CBBLE UDHC SIMILAR CASES

 "This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current based inputs.


Unit 3 & 6

ICU BED 2

Chief complaints:

50 Male Patient Came To Casualty With Complaints Of TINGLING in both legs and Arms since 1 day

SLURRING of Speech Since 3 hours


Patient Is Diabetic Since 10 years , incidentally Diagnosed .


Patient Was Apparently Asymptomatic 1 day Back And Then He Developed Numbness And Tingling In Both upper ( extending upto Wrist )and Lower limbs (extending Upto Knee) which resolved for a few hours today morning But Started Again at 3:00 pm . Also Complains Of Slurring Of Speech . No H/o Headache , Vomitings , Blurring Of Vision , No H/o Facial Drop , Seizures , Loss Of Consciousness .


Surgical history:

4 years Back Due To Trauma & Uncontrolled Diabetes Mellitus , 1st Thumb & Little Finger were Removed , Later All Fingers were Removed since Then He Is Ion Daily Mixtard 25 U once a Day .


Past history:

K/C/O HTN since 6 years on Tab Amlong 2.5

K/C/O DM since 10 years

Vitals:

Temp : 98.4 F

PR : 93 bpm

RR : 18 cpm

BP : 130/90 mmhg

Spo2 : 98 % at RA

CVS   : S1 S2 + , No murmurs 

RS      :  BAE +  

PA      :  Soft, non tender  


CNS examination: patient conscious with slurred speech


Tone :-         Right.        Left

 Upper limb.      Normal.  Normal

Lower limb.      Normal.   Normal 



    Reflexes        Right        Left

   Biceps.        Present    Present 

   Triceps             +         +

  Supinator.         +            +

   Knee.                +           +

   Ankle.               +            +

   Plantar.              Present       Present 


Corneal reflex- present

Conjunctival reflex- present


2) Power    UL          5/5               5/5

                    LL           5/5             5/5


Slipping Of Footwear +

Sensory examination:

Fine touch,crude touch +

Pain and temperature- normal 

Vibration and proprioception intact

Gait-normal


Cerebral signs:

1.finger nose coordination: normal

2.knee heel coordination: normal 



Provisional diagnosis:

TIA with uncontrolled sugars 



Clinical images:




Investigations:


Cxr:


ECG


Plan:

1) NBM till further orders

2) Allow only Water

3) Inj HAI  S/C 6U IV / Stat. >> Inj HAI IV infusion Acc to Algorithm

4) Inj Pan 40 mg IV / BD

5) Inj Ondansetron 4 mg IV / BD

6) IVF  NS, RL @ 125 ml/hr

7) Inj Thiamine 1 Amp in 100 ml NS IV / BD

8) GRBS charting


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