Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for...
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Transcript of Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for...
![Page 1: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/1.jpg)
Medical Department,Penang General Hospital
![Page 2: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/2.jpg)
68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis. On regular medications from Klinik Kesihatan.
1 week history of poor appetite, lethargic, cough. Noted by family to be confused, SOB on the day of admission.
BP: 90/50mmHg HR : 120 bpm
![Page 3: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/3.jpg)
What other information from the history do you need?
What are the other vital signs that you want to know?
![Page 4: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/4.jpg)
GCS: 11/15 BP: 90/50mmHg PR: 120bpm, not feeble Temperature: 38 degree celsius RR: 40breath/ min, SpO2 under room air: 93% Reflomet: 20mmol/L Clinically pale, dehydrated. Lungs: Lt basal crepitation with occasional rhonchi. CVS: NAD CNS: moving all 4 limbs (unable to follow
command) PA: mild tenderness at epigastric region, otherwise
soft. BS normal.
![Page 5: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/5.jpg)
Why is her GCS low? Why is she tachycardic but with a pulse
which is not feeble? Why is she tachypnoeic? What do the lung findings suggest? Why does she have a tender epigastrium?
![Page 6: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/6.jpg)
What is the cause of her shock?
What tests can you do to help with your diagnosis?
![Page 7: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/7.jpg)
How would you resuscitate her?
![Page 8: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/8.jpg)
24 year old Vietnamese lady, factory worker, came to A+E with 2 days history of abdominal pain, worsening in nature.
Language barrier, minimal history.
![Page 9: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/9.jpg)
On examination:◦ In pain, restless, obey command, moving all 4
limbs.◦ Pale, no jaundice, dry◦ BP: 90/60mmHg PR: 123bpm (feeble) ◦ SpO2: 100% room air RR: 36 breath/min◦ Afebrile
◦ CVS, lungs: NAD◦ PA:
guarded, tender. No hepatosplenomegaly. Bowel sounds present and normal.
![Page 10: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/10.jpg)
What is the diagnosis?
Why is her pulse feeble? Why is she dry?
How would you manage her?
![Page 11: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/11.jpg)
55 year old gentleman, a case of diabetes mellitus, hypertension, dyslipidemia, on treatment. Under OPD follow up.
C/O: ◦ Sudden left sided chest pain since morning,
associated with SOB, vomiting, profuse sweating.
On examination:◦ Conscious, alert, in pain ◦ BP: 90/60bpm, PR: 110bpm (regular, poor volume),
afebrile, SpO2: 96% under room air, RR: 28breaths/ min
![Page 12: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/12.jpg)
Hydration: fair CVS: S1S2 ESM mitral area Lungs: clear, air entry equal PA: soft, non tender, BS present
Diagnosis?
Explain the murmur? What is the one investigation to order immediately?
![Page 13: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/13.jpg)
![Page 14: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/14.jpg)
What is the diagnosis?
How would you manage him?
![Page 15: Medical Department, Penang General Hospital. 68 year old lady, known case of diabetes mellitus for 15 years, hypertension, bilateral knees osteoarthritis.](https://reader036.fdocuments.us/reader036/viewer/2022070410/56649eeb5503460f94bfcf72/html5/thumbnails/15.jpg)
So how do you classify shock?
How do you tell them apart?