Historia Clinica

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HISTORIA CLINICA

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9 views1 page

Historia Clinica

Uploaded by

Sofi Behr

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Attribution Non-Commercial (BY-NC)

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PlS1C8lA CLlnlCA

lLCPA 13 sepLlembre de 2010

nCM88L Lorenzo AgusLln CuLlerrez
LuAu 66 anos
CluuAu uL LA CuL 8CvlLnL Manabl
LS1AuC ClvlL Casado
MC1lvC uL CCnSuL1A
aclenLe reflere que lngreso hace 3 semanas por hlperLensln
A no reflere
Al no reflere
SlCnCS vl1ALLS
uLSC 31 pulsaclones/mln
l8 16 resplraclones/mln
A 133/73
1 363
LxAMLn llSlCC
aclenLe no orlenLado en Llempo y espaclo
A la lnspeccln el paclenLe presenLa palldez generallzada normocefalo Lrax y abdomen slmeLrlco
hemaLoma en mlembro superlor derecho aclenLe usa panal gerlLrlco
PlpoLonla de MlS y MSS uebllldad muscular del lado lzqulerdo
Plporeflexla del lado lzqulerdo
8efle[o consensual normal

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