40F HYPOVOLEMIC SHOCK 2⁰ TO ACUTE GE WITH LEFT LOWER LOBE CONSOLIDATION

Chief Complaints: 

40yr female with to casuality with complaints of
 high grade fever since 5-6 days
C/o vomitings since yesterday
C/i loose stools since today .

Pt was apparently asymptomatic 5-6 days then she developed fever , sudden high grade not a/w chills and rigors , intermittent, releived temporarily on medication.

C/o vomiting since yesterday h/o 3-4 episodes , content good particles ,non bilious , non projectile , nausea present 

C/o abdominal bloating since yesterday
C/o SOB since yesterday , releived on lying down, 
No chestpain , palpitations PND orthopnea

C/o loose stools since today , watery consistency, 4-5 episodes ,small quantity, non blood stained , not associated with pain abdomen.

C/o epigastric pain since today , insidious onset , continuous , non radiating

Past History: 

N/k/c/o HTN DM CVA CAD TB ATHMA

K/c/o Hypothyroidism since 10 years on tab. Thyronorm 100mcg /po/ od using irregularly since 15 days

On examination: 
Pt is c/c/c 
No pallor , icterus , cyanosis, clubbing, lympadenopathy, edema 

Vitals : 
PR: 124bpm
RR: 18cpm
BP: 70 systolic ( palpatory)
GRBS : 183mg%

CVS : S1 s2 heard no murmurs
RS BAE NVBS heard
P/A : epigastric tenderness present 
No free fluid.


ECG (6/6/23): 


USG (6/6/23): 
Impression: 
Grade I fatty liver with mild hepatomegaly 
Hyperechoic focus noted in contracted gall bladder 
Review in fasting state for gall bladder pathology

Review USG (7/6/23): 
Impression: 
Gall bladder wall edema

Treatment: 
1. INJ. PIPTAZ 4.5GM IV/STAT 
    Followed by, INJ. PIPTAZ  2.5GM IV/TID
2. INJ. PAN 40MG IV/TID 
3. IVF FLUIDS NS AND RL @100ML/HR 
4. INJ. ZOFER IV/BD 
5. ORS- 1 PACKET IN 1 LT OF WATER, 200ML AFTER EVERY LOOSE STOOL EPISODE
6. TAB. SPOROLAC - DS PO/BD 
7. GRBS 7 POINT PROFILE MONITORING
8. MONITOR VITALS 
9. TEMPERATURE MONITORING 4TH HOURLY 

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