She has experienced cough productive of green sputum since 2 month ago and it's had a progressive course.The symptoms deteriorate at night and when lying in bed.
Past Medical History:She has had a history of 2 times admission in Emergency Deoartment in 2005 and early 2009:both with episodes of Asthmatic Exacerbation; on 2005 admission the patient was presented with coma and peripheral cyanosis in upper and lower extremities.
Drug History:Salbutamol/Atrovent
the patient has shown allergic response to Penicillin,Azithromycin,ASA,Anti-Histamine
Habitual Hx:-
Family Hx: Tuberclosis in her mother
Ph/Ex:
On initial presentation she had a Respiratory Rate of 25/min Temperature:37(Axi) BP:120/70 PR:88
Head and Neck: NL
Chest: Heart : S1S2 NL
Chest :Generalized Wheezing through both lungs fields
The remainder of Physical Exam was NL
no signs of heart failure were detected
The patient's dyspnea was refractory to all standard Therapy
A light imorovement was mentioned during Ntbiotic therapy but after discontinuation the symptoms including productive cough ,dyspnea,ortopnea got worse.
on the PA view of patient's chest x-ray there was an apparent huge consolidation area in lower lobe of right lung.
Bsic Laboratory tests were within normal limits.
An Spiral CT scan is orequested and it's arranged for saturday .
till then the patient recieves:
Nasal O2
Amp Enoxaparin 1mg/kg Q12h
Spray Salbutamol 3puff /QID
Spray Ipratropium Bromide 4puff/QID
Differential Diagnosis :
1-Asthma Exacerbation
2-Pneumonia
3-Paroxysmal Nocturnal Dyspnea
to be continued...
No comments:
Post a Comment