This document presents the case of a 53-year-old female admitted with a fractured left distal radius from a bicycle fall. She has a history of dilated cardiomyopathy and heart failure. Her echocardiogram showed dilated left ventricle, global hypokinesia, and left ventricular ejection fraction of 27%. She underwent an ultrasound-guided supraclavicular brachial plexus block with minimal intravenous fluids for her fracture repair, which was uncomplicated. The discussion covers dilated cardiomyopathy, signs and symptoms, diagnostic studies, anesthetic concerns, and optimization for surgery. Brachial plexus anatomy and the supraclavicular approach are also described.
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Pathology case presentation with discussion, squamous cell carcinoma, grossly and histology with IHC markers differentiation of different types of non small cell carcinoma .
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a case presentation on diabetic foot/ case study on diabetic foot.martinshaji
This is a detailed study on diabetic foot a condition usually seen on patients with diabetics. this may become complicated according to the severity of the condition and diabetes , ideal management is needed with drugs sometimes surgical methods. this case study will give a detailed study about diabetic foot ............... the treatment, diagnosis , management, patient counselling, pharmacist intervention, pathophysiology etc
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a case presentation on diabetic foot/ case study on diabetic foot.martinshaji
This is a detailed study on diabetic foot a condition usually seen on patients with diabetics. this may become complicated according to the severity of the condition and diabetes , ideal management is needed with drugs sometimes surgical methods. this case study will give a detailed study about diabetic foot ............... the treatment, diagnosis , management, patient counselling, pharmacist intervention, pathophysiology etc
Please leave a comment if you visited this
thank u
Dr Neerav Goyal discusses the various aspects of acute liver failure that includes the criteria, pre transplant issues, critical care management, overall survival.
2. • 53/F, 52 kgs
• Admitted by orthopaedics dept.
• h/o RTA (fall from bike) 5 days back
• # Lt distal radius
3. • No other associated injuries xcept for minor
scratches (lt knee,ext surface lt forearm,rt
hand)
• No LOC, Vomitting
4. • h/o dyspnea (NYHA II) since 2 yrs
• Dizziness Off and on
• No orthopnea or PND
5. Past History
• ICU adm. 5 mnths back (4 days) due to increased
dyspnea severity
• Discharged on
T. Spironolactone 25 mg OD
T. Lasix 40 mg OD
T. Ecosprin 75 mg OD
T. Losartan 50 mg OD
T. Isosorbide Dinitrate 20 mg
T. Atorvastatin 10 mg OD’
• Taking Till date
6. • No h/o any previous surgery or anesthetic
exposure
20. DCM
• Most common cardiomyopathy
• Progressive disease with ventricular
enlargement & contractile dysfunction but
NORMAL LV thickness
• Rt ventricle can be involved
• Amongst common causes of heart failure
21. • Cause unknown
• May be genetic or a/w Coxsackie B infection
• Secondary cardiomyopathies might have features
of DCM
Alcohol/Cocaine abuse
Peripartum CM
HIV
Pheochromocytoma
Hyperthyroidism
CAD,IHD
23. SIGNS
• Tachypnea
• Tachycardia
• Hypertension/hypotension
• Signs of pulmonary and systemic vascular
congestion
• Valvular regurgitation (due to AV ring dilation)
27. Preparation/Optimization
• Determining optimal time for elective surgery
• Grading the severity
• Heart failure control at least >1 week
• Treatment of arrhythmias if any
• Correction of electrolyte anomalies
28. Overall aim
• avoid tachycardia;
• avoid/minimize the effects of negative
inotropic agents, in particular anesthetic
drugs;
• prevent increases in afterload;
• maintain adequate preload in the presence of
elevated LVEDP.
• Treatment be considered if a >10% decrease
in systolic pressures occurs.
29. Poor Prognosis
• EF < 25 %
• PCWP > 20 mm Hg
• Systemic hypotension
• Pulm. HTN
• Inc. CVP
• Cardiac index < 2.5 L/min/M2