MADZANAH BT MUSTAFA/ 58 YO/ MALAY/ FEMALE U/L 1) ESRF-SINCE 2009 -ON REGULAR HD 1,3,5 AT HOSPITAL JEMPOL VIA RIGHT

AV FISTULA -RIGHT AV FISTULA WAS CREATED AT MAWAR MEDICAL CENTER, SEREMBAN IN 2009 -H/O COMPLETE THROMBOSIS ON RIGHT SUBCLAVIAN AND RIGHT BRACHIOCEPHALIC VEIN IN 2 011, FISTULOGRAM DONE 21/3/2011 2) LEFT BKA SECONDARY TO GAS GANGRENE -DONE IN 2009 AT HTJS -CURRENTLY ON PROSTHETIC LIMB -ADL DEPENDENT 3) IHD -UNSURE ANGIOGRAM DONE -CALIMED WAS DISCHARGED FORM IJN SINCE 3 YEARS AGO -ECHO IN 2008: EF 55% HYPOKINESIA AT APICAL SEPTAL REGION 4) EPILEPSY -CALIMED NO CT BRAIN AND EEG DONE -FIT FREE THIS YEAR -ON T. PHENYTOIN 200MG ON 5) HPT >20 YEARS -FOLLOW UP IN KK JEMPOL -ON T. METOPROLOL 50MG BD -ON T. AMLODIPINE 10MG BD 6) DM >20 YEARS -FOLLOW UP IN KK JEMPOL -ON S/C ACTRAPID 16 U TDS -ON S/C INSULATARD 20 U ON 7) DYSLIPIDEMIA -ON T. SIMVASTATIN 20MG ON P/W -PT REFERRED FROM HOSPITAL KUALA PILAH FOR ULTRASOUND-GUIDED FOR IJC INSERTION F OR TEMPORAL HD SUPPORT D/T RIGHT AV FISTULA THROMBOAIA. -PT WENT TO HOSPITAL JEMPOL ON 16/9/2013 FOR HD AND VASCULAR ACCESS WAS NOT SUCC ESSFUL. PT WAS TOLD TO GO AGAINTHE NEXT DAY. -SUCCESS VASCULAR ACCESS ON 17/9/2013 AND 5 HOURS HD WAS DONE. -THE HD PLANNED ON 18/9/2013 WAS UNSUCCESSFUL D/T NO VASCULAR ACCESS CAN BE OBTA INED. -REFERRED TO KUALA PILAH HOSPITAL ON 18/9/2013. -1ST ATTEMPT OF IJC DONE ON 18/9/2013 BUT FAILED. -RIGHT FEMORAL CATHETER WAS INSERTED ON 19/9/2013 AND 4 HOURS HD WAS DONE ON 19/ 9/2013. O/E ALERT, CONSCIOUS BP 128/70 HR 96 RR 21 T 37 REFLO 7.3 LUNGS CLEAR CVS S1S2 P/A SNT UPON DISCHARGE, -PT IS WELL -NO ACTIVE COMPLAINTS -ABLE TO TOLERATE ORALLY -PT STABLE

O/E ALERT, CONSCIOUS BP 113/63 HR 80 RR 21 T 37 REFLO 5.1 LUNGS CLEAR CVS S1S2 P/A SNT

FOR HD VIA RIGHT IJC AND SEND TO HKL FOR FISTULOGRAM

DX RIGHT AV FISTULA THROMBOSIS ESRF IHD DIABETES MELLITUS HYPERTENSION EPILEPSY LEFT BKA MEDICATIONS GIVEN: -S/C INSULATARD 16 U ON -S.C ACTRAPID 16 U TDS -C PHENYTION 100MG OD -T. ASCORBIC ACID 100MG OD -T.A MLODIPINE 10MG OD -T. VASTERAL 20MG TDS -FOLIC ACID 5 MG OD -T. SIMVASTATIN 20MG ON -T. ISORDIL 10MG TDS -T. B COM II/II OD -T. CA CARBONATE 500MG TDS -T. METAPROLOL 100MG BD -T. ASPIRIN 75MG OD HB 10.9 TWDC 12.6 PLT 294 T. PRTOEIN 78 ALBUMIN 33 GLOBULIN 45 T. BILIRUBIN 6 UREA 12.4 SODIUM 137 POTASSIUM 4.2 CREATININE 607

CXR: NO CARDIOMEGALY : NO IJC INSERTION AT PLACE