemia secondary to ckd

Dengue igm positive

P

Inj.pan 40 iv od

Rt feeds milk 4th hrly 200ml

Inj.hai sc/tid acc to grbs

Inj.epo 4000 iu sc/od

T.proferxt po od

Inj.piptaz 2.26 iv/bd

Protein powder 2 spoons in one glass of water

Grbs, pr, bp, temp monitoring

[9/2, 7:54 PM] Ishrath Parveen: What was the reason for rise in temperature after admitting into hospital?

[9/2, 7:56 PM] Rakesh Biswas: What brought her to the hospital? 

Weakness and drowsiness?

[9/2, 7:59 PM] Ishrath Parveen: This was the fever chart of the patient we can see that their is rise in temperature so wt was the reason behind that? Sir it might be thrombophlebitis and urinary catheter acquired infections which was due to nosocomial infections

[9/2, 8:09 PM] Rakesh Biswas sir: Why is she having anemia and azotemia?

[9/2, 8:10 PM] Rakesh Biswas sir: Does she have a urinary catheter? Where's the image? Why was she put on catheter?

[9/2, 8:33 PM] Ishrath Parveen: Yes sir, sir actually i didnt have the image i will take and upload sir

[9/2, 8:34 PM] Ishrath Parveen: As she is unable to stand she was put on catheter sir

[9/2, 8:40 PM] Ishrath Parveen: Due to high fever the oxygen binding capacity to hb is decresed so it may lead to anemia sir

[9/2, 8:43 PM] Rakesh Biswas sir: Astonishing hypothesis 👏

Has anyone tested this hypothesis? 

Any review of literature you can share?

[9/3, 11:57 AM] Dr.Dinesh Datta: It's from static Oxygen dissociation curve

[9/3, 11:59 AM] Dr.Dinesh Datta: effect of temperature on the curve is relatively straightforward. Oxygen unloading is favored at higher temperatures which will cause a rightward shift. On the other hand, lower temperatures will cause a leftward shift in the dissociation curve. A notable example of this is exercise, where the temperature of muscle increases secondary to its utilization, thus shifting the curve to the right and allowing oxygen to be more easily unloaded from hemoglobin and deliver to tissues in need.

https://www.ncbi.nlm.nih.gov/books/NBK539815/#:~:text=The%20effect%20of%20temperature%20on,shift%20in%20the%20dissociation%20curve.

[9/3, 12:02 PM] Rakesh Biswas sir: But would it cause anemia as claimed above!?

[9/3, 12:03 PM] Dr.Dinesh Datta: Can anemia also be defined as decreased oxygen loading capacity?

[9/3, 12:03 PM] Dr.Dinesh Datta: Or is anemia only defined through Hb%,concentration etc?

[9/3, 2:18 PM] Rakesh Biswas sir: Share some review of literature around current definition of anemia and if it is amenable to modification

[9/4, 4:05 PM] Ishrath Parveen: It is defined through hb concentration sir

[9/4, 4:06 PM] Dr.Dinesh Datta: Is it your definition?

Or is it any standard definition?

Or is it physiological rationale?(if so,elaborate the rationale)

[9/4, 4:17 PM] Ishrath Parveen: Anemia is a problem of not having enough healthy red blood cells or hemoglobin to carry oxygen to the body tissues.

[9/4, 4:18 PM] Dr.Dinesh Datta: Nice opinion.

Any evidence or literature backing it?

Case 3

Pajr 

https://chat.whatsapp.com/H46R5oxEBw92X2tEqSUigI

 

Blog

http://bhargavimalothu84.blogspot.com/2023/08/38-old-female-with-inability-to-open.html

[8/8, 10:30 AM] Rakesh Biswas Sir: Share the complete hemogram 

Clinical images abd and biceps

[8/8, 10:31 AM] Rakesh Biswas Sir: Add Keerthi as this could be mycobacteria

[8/8, 10:37 AM] Rakesh Biswas Sir: Any radiology images of her neck?

[8/8, 11:18 AM] Rakesh Biswas Sir: Share the images

[8/8, 11:19 AM] Chetana: Ok sir

[8/8, 11:21 AM] Rakesh Biswas Sir: Clinical images abd and biceps

[8/9, 8:50 AM] Rakesh Biswas Sir: @⁨Dr.Dinesh Datta⁩ @⁨Durga Krishna Sir⁩ We had a discussion regarding high vitamin B12 levels and the problems with this test? Is it a problem with the test or our lab? I guess it's with the test? Why do we keep ordering it again and again @⁨Navya Maam Gm⁩ ? There are better means to arrive at the diagnosis of chronic inflammatory anemia of paraphryngeal abscess? A bone marrow aspiration biopsy may have revealed tubercular granuloma and a culture of the same could have shown mycobacteria @⁨Keerthi Maam Gm⁩ ?

[8/9, 8:53 AM] Durga Krishna Sir: @⁨Navya Maam Gm⁩ ...have you given any b12 injections prior to the test ( as before ).. Can you please share the complete case report of this patient??

[8/9, 8:55 AM] Navya Maam Gm: No sir not given

[8/9, 10:35 AM] Bhargavi: http://bhargavimalothu84.blogspot.com/2023/08/38-old-female-with-inability-to-open.html

[8/9, 11:36 AM]

 Dr.Chandana Vishwanatham: Any CBP done during tooth extraction 2months ago??Does she have any previous reports of CBP with her?

[8/9, 11:39 AM] Nishitha Maam Gm: No mam

She didnt get any investigations done anytime

[8/9, 11:46 AM] Dr.Chandana Vishwanatham: Did we rule out a retroviral infection?

[8/9, 11:53 AM] Dr.Dinesh Datta: Plummer Wilson syndrome is in our differential list right?

[8/9, 11:53 AM] Nishitha Maam Gm: Yes mam

Serology negative

[8/9, 11:57 AM] Dr.Dinesh Datta: Dimorphic/nutritional anemia?

Can you share peripheral smear images?

[8/9, 12:04 PM] Dr.Chandana Vishwanatham: Serum b12 test has high sensitivity and low specificity.

It means if the value is low ,we can label the patient to be deficient

but if the value is high,we can’t rule out deficiency as in this patient.

So what is the plan? a BM biopsy or a trial of b12? @⁨Nishitha Maam Gm⁩ @⁨Rakesh Biswas Sir

[8/9, 12:05 PM] Nishitha Maam Gm: We asked patho people for bone marrow biopsy mam

They told they will only do aspiratuon not biopsy that too only after blood transfusion

[8/9, 12:06 PM] Durga Krishna Sir: @⁨Nishitha Maam Gm⁩ ..ask them to document the same !!

[8/9, 12:21 PM] Dr.Chandana Vishwanatham: And what are the chances of we missing a BM pathology by not doing biopsy?

She isnt having neurological symptoms,Bilirubin completely normal,no organomegaly,

LDH is normal.

BM pathology is high on cards compared to B12 deficiency!

[8/9, 12:25 PM] Dr.Chandana Vishwanatham: LAD hypokinesia and no Q waves in ecg? 

Can you share the echo video?

[8/9, 12:33 PM] Durga Krishna Sir: @⁨Nishitha Maam Gm⁩ ... please also ask the faculty pg to review the slide with Dysplastic cells !!

[8/9, 12:34 PM] Nishitha Maam Gm: Ok sir

[8/9, 12:34 PM] Durga Krishna Sir: *for

[8/9, 9:18 PM] Rakesh Biswas Sir: How about a biopsy from the paraphryngeal lesion that can show mycobacteria and then assume the anemia is myelophthisic due to mycobacterial infiltration? 

However we can at the same time get a bone marrow aspiration biopsy after a blood transfusion asap

[8/9, 9:21 PM] Navya Maam Gm: Yes sir ent ppl are thinking about biopsy but even to do biopsy she is unable to open her mouth

[8/9, 9:41 PM] Navya Maam Gm: Today radiology opinion was taken ..sir said that it might be left peritonsillar abscess 

And also there is IJV thrombus 

But ent team said that there is no abscess in the peritonsillar region it looks like paraphrayngeal abcess 

Final report will be given tomorrow sir

[8/12, 8:38 AM] Navya Maam Gm: Sir she went to nims for bone marrow biopsy sir and she will come back to us for follow up sir

[8/12, 8:41 AM] Rakesh Biswas Sir: Yes although I saw her yesterday I had the feeling our system would make her abscond which none of our interns can prevent!!

[8/18, 9:31 PM] Rakesh Biswas Sir: Update on her bone marrow biopsy?

[8/18, 9:34 PM] Navya Maam Gm: Bone marrow biopsy was done and report will be available in 2 days sir

Case 4

Pajr

https://chat.whatsapp.com/KmTWix0GRJNEgFfL5AudlK

Blog

http://bhargavimalothu84.blogspot.com/2023/08/this-is-a-online-e-log-book-to-discuss.html

[8/28, 7:57 AM] Bhargavi: Patient came with c/o sleeplessness , yellowing of eyes, knee pains 

Patient was apparently asymptomatic one month back, then he developed graduall weight loss , psychotic behaviour like( talking irrelevant, beating his mom) wrist pains , knee pains so he was taken to hospital in nalgonda and used medication for 2 -3 days , he started to drink again, so then the took to another hospital in miryalaguda , he was said to have gallstones, renal stones, and jaundice so they brought here to kamineni

Past h/o denovo , dm type 2

No htn, asthma, cva cad, throid

Personal history:

He started to have alcohol from 3 years every day 2 quarters daily ( stressor: financial problems) , since one months he is having the cheif complaints , he had graduall weight loss of 10 kgs since past one year

Before 3 years: patient is auto driver ,he used to take care of his family financially, and 

 Since when he had alcohol, his son is taking care of the family financially, and the patient wasn't going to any work, he has decreased appetite, 

bowel and bladder regular, yellowish urine since one month

[8/29, 3:27 PM] Bhargavi: S

 patient came with c/o sleeplessness , yellowing of eyes, knee pains 

O/e :

Pt is c/c/c 

Bp : 120/80 mm hg

Pr 82 bpm

Cvs s1s2 heard

Rs b/l ae+

P/a : soft npn tender

Cns : patient os conscious drowsy

A

Alcoholic liver disease

Alcohol dependence syndrome

Tobacoo harmful use

P

Inj. Thaimine 200 mg 1 amp in 100ml ns iv tid

T.lorazepam 2mg 

T.baclofen x l 20 mg

Nicotine gums 2mg

[8/29, 4:27 PM] Rakesh Biswas Sir: Clinical images DP

[8/29, 4:41 PM] Rakesh Biswas Sir: DP this

[8/29, 4:41 PM] Bhargavi: Ok sir

[8/29, 4:41 PM] Rakesh Biswas Sir: Share bulbar conjunctiva without the eye ball

Case 5

Pajr

https://chat.whatsapp.com/EBsNGKc8hxrLWuG2yFYXeV

Blog:

http://bhargavimalothu84.blogspot.com/2023/08/70year-old-male-with-acute-excebaration.html

[8/16, 1:35 PM] Bhargavi: Admission:14/8/23 under

Dr.shushmitha

Dr.nishitha

Dr.navya

Pt came with c/o of fever since 5 days and

Sob since 1 day

Patient was apparently asymptomatic and then developed fever which is intermittent, increased during night not associated with chills and rigor and relivied on medication

And sob grade 2 mmrc since one day, no relieving factors, not associated with wheeze, no h/o chest pain chest tightness, hemoptysis, orthopnea, pnd

Past history:

2 years back he was admitted in the hospital for abdominal tightness and decreased urine output and got admitted in the hospital and treated

H/o of loss of consciousness 1 year back and then got admitted at nalgonda private hospital and got treatment

No past h/o tb ,loose of weight,

N/k/c/o DM , HTN, , epilepsy, bronchial asthama,

Known smoker from 50 years, one pack per day( beedi)

K/c/o CAD, BPH. And on medication ecosprin 75 mg , dytor 10, urilosin n

Pt is c/c/c

Bp : 90/60mmhg

Pr: 82bpm

Rr: 17

Grbs : 118mg/ dl

Cvs : s1 s2 heard

Rs : crepts heard at left infraaxillary area 

Cns : no fnd

P/ a : soft non tender

Personal history:

Diet: mixed diet

Appetite: normal

B/b : regular

Sleep : adequate

Treatment

Inj.norad in 46 ml ms 1 ml /hr to maintain MAP. More than or equal to 65 mg

Inj. Ceftriaxone 1gm iv bd

T.nitrofurantoin 100 po bd

T.pcm 650 mg po sos

T.tamsulosin po hs

T.ecosprin av 75/10 po hs

[8/16, 2:53 PM] Rakesh Biswas Sir: Ward?

 @⁨Navya Maam Gm⁩

[8/16, 2:54 PM] Navya Maam Gm: Icu bed 2 sir

[8/16, 2:58 PM] Rakesh Biswas Sir: Clinical images?

[8/16, 3:25 PM] Akhil Chowdary: He is also in altered sensorium sir

[8/16, 3:28 PM] Akhil Chowdary: Talking irrelevant talks

[8/16, 6:19 PM] Rakesh Biswas Sir: Standing images

[8/16, 6:20 PM] Rakesh Biswas Sir: When we tried to make the other patient stand we found he was having upper GI bleed. Maybe we can find something here as well "

Case 6:

http://bhargavimalothu84.blogspot.com/2023/09/this-is-online-e-log-book-to-discuss.html