MEDICINE_CASE_PRESENTATION[1]-1.pptx
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A 13-year-old boy was admitted to the hospital with symptoms of a scorpion sting including severe breathing difficulty, palpitations, increased sweating, and cough. Initial examination found the boy to be tachypnic and hypoxic. Echocardiogram showed global hypokinesia of the left ventricle, mildly reduced ejection fraction, and signs of toxic myocarditis and cardiogenic shock. The boy was treated with intubation, insulin/glucose infusion, dobutamine, alpha blockers, and other supportive care. His condition stabilized and he was successfully weaned off ventilation support before being discharged.
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ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITALThe followi.docx
ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITAL
The following information should be included daily as it applies to your patient.
Demographic DataDate of AdmissionVital Signs
39 y/o African American male
10/28/18
BP: 115/60. Pain: 2
P: 91
T: 98.2.
RR: 22
SP02: 95
Significant Past Medical HistoryAllergies/Reactions
HTN, Hyperlipemia, Diabetes
NKA
Reason for Hospitalization and Current Diagnosis
Current Diagnosis: Acute Embolic Stroke, Cerebral Edema, R Hemiparesis, Pneumonia
Reason for hospitalization: 38 y/o male with a history of HTN presented with onset Right Sided Weakness and confusion at 11pm on 10-27-18 when he went to sleep. He woke up at 3am and he was talking gibberish to his fiancé. He went back to sleep and 2 hours later his symptoms had worsened. On 10-28-18, EMS was called by his fiancé and he was taken to the ER. His fiancé said he had taken “something” possibly cocaine. Patient was diagnosed with Acute Embolic Stroke, Cerebral Edema, R Hemiparesis and recently Pnuemonia.
Describe thepathophysiologyincluding signs, symptoms and incidence; and compare with patient findings:
· Acute Embolic Stroke:
Pathophysiology: Occurs when a blood clot that forms somewhere elsewhere in the body breaks loose and then travels to the brain through the bloodstream. The clot can lodge in an artery and blocks the flow of blood.
Common symptoms:Difficulty speaking or understanding words, numbness and tingling, temporary paralysis, blurred vision or blindness, slurred speech, dizziness, feeling faint, difficulty swallowing, nausea, sleepiness. Embolic stroke doesn’t cause any unique symptoms
Muscular symptoms: Difficulty with coordination, stiff muscles, feelings of weakness on one side or all of the body.
Cognitive symptoms: Mental confusion, an altered level of consciousness, visual agnosia
Patient Findings: Patient presented with R hemiparesis, facial drooping, slurred speech, difficulty swallowing.
· Cerebral Edema
Pathophysiology: It’s a life threatening condition that causes fluid to develop in the brain.
This fluid increases the pressure inside of the skull causing intracranial pressure (ICP). Increased ICP can reduce brain blood flow and decrease the oxygen your brain receives. The brain needs an uninterrupted flow of oxygen to function properly.
Symptoms: Headache, dizziness, nausea, lack of coordination, numbness, mood changes, memory loss, difficulty speaking, incontinence, change in consciousness, seizures, weakness in extremities
Patient Findings: Patient presented with difficulty speaking, incontinence, change in consciousness, weakness in extremities
· Hemiparesis
Pathophysiology: Hemiparesis is weakness on one side of the body. One side can still move but with reduced muscular strength.
Symptoms: Difficulty walking, standing, and maintaining your balance. You may also have numbness or tingling on your weaker side.
Patient findings: Patient has right sided weakness.
· Pneumonia
.
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ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITALThe followi.docx
ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITAL
The following information should be included daily as it applies to your patient.
Demographic DataDate of AdmissionVital Signs
39 y/o African American male
10/28/18
BP: 115/60. Pain: 2
P: 91
T: 98.2.
RR: 22
SP02: 95
Significant Past Medical HistoryAllergies/Reactions
HTN, Hyperlipemia, Diabetes
NKA
Reason for Hospitalization and Current Diagnosis
Current Diagnosis: Acute Embolic Stroke, Cerebral Edema, R Hemiparesis, Pneumonia
Reason for hospitalization: 38 y/o male with a history of HTN presented with onset Right Sided Weakness and confusion at 11pm on 10-27-18 when he went to sleep. He woke up at 3am and he was talking gibberish to his fiancé. He went back to sleep and 2 hours later his symptoms had worsened. On 10-28-18, EMS was called by his fiancé and he was taken to the ER. His fiancé said he had taken “something” possibly cocaine. Patient was diagnosed with Acute Embolic Stroke, Cerebral Edema, R Hemiparesis and recently Pnuemonia.
Describe thepathophysiologyincluding signs, symptoms and incidence; and compare with patient findings:
· Acute Embolic Stroke:
Pathophysiology: Occurs when a blood clot that forms somewhere elsewhere in the body breaks loose and then travels to the brain through the bloodstream. The clot can lodge in an artery and blocks the flow of blood.
Common symptoms:Difficulty speaking or understanding words, numbness and tingling, temporary paralysis, blurred vision or blindness, slurred speech, dizziness, feeling faint, difficulty swallowing, nausea, sleepiness. Embolic stroke doesn’t cause any unique symptoms
Muscular symptoms: Difficulty with coordination, stiff muscles, feelings of weakness on one side or all of the body.
Cognitive symptoms: Mental confusion, an altered level of consciousness, visual agnosia
Patient Findings: Patient presented with R hemiparesis, facial drooping, slurred speech, difficulty swallowing.
· Cerebral Edema
Pathophysiology: It’s a life threatening condition that causes fluid to develop in the brain.
This fluid increases the pressure inside of the skull causing intracranial pressure (ICP). Increased ICP can reduce brain blood flow and decrease the oxygen your brain receives. The brain needs an uninterrupted flow of oxygen to function properly.
Symptoms: Headache, dizziness, nausea, lack of coordination, numbness, mood changes, memory loss, difficulty speaking, incontinence, change in consciousness, seizures, weakness in extremities
Patient Findings: Patient presented with difficulty speaking, incontinence, change in consciousness, weakness in extremities
· Hemiparesis
Pathophysiology: Hemiparesis is weakness on one side of the body. One side can still move but with reduced muscular strength.
Symptoms: Difficulty walking, standing, and maintaining your balance. You may also have numbness or tingling on your weaker side.
Patient findings: Patient has right sided weakness.
· Pneumonia
.
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MEDICINE_CASE_PRESENTATION[1]-1.pptx
- 2. 13 year old boy with no comorbidities was admitted on 11/07/21 in ward with alleged H/o scorpion sting - left foot on 10/07/2021 H/o presenting illness : on 10/07/2021 the boy had alleged h/o scorpion sting on left foot,then he himself went to nearby hospital and took first aid(Inj.TT) and went to his home without any complaints.
- 3. On the same day evening, patient developed mild cough, palpitation and breathlessness which persisted throughout the night. The next day morning patient was brought to TMCH, with severe breathlessness and cough.
- 4. H/o Severe breathing difficulty H/o Palpitation. H/o Increased sweating. H/o Cough. H/o Cold peripheries. H/o Vomiting. H/o Blood stained sputum. No h/o Chest pain. No h/o Fever. No h/o Local swelling No h/o Abdominal pain. No h/o Puffiness of face. No h/o Decreased urine output. No h/o Altered sensorium. No h/o Seizure. No h/o LOC
- 5. O/E- -Awake -Responding to oral commands -Afebrile -Tachypnoeic -No pallor, -No pedal edema, -No icterus VITALS PR- 140/min BP- 80/50 mmhg SpO2-50 % in RA - 69% with 15 litres nasal O2 -75% with CPAP
- 6. S/E- CVS- S1S2 (+),no murmur RS- B/L vesicular breath sounds with B/L scattered crepitations [+] P/A-Soft,BS(+) CNS- Awake, Responding to oral commands, B/L pupils 2.5 mm reacting to light, Moves all 4 limbs.
- 7. Diagnosed as -SCORPION STING LEFT FOOT/ LATE PRESENTATION/TOXIC MYOCARDITIS/ ACUTE PULMONARY EDEMA/CARDIOGENIC SHOCK Pt was immediately intubated with 6.5 size tube and connected to mechanical ventilation with the help of anaesthetist and shifted to IMCU. After intubation patient vitals PR – 140/min BP – 80/50 mmHg (with support) SPO2 – 99% MV
- 8. INITIAL ECG:
- 9. ECHOCARDIOGRAPHY SHOWED: Global hypokinesia of LV EF-45% Mild LVSD Grade 1 LVDD No AS or AR or MR No PHT TAPSE 20mm Good RV systolic function Tachycardia during study
- 11. 12/07/2021 15/07/2021 TOTAL COUNT 13900 18600 HB 9.5 10.9 HEMATOCRIT 29 34 PLATELET 278000 352000 RBS 89 80 UREA 30 46 CREATININE 0.7 0.8 PT 20 sec 18 sec INR 1.4 1.2
- 12. 11/07/2021 12/07/2021 pH 7.135 7.566 pCO2 58 30.7 pO2 46.9 95 BICARBONATE 19.9 26 11/07/2021 12/07/2021 MORNING 12/07/2021 EVENING 13/07/2021 SODIUM 139 130 139 138 POTTASSIU M 4.5 3.5 3.8 4.2 CHLORIDE 99 101 108 102
- 13. TREATMENT GIVEN: -DIL/VITALS MONITORING -BACK REST/ET TUBE CARE -BP CHART -T.IVABRADINE 5mg bd -T.PRAZOSIN 2mg(stat) P/O -T.PRAZOSIN 1mg od -Inj.DOBUTAMINE 0.4mg/min in 500ml of NS iv -Inj.HYDROCORTISONE 100mg IV stat -Inj.DEXA 6mg iv od
- 14. -Inj.PLAIN INSULIN 0.3 units/gm of glucose and glucose infusion at 0.1 gm/kg/hr for 48 hours with close monitoring of CBG and serum potassium.
- 15. BP CHART:
- 16. Patient was treated with INSULIN GLUCOSE INFUSION FOR 48 HRS along with dobutamine infusion. Once patient vitals were stabilised patient was maintained on dobutamine infusion for 24 hours. On 15/07/21,patient was weaned from mechanical ventilation and inotrophic support and observed for one day and then shifted to normal ward. Repeat ECHO was normal.
- 18. MECHANISM OF ACTION Mechanism of action: Scorpion envenomation causes massive release of catecholomines and other counter regulatory hormones. -Cardiac and liver glycogen content was found to be reduced in scorpion envenomation. -To counter act this effect , cases are treated with insulin and glucose infusion along with alpha blocker.
- 19. INSULIN ROLE: - Increase the glycogen level and glucose entry into the cells of liver and heart which improves the myocardial contractility. - Prevent the lipolysis and decreases the FFA levels which are arrhythmogenic in nature. - Accelerates the ATP production in ischemic areas of heart. - Maintain NA+K+ ATPase and maintain the cell membrane integrity. - Insulin itself assists in the recovery of myocardial contractility after ischaemic insult and increases cardiac output .
- 21. TO CONCLUDE : Alpha blocker still remains the first choice of therapy. It is the LIFE SAVING DRUG in scorpion sting. Alpha blocker can prevent the actions caused by released catecholamines, preventing further damage. Alpha blocker cannot reverse the tissue damage that has already been caused by catecholamines. Thus, insulin remains the only choice as the physiological antagonist to the actions of catecholamines.
- 22. THANK YOU