Medical e log book

 45 year old female patient came to casuality with c/o B/L left leg swelling since 1 and half year and right toe swelling and relieved treatment. Since 1 month she developed B/L upper limb and face along with abdominal distention with decreased urine output since 10 days. She started to experience dyspnea on exertion since 20 days which aggravated to dyspnea at rest since 3 days increased onlying down in supine position. Also C/o non productive cough since 5 days. Treatment history: 1. T. DYTOR 10 MG BD  2. T. MET XL 12.5 MG OD 3. T ATORVAS 40 MG OD 4. SYP ARISTOZYME 10 ML TID 5. T FRUSELAC 50 MG OD DAILY WITH T. METXL 3D 50 MG OD Patient is diagnosed with DM 2 since 2 years and is on T. Glimi M2 BD  Personal history: Passed stools 2 days back with reduced urine output. General Examination: Patient was C/C/C No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema Vitals at admission: PR- 80 bpm BP- 170/60 mmHg RR- 22 cpm SpO2- 98%  CVS: S1 S2 +, RS: B/L inspirator

Patient brought to casualty with complaints of unresponsiveness since 4 am morning Yellowish discoloration of sclera and eyes since 6 months Abdominal distension since 1 week Pedal edema since 1 week HOPI : patient was apparently normal till 6 yrs (2014) back then he developed jaundice with altered behaviour went to local hospital and diagnosed with CLD Patient was chronic alcoholic since 20yrs In 2014 patient visited hospital with c/o b/l pedal edema, jaundice and abdominal distension and was diagnosed with CLD Since then patient was on irregular medication and continued taking alcohol intermittently Since 4 days, patient has c/o fever subsided now used 4 tablets of DOLO C/o loose stools 4-5 episodes per day,no h/o malena , pain abdomen C/o nausea and loss of appetite C/o altered sensorium since today morning not responding to commands No h/o weakness and no h/o involuntary movements PAST HISTORY:      N/K/C/O HTN/DM/ASTHMA/CAD       K/C/O PULMONARY KOCHS 15 YRS BACK USED ATT General

Patient came to casualty with  c/o burning micturition since 15 days  fever since 5 days  decreased urine output since 4 days,  sob since 4 days Hematuria + for 3 days HOPI :  Patient was apparently normal 8 years back then he had pain abdomen a/w fever and vomitings and diagnosed with ? Liver abscess and needle aspiration was done. 4 years back patient developed a blister over right ankle which ruptured and for ulcer and cellulitis debridement was done. Since 15 days patient had c/o burning micturition associated with fever, nausea, vomitings and treated accordingly. Fever since 4-5 days, intermittent,not a/w chills and rigors.no loose stools PAST HISTORY : No HTN/DM                         NON ALCOHOLIC/NON SMOKER General examination : Pt is conscious,coherent and cooperative.thin built and malnourished. No pallor No icterus No clubbing No lymphadenopathy No edema   Vitals : Temp : Afebrile BP : 170/90 mm Hg PR : 118 bpm RR : 16 cpm GRBS : 114 mg / dl SpO2 : 98 % @ RA Systemic Examin

A 64yr old male presented to casualty with 3 day history of slurring of speech with  Worsening breathlessness since 2 days  Decreased urine output since 2 days  B/l Pedal oedema since 10 years on and off  He used to work as farmer and occasionally as shepherd and most of the time stays at home ( eat ,sleep,repeat ) and occasionally indulging in alcohol ( festival times) and he used to have weakness in both lower limbs and sometime unable to stand too and shows recurrent pattern twice or thrice a year and subsided on taking medication. History of pedal oedema dates back to 10 years prior to the presentation on and off and usually self resolves or OTC medication not associated with shortness of breath, hematuria or decreased urine output, palpitations. 3 days prior to the presentation response to commands decreased and loss of appetite was apparent and decreased urine output with shortness of breath amounting to grade 4, with cough with scanty sputum ( most of the time grunts) and slur