Pulmonary embolism

30 year old male patient presented to casualty with complaints of 
-bilateral pedal edema extending upto ankle since 7 days which was pitting type.
-decreased urine output,burning micturition and loss of appetite since 2 days.
-shortness of breath since 1day(grade 3-4)
patient got admitted in outside hospital and got treated for urosepsis and AKI,where HRCT was done(CO RADS-1)
On presentation to our casualty patient had grade 4 dyspnea with mild confusion.

GENERAL EXAMINATION-
pt was drowsy
BP-80/50 mmhg, on giving fluid bolus bp was 90/60mmhg.
PR-91bpm
RR-26cpm
spo2-82% on room air-after supplying12lit O2 it was 96%
CVS-S1S2 heard,no murmurs
RS-BAE +,b/l fine crepitus+

INVESTIGATIONS-
ABG-
ph-6.83
pco2-28.9 mmhg
po2-93.4 mmhg
Hco3-5.1 mmol/l
st.Hco3-3.8 mmol/l
s.O2-82.1%
ECG-


Showing S1 Q3 T3 pattern

CHEST X-RAY AP VIEW-

2D ECHO-
Showing RA,RV dilated with RV hypokinesia

PROVISIONAL DIAGNOSIS-
? pulmonary embolism with AKI secondary to urosepsis 


 

Comments

Post a Comment

Popular posts from this blog

45 yr female with anasarca

Image
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 available 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-centered online learning portfolio and your valuable inputs on the comment box is welcome.  Case presentation: 45 yr old lady who is a housewife and K/C/O DM 2 since 5yrs and HTN since 1yr,she  was apparently normal 6months back,used to develop pedal edema on and off  aggravates on walking and relieves on taking rest for which she was taken to nalgonda hospital and the doctor had advised her to decrease the fluid intake and gave some medications.It was associated with shortness of breath grade 3. 5days back she had developed pedal edema which got prog...
Read more

35 male with sudden onset seizures

Image
  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 available 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-centered online learning portfolio and your valuable inputs on the comment box is welcome.  Case presentation: 35yr old male, a lorry driver by occupation came with complaints of involuntary movements of bilateral upper and lower limbs @arount 6AM yesterday. Pt was apparently asymptomatic before the attack and was watching tv .suddenly patient collapsed and had involuntary movements of bilateral upper and lower limbs tonic- clonic type lasting for 15min. Associated with uprolling of eyes and involuntary passage of urine. No h/o frothing, tounge bite, dev...
Read more

22yr male with pain abdomen and recurrent ascites

Image
  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 available 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-centered online learning portfolio and your valuable inputs on the comment box is welcome.  Case presentation: A 22 yr old male who works in pharmacy was apparently normal 3months back , consumed toddy continuously for 15days after which,  on May 10th he developed severe pain in the left hypochondric and left lumbar region which was not associated with fever/vomiting.He was taken to local rmp who gave him medications for pain. After a week as the pain was not subsided he went to nalgonda hospital where ct scan was performed. Ct on May 17th--- Serum ...
Read more