1 / 20

RT, 5/M

RT, 5/M. RCT, 5/M from Paranaque admitted for the first time for diarrhea and vomiting. HISTORY OF PRESENT ILLNESS. 2 days PTA: (+) increased sleeping time (+) lethargic 1 day PTA  loose watery stool, non- mucoid, non-bloody

carsyn
Télécharger la présentation

RT, 5/M

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. RT, 5/M

  2. RCT, 5/M from Paranaque admitted for the first time for diarrhea and vomiting

  3. HISTORY OF PRESENT ILLNESS • 2 days PTA: (+) increased sleeping time (+) lethargic • 1 day PTAloose watery stool, non- mucoid, non-bloody >5x/day ½ cup/episode non-projectile vomiting >5x/day  high grade fever

  4. HISTORY OF PRESENT ILLNESS • 1 day PTA brought to local hospital  persistence of symptoms  3 episodes GTC seizures 5 mins duration, 1 min interval, no regain in consciousness Transferred to PGH

  5. REVIEW OF SYSTEMS (+) cough/colds x 1 month duration (-) DOB (-) chest pain (-) ab pain (-) urinary changes (-) polyuria (-) polyphagia (-) polydipsia (-) rashes (-) behavioral changes

  6. PMHx: (+) typhoid fever – 2006 FMHx: (+) PTB – grandfather tx for 6 mos 2007 (+) liver Ca – grandmother ImmHx: unknown to informant BMHx: Born FT to a ? Yo G1 at a local hospital Devt Hx: at par with age P/SHx: Pt is the eldest of 2 siblings. Parents separated when he was 2 yo Lives with maternal grandparents Drinking water is from the faucet

  7. PHYSICAL EXAMINATION -ER - received unarousable - BP 80/40 HR 110 RR30 febrile - anicteric sclerae, pink conj, (+) sunken eyeballs - ECE, (+) course crackles, (-) rales/wheezes -AP, distinct heart sounds, NRRR, murmur - fair pulses, pink nailbeds, (-) cyanosis/edema

  8. PHYSICAL EXAMINATION -ER (+) spastic extremities with opisthotonos pupils 3-4 mm SRTL, (-) facial asymmtetry, (+) drooling withdraws to pain DTR +++ on all extremities, (+) babinski

  9. Initial Working Impression AGE with severe signs of Dehydration Acute symptomatic seizure prob secondary to 1) metabolic 2) CNS infection (TB, bacterial) Community Acquired Pneumonia r/o sepsis

  10. COURSE AT THE ER

  11. Infectious/Neurologic P:Dx: CBC BUN, Crea, Na, K, Cl, Ca, Mg, RBS, AST, ALT, Ck-MB blood CS, ETA GS/CS PT/PTT 12LECG U/A CXR APL Cranial CT scan Lumbar tap, HSV, Jap B titers Tx: Pen G (200,000) Chloramphenicol (100) t/s Ceftriaxone  Acyclovir Pb (20) as LD then (5) as MD

  12. Infectious/Neurologic P: intubated ET5 L14 given total 80cc/kg pNSS Dopamine (10), Dobutamine (10) started given 5cc/kg D10W given O2 support at 5-6LPM IVF: D50.9NaCl 660 cc (30cc/kg x 30 mins) then, 195cc/hr (70cc/kg x 5 hrs)  FM: 58cc/hr

  13. COURSE IN THE WARDS

  14. INFECTIOUS/NEUROLOGIC S/O : still with hypotensive episodes (70/40) : (+) melena (+) coffee ground material/NGT 12LECG: (-) low voltage QRS

  15. Infectious/Neurologic

  16. Infectious/Neurologic

  17. Infectious/Neurologic A: AGE with severe signs of Dehydration Acute symptomatic seizure prob sec to 1) Suppurative Meningitis 2) Salmonella/Shigella Meningitis 3) Viral encephalitis r/o sepsis CAP

  18. Infectious/Neurologic P:Tx: Vit. K (1) Omeprazole (0.8) Dopamine (20) , Dobutamine (20) Epinephrine (1) Ceftriaxone (100)  Pen G + Chloramphenicol IVF: D50.9NaCl (FM+100%) For BT of FFP  DNR directive

  19. Referred for HR = O DNR directive noted Pronounced 5:15 PM Post mortem care rendered

  20. PCOD: septic shock

More Related