Pt. C/0 pain and swelling in the left knee 22 days back 
C/O deformity 

HOPI - pt was apparently asymptomatic 22 days back then she had alleged h/o slip and fall at home and unable to bear weight in the left lower limb for which she was admitted and operated ( open reduction internal fixation + plating) on 12th March since then she's complaining of SOB on supine position (grade 4) .SOB not associated with PND , increased on excretion and lying down , decreased in sitting position
Pt sleeps well during day 
On Jan 2022 pt complaints of decreased urine output for which she was admitted and treated . Her creatinine was 2.2 
No c/o palpitations , headache, burning micturation 

PAST HISTORY: 
 Pt underwent spinal surgery 15yrs ago with alleged h/o fall 
H/O of similar complaints (sob) in the past 5months back 
K/C/O HTN since 10yrs on T. Olmesarta 
  Asthma since 7yrs use inhaler 
 DM since 2yrs on Glimiperide  and Hypothyroidism on T. Thyronorm  

PERSONAL HISTORY: 
Diet - mixed 
Appetite- normal 
Sleep - disturbed 
Bowel and bladder -regular 
Addictions- teetotaler 

FAMILY HISTORY: 
No similar complaints

EXAMINATION:
 No Pallor , icterus, cyanosis, clubbing , koilonychia , lymphadenopathy 
Temperature - afebril 
Bp- 130/80mmhg
PR- 75bpm 
RR - 24cpm 
Spo2- 99%5litres of 02 
GRBS- 104mg/dl
ABG - 
CVS - s1s2 heard , no murmurs 
P/A - soft and nontender
RS - 

INSPECTION- 
Shape of chest - eliptical
B/L symmetrical chest 
Trachea center 
Expansion of chest equal on both sides 
No droping of shoulders 
No supraclavicular / infraclavicular hollowed 
No crowding of ribs 
No wasting of muscles 

PALPITATION: 
No local rise of temperature
No tenderness
All inspectory findings are confirmed 
Apex beat @ 5 lcs lateral to modclavicular line 

L Lower Limb examination:
Left leg- externally rotated 
Tenderness over left knee joint , diffuse swelling over the knee 
Crepts+ 
Skin - normal 
Distal pulses + 

9/ 3/22:
Pt. Complaints of SOB since 1day grade-1 (on&off) 
Bp-110/70 mm hg
RR-22cpm
Spo2-90@RA
         
Pt. Was reffered to pulmonology department
Advised:
1)O2 with nasal  prongs with 2-4L/min
To maintain spo2>94%
2)Nebulization with duolin 6th hrly , budecort 12th hrly
21/3/22 
C/0 sob 
Cough decreased
Treatment: 
1) CST 
2) advised 02 concentration and CPAP  support overnight 
3) O2 support with 2-3 litres of 02 with nasal prongs 
26/3/22:
SOB +
Cough decreased
BP- 110/70 mmHg
RR- 20cpm 
Spo2- - 86% on RA 
            97% on O2 
Treatment given 
1) Nebulisation with Duolin _ morning 
Budecort - night 
2) O2 inhalation with 2-3litres/min to maintain spo2 >95%
3) home overnight CPAP  advised 
4) T. Mucinac -Ab 
5) syp. Ascoril 2tsp 
27/3/22 
C/o SOB
Abdominal distension

Bp-160/100 mm hg
PR -94 BPM
Spo2-79%@RA ,99% with 4L of o2
RR-30cpm
RS-BAE+
b/l Ronchi @IAA,ISA
Crepts@b/l ISA
Rx:
1.CST
2. Neb with duolin/TID
3.Budecort & mucomist/ BD
4. Chest PT / TID
5.Lasix 20mg/ IV STAT
6.O2 with face mask@6L/min
7/3/22:
USG
15/3/22:
USG
HB:
2d ECHO:
CRP:

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