PNEUMOCONIOSIS WITH TYPE 1 RESPIRATORY FAILURE WITH. ?CORPULMONALE (SEVERE PAH) WITH DM TYPE 2

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RICU admission

Bed 1

A 64yr old male patient came to causality with chief complaints of SOB since 1month 

Dry cough since 1month

HOPI:-

Patient was apparently asymptomatic 1month back,then he developed SOB GRADE (||| MMRC) which is invidious onset, gradually progressive increased on exertion, associated with orthopnea and wheeze since 1month .

Cough since 1month ,dry cough, increase on lying down

C/o dragging type of chest pain,not radiating, not associated with sweating and palpitation

No h/o fever, burning micturition, decreased urine output

No h/o wt loss ,loss of appetite & night sweats

C/o swelling of both lower limbs since 1month (upto knee)& discharge ( serous) since 5days from both LL

PAST HISTORY:-

K/C/O DM since 10yr medication (metformin500mg)

H/o similar c/o in the from past 10yrs on inhales (salmetrol25mcg &flulicosone 250mcg)

H/o TB 13yr back used ATT for 6months 

N/C/O HTN,CAD, Epilepsy

Bioman exposure 20yrs

Treatment history:-

DM 10yrs on OHA

TB 13yrs back used ATT for 6months

Personal history:-

Occupation:-worked in industry (cement factory)15yrs back now retired

Appetite-normal

Mixed food

Bowel and bladder movement-regular

Micturition-normal

No addiction

Family history:-NAD

PHYSICAL EXAMINATION:-

Pt was C/C/C 

Pallor - 

icterus-

cyanosis -

clubbing-

oedma+ both lower limbs ,pitting type

 lymphadenopathy-

Vitals;-

TEMP- afebrile

PR-96bpm

RR-26cpm

Bp-80/60mmhg

Spo2-95%at rt arm

GRBs-210mgdl

SYSTEMIC EXAMINATION:-

CVS:-S1,S2 Heard ,no murmur

Respiratory system:-

Dyspnea +

Wheez +

Position of trachea-central

Breath sounds+vascular

Adventitious sounds-rhonchi

Inspection:-

Shape of chest:-trachea appear to be central

Expansion of chest equal on B.S 

Rr-22cpm

No usage of accessory muscle of resp

No dropping of shoulder

No crowding of ribs

No wasting of muscle

Apical impulse couldn't seen

Rt supra clavicular,infra clavicular hollowness

Soft,non tender

Spinoscapular distance equal on BS 

PALPITATION:-

All inspiratory findings confirmed

No local rise of temp

No tenderness

Trachea be central in position

Chest movement equal on BS 

Apex beat -lt 5th ICS medial to midclavicular line

TVF equal in all accen

Percussion:-

Direct-resonant

Indirect:-resonant

Liver dullness from rt 5th ICS cardiac dullness with in Normal limits

Ascultation:-

Rt -ronchi +IMA ,IEA,VBS+

P.ABDOMEN:-NAD

CNS:-NAD

PROVISIONAL DIAGNOSIS:-

PNEUMOCONIOSIS WITH TYPE 1 RESPIRATORY FAILURE WITH. ?CORPULMONALE (SEVERE PAH) WITH DM TYPE 2

INVESTIGATION:-

CBP,LFT,RFT,CXR, 

SEROLOGY:-Negative

ECG:-

Treatment:-

1) O2 with nasal prong 2-4lit maintain>94%spo2

2)Inj.Norad 5ml /he ( 0.5-0.15mcg/kg/min)

3)Neb with Budecort BD

Duolines TID ,mucomist

4)INJ.LASIX 20mg BD if SBP>110mmhg

5)syp.ASCORIL-Ls 2TBSP BD

6)INJ.PANTOP 40mg OD (BBF)

7)Inj. CEFTRIAXONE 1mg. TID

8) GRBS MONITORING

9)BP MONITORING

10) INPUT & OUT PUT CHARTING

11)2EGG WHITE PER DAY