ACUTE PULMONARY EDEMA ?CARDIOGENIC WITH K/C/O DM-II AND HYPERTENSION AND CAD ? OLD AWMISOB DECREASED



56/M lorry driver by occupation came to Casuality with SOB grade 4 since 30 min

- Pt was apparently asymptomatic 1 year back, chronic Smoker [ daily 1 packet of cigarettes] since 20 years & occasional alcoholic went to hospital with c/o Generalised weakness and lethargy on routine as DM type-2 (ON OHA since 1 yr) 
In the month of February 2021, Early morning at 6 am patient had Sudden onset of SOB(GRADE-III-IV) associated with orthopnea with profuse sweating went to hospital in Hyderabad diagnosed as hypertensive urgency with acute LVF
ECG -showed- ST ELEVATION
in V2-V4
? ANT  
  G you ERIOR k j. WALL MI 
Adviced 2D echo- Normal findings, no hypokinesia

And managed Symptomatically with
 
T. Met-XL 25mg PO/OD
T. Nicardia 20ng PO/OD T.Ecospirin - AV(10/75) PO/OD
T.Telma H+AM(40/12-5)/5mg)
24/2: (HbA1C: 6-8, SR.Cr:1-6) 
Discontinued treatment since 3 months.Currently on oral hypoglycemic agents(OHA)

HOPI:
Diabetic since 1 yr-on regular medication T.Glimi m2(500mg)
Hypertensive since 1 yr- not on regular medication

On examination : 
Pt is c/c/c
No signs of pallor, icterus, cyanosis, clubbing, lymphadenoapathy, edema

Vitals:
Afebrile
PR: 92 bpm, regular
RR: 26 cpm
BP: 120/70 mmHg
SPO2:
AT ROOM AIR-76%
98% WITH 16L of O2
GRBS:206 mg/dl
Systemic examination :
 CVS:S1,S2 heard
 Apex beat:5th ICS
Resp:
Dyspnoea +nt,orthopnea + 
Wheeze +nt
BAE+(vesicular breath sounds)
Nvbs heard
Position of trachea- central
Right side crept +nt in IAA,ISA

P/A: obese, tenderness absent, bowel sounds heard
Cns: NFND


Provisional diagnosis :
 ACUTE PULMONARY EDEMA ?CARDIOGENIC
 WITH K/C/O DM-II AND HYPERTENSION AND CAD ? OLD AWMI
SOB DECREASED


Today day 0 Mrng vitals - 
Temp -Afebrile
PR- 80 Bpm, regular .
BP-100/70 mmHg 
RR-30 cpm
Spo2- 99 @ 9L of O2
grbs- 199mg/dl
Stools not passed
ECG ON PRESENTATION- 12:30 AM ON DAY O

ECG AT 2:15 AM ON DAY 0
ECG AT 9:30 AM ON DAY 1

CHEST X RAY
INVESTIGATIONS

SOAP NOTES DAY 0
SUBJECTIVE- 
SOB GRADE-4, LOW SATURATION 73% AT ROOM AIR
OBJECTIVE- 
Temp -Afebrile
PR- 80 Bpm, regular .
BP-100/70 mmHg 
RR-30 cpm
Spo2- 99 @ 9L of O2
grbs- 199mg/dl
ASSESSMENT:-
ACUTE PULMONARY ODEMA 
? CARDIOGENIC K/C/O- HTN / DM-I / CAD (?OID ? AWMI)
PLAN OF CARE:-
DAY 0
1. Head End Elevation 
2.O2 inhalation to maintain.
SpO₂> 92%

3 T.Nicardia 20 mg Po/ OD

4.T. Met-XL 25 mg PO TOD

5. T. GLIMI - M₂ PO/OD 
6.T. Ecospirin Av (75/70) Po/OD

7.T. clopitab 75mg PO OD

8. T.Lasix 2omg Po/BD.

Dy 9. Ini ceftriaxone 1gm IV/ BD

10. Syp Ascoril 15ml PO/TID
 11. BP | PR | Temp /RR-4th hrly
SOAP NOTES DAY 1
SUBJECTIVE-
SOB SUBSIDED
DRY COUGH +NT INTERMITTENT
OBJECTIVE-
Temp -Afebrile
PR- 78 Bpm, regular .
BP-120/60 mmHg 
RR-28 cpm
Spo2- 96% at room air
grbs- 120mg/dl
ASSESSMENT-
ACUTE PULMONARY ODEMA 
? CARDIOGENIC K/C/O- HTN / DM-I / CAD (?OID ? AWMI)
SOB SUBSIDED
DRY COUGH +NT INTERMITTENT
PLAN OF CARE
DAY 1
1. Head End Elevation 20. Inhalation to maintain.
SpO₂> 92%

3 T.Nicardia 20 mg Po/ OD
4.T. Met-XL 25 mg PO TOD
5. T. GLIMI - M₂ PO/OD 
6.T. Ecospirin Av (75/70) Po/OD
7.T. clopitab 75mg PO OD
8. T.Lasix 2omg Po/BD.
 9. Ini ceftriaxone 1gm IV/ BD

10. Syp Ascoril 10ml PO/TID
 11. BP | PR | Temp /RR-4th hrly
SOAP NOTES DAY2
SUBJECTIVE-
SOB SUBSIDED
OBJECTIVE-
Temp -Afebrile
PR- 77 Bpm, regular .
BP-130/80 mmHg 
RR-22 cpm
Spo2- 97% at room air
grbs- 134mg/dl

ASSESSMENT-
ACUTE PULMONARY ODEMA 
? CARDIOGENIC K/C/O - HTN / DM-I / CAD (?OID ? AWMI)
C/O:SOB SUBSIDED
PLAN OF CARE:-
DAY 2
1. Head End Elevation 20. Inhalation to maintain.
SpO₂> 92%

3 T.Nicardia 20 mg Po/ OD

4.T. Met-XL 25 mg PO TOD

5. T. GLIMI - M₂ PO/OD 
6.T. Ecospirin Av (75/70) Po/OD

7.T. clopitab 75mg PO OD

8. T.Lasix 2omg Po/BD.

 9. Ini ceftriaxone 1gm IV/ BD

10. Syp Ascoril 10ml PO/TID
 11. BP | PR | Temp /RR-4th hrly

DISCHARGE SUMMARY

56/M lorry driver by occupation came to Casuality with SOB grade 4 since 30 min

- Pt was apparently asymptomatic 1 year back, chronic Smoker [ daily 1 packet of cigarettes] since 20 years & occasional alcoholic went to hospital with c/o Generalised weakness and lethargy on routine as DM type-2 (ON OHA since 1 yr) 
In the month of February 2021, Early morning at 6 am patient had Sudden onset of SOB(GRADE-III-IV) associated with orthopnea with profuse sweating went to hospital in Hyderabad diagnosed as hypertensive urgency with acute LVF
ECG -showed- ST ELEVATION
in V2-V4
? ANTERIOR WALL MI 
Adviced 2D echo- Normal findings, no hypokinesia

And managed Symptomatically with
 
T. Met-XL 25mg PO/OD
T. Nicardia 20ng PO/OD T.Ecospirin - AV(10/75) PO/OD
T.Telma H+AM(40/12-5)/5mg)
24/2: (HbA1C: 6-8, SR.Cr:1-6) 
Discontinued treatment since 3 months.Currently on oral hypoglycemic agents(OHA)

HOPI:
Diabetic since 1 yr-on regular medication T.Glimi m2(500mg)
Hypertensive since 1 yr- not on regular medication




On examination : 
Pt is c/c/c
No signs of pallor, icterus, cyanosis, clubbing, lymphadenoapathy, edema

Vitals:
Afebrile
PR: 92 bpm, regular
RR: 26 cpm
BP: 120/70 mmHg
SPO2:
AT ROOM AIR-76%
98% WITH 16L of O2
GRBS:206 mg/dl
Systemic examination :
 CVS:S1,S2 heard
 Apex beat:5th ICS
Resp:
Dyspnoea +nt,orthopnea + 
Wheeze +nt
BAE+(vesicular breath sounds)
Nvbs heard
Position of trachea- central
Right side crept +nt in IAA,ISA

P/A: soft, tenderness absent, bowel sounds heard
Cns: NFND


Provisional diagnosis :
 ACUTE PULMONARY EDEMA ?CARDIOGENIC
 WITH K/C/O DM-II AND HYPERTENSION AND CAD ? OLD AWMI
SOB DECREASED
SOAP NOTES DAY 0
SUBJECTIVE- 
SOB GRADE-4, LOW SATURATION 73% AT ROOM AIR
OBJECTIVE- 
Temp -Afebrile
PR- 80 Bpm, regular .
BP-100/70 mmHg 
RR-30 cpm
Spo2- 99 @ 9L of O2
grbs- 199mg/dl
ASSESSMENT:-
ACUTE PULMONARY ODEMA 
? CARDIOGENIC K/C/O- HTN / DM-I / CAD (?OID ? AWMI)
PLAN OF CARE:-
DAY 0
1. Head End Elevation 
2.O2 inhalation to maintain.
SpO₂> 92%

3 T.Nicardia 20 mg Po/ OD

4.T. Met-XL 25 mg PO TOD

5. T. GLIMI - M₂ PO/OD 
6.T. Ecospirin Av (75/70) Po/OD

7.T. clopitab 75mg PO OD

8. T.Lasix 2omg Po/BD.

Dy 9. Ini ceftriaxone 1gm IV/ BD

10. Syp Ascoril 15ml PO/TID
 11. BP | PR | Temp /RR-4th hrly
SOAP NOTES DAY 1
SUBJECTIVE-
SOB SUBSIDED
DRY COUGH +NT INTERMITTENT
OBJECTIVE-
Temp -Afebrile
PR- 78 Bpm, regular .
BP-120/60 mmHg 
RR-28 cpm
Spo2- 96% at room air
grbs- 120mg/dl
ASSESSMENT-
ACUTE PULMONARY ODEMA 
? CARDIOGENIC K/C/O- HTN / DM-I / CAD (?OID ? AWMI)
SOB SUBSIDED
DRY COUGH +NT INTERMITTENT
PLAN OF CARE
DAY 1
1. Head End Elevation 20. Inhalation to maintain.
SpO₂> 92%

3 T.Nicardia 20 mg Po/ OD
4.T. Met-XL 25 mg PO TOD
5. T. GLIMI - M₂ PO/OD 
6.T. Ecospirin Av (75/70) Po/OD
7.T. clopitab 75mg PO OD
8. T.Lasix 2omg Po/BD.
 9. Ini ceftriaxone 1gm IV/ BD

10. Syp Ascoril 10ml PO/TID
 11. BP | PR | Temp /RR-4th hrly
SOAP NOTES DAY2
SUBJECTIVE-
SOB SUBSIDED
OBJECTIVE-
Temp -Afebrile
PR- 77 Bpm, regular .
BP-130/80 mmHg 
RR-22 cpm
Spo2- 97% at room air
grbs- 134mg/dl

ASSESSMENT-
ACUTE PULMONARY ODEMA 
? CARDIOGENIC K/C/O - HTN / DM-I / CAD (?OID ? AWMI)
C/O:SOB SUBSIDED
PLAN OF CARE:-
DAY 2
1. Head End Elevation 20. Inhalation to maintain.
SpO₂> 92%

3 T.Nicardia 20 mg Po/ OD

4.T. Met-XL 25 mg PO TOD

5. T. GLIMI - M₂ PO/OD 
6.T. Ecospirin Av (75/70) Po/OD

7.T. clopitab 75mg PO OD

8. T.Lasix 2omg Po/BD.

 9. Ini ceftriaxone 1gm IV/ BD

10. Syp Ascoril 10ml PO/TID
 11. BP | PR | Temp /RR-4th hrly

Discharged

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