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  • OPD Pulmo Case by Doc. Peachy Natividad-AUG-2020-FEB-2021-INDIGO-AND-VIOLET-Bb-Collaborat

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    Jolaine Vallo
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    This document discusses the case of a 60-year-old female patient presenting with shortness of breath. Upon examination, she was found to have decreased breath sounds and dullness on the left lower lung field. Imaging and labs were ordered which showed a left pleural effusion. She was admitted with an impression of community-acquired pneumonia with possible parapneumonic effusion or uncontrolled diabetes. During a thoracentesis procedure for fluid drainage, she developed chest pain, dyspnea, diaphoresis and weak pulses, concerning for tension pneumothorax which required needle aspiration. Her hospital course and medications were discussed as well as follow up instructions prior to discharge.

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    This document discusses the case of a 60-year-old female patient presenting with shortness of breath. Upon examination, she was found to have decreased breath sounds and dullness on the left lower lung field. Imaging and labs were ordered which showed a left pleural effusion. She was admitted with an impression of community-acquired pneumonia with possible parapneumonic effusion or uncontrolled diabetes. During a thoracentesis procedure for fluid drainage, she developed chest pain, dyspnea, diaphoresis and weak pulses, concerning for tension pneumothorax which required needle aspiration. Her hospital course and medications were discussed as well as follow up instructions prior to discharge.

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    © All Rights Reserved
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    18 views39 pages

    OPD Pulmo Case by Doc. Peachy Natividad-AUG-2020-FEB-2021-INDIGO-AND-VIOLET-Bb-Collaborat

    Uploaded by

    Jolaine Vallo
    This document discusses the case of a 60-year-old female patient presenting with shortness of breath. Upon examination, she was found to have decreased breath sounds and dullness on the left lower lung field. Imaging and labs were ordered which showed a left pleural effusion. She was admitted with an impression of community-acquired pneumonia with possible parapneumonic effusion or uncontrolled diabetes. During a thoracentesis procedure for fluid drainage, she developed chest pain, dyspnea, diaphoresis and weak pulses, concerning for tension pneumothorax which required needle aspiration. Her hospital course and medications were discussed as well as follow up instructions prior to discharge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 39

    PULMO CASE

    DISCUSSION

    MPR NATIVIDAD, MD
    PULMO CASE DISCUSSION

    60 year old
    female
    Hinihingal po ako

    INTERVIEW THE PATIENT


    PULMO CASE DISCUSSION

    60 year old
    female
    Hinihingal po ako

    WORKING IMPRESSION?
    PULMO CASE DISCUSSION

    60 year old
    female
    Hinihingal po ako

    WORKING IMPRESSION?
    CAP, MR
    DM, uncontrolled
    ? CAD
    FOCUSED PHYSICAL EXAM
    FOCUSED PHYSICAL EXAM
    • GS- awake, aware, cooperatve; slight prominence of the SCM, can speak in
    short sentences, suprasternal and supraclavicular retractons
    • VS- BP 130/80, CR 110, RR 25, T 38, O2sat 93% at room air
    • Trachea midline, JVP 3 cm at 45o
    • Chest
    • I- lagging of L
    • P- decreased tactle fremit T4 down L
    • P- dull T4 down L
    • A- absent BS T4 down L
    • Apex beat 5th LICS parasternal line not difuse/sustained, no murmurs, no S3
    FOCUSED PHYSICAL EXAM for DM

    • Examine for the complicatons of DM


    • Retnopathy- funduscopic exam
    • Vasculopathy- (aside from examinaton of the heart) peripheral
    pulses
    • Nephropathy- examine skin color, presence of acetone breath,
    edema
    • Neuropathy- sensory exam
    PULMO CASE DISCUSSION

    60 year old
    female
    ADMITTING IMPRESSION?
    PULMO CASE DISCUSSION

    60 year old
    female
    ADMITTING IMPRESSION?
    CAP, MR
    Pleural efusion L ?etology
    DM uncontrolled
    ? CAD
    PULMO CASE DISCUSSION

    60 year old
    female
    What will we request for?
    PULMO CASE DISCUSSION

    60 year old
    female
    What will we request for?
    -Chest x-ray PA and lat
    -ABG
    -12 lead EKG
    -CBG
    -PT with INR
    -CBC
    PULMO CASE DISCUSSION

    60 year old
    female
    What will we request for?
    -Work up for DM
    PULMO CASE DISCUSSION

    60 year old
    female
    What will we prescribe?
    PULMO CASE DISCUSSION

    60 year old
    female
    What will we prescribe?
    - B lactam + macrolide or
    respi FQ
    - O2 inhalaton

    - Medicatons for DM
    PULMO CASE DISCUSSION
    PULMO CASE DISCUSSION

    Take a screenshot!!
    SUBMIT - ATMLL
    PULMO CASE DISCUSSION
    PULMO CASE DISCUSSION
    PULMO CASE DISCUSSION

    WHAT WILL WE REQUEST FOR?


    PULMO CASE DISCUSSION

    WHAT WILL WE REQUEST FOR?


    - Diferental count
    - Gram stain, culture
    - AFB smear, Genexpert
    - Cytology, mesothelial cell count
    PULMO CASE DISCUSSION
    PULMO CASE DISCUSSION
    During the procedure, the patent complains
    of sudden chest pain and dyspnea.

    WHAT SHOULD WE CONSIDER?


    PULMO CASE DISCUSSION
    During the procedure, the patent complains
    of sudden chest pain and dyspnea.

    WHAT SHOULD WE CONSIDER?


    - PNEUMOTHORAX

    HOW DO WE CONFIRM?
    PULMO CASE DISCUSSION
    During the procedure, the patent complains
    of sudden chest pain and dyspnea.

    WHAT SHOULD WE CONSIDER?


    - PNEUMOTHORAX

    HOW DO WE CONFIRM?
    - ULTRASOUND
    PULMO CASE DISCUSSION
    PULMO CASE DISCUSSION
    During the procedure, the patent complains
    of sudden chest pain and dyspnea. She
    becomes diaphoretc and pulses are weak.
    WHAT SHOULD WE CONSIDER?
    PULMO CASE DISCUSSION
    During the procedure, the patent complains
    of sudden chest pain and dyspnea. She
    becomes diaphoretc and pulses are weak.
    WHAT SHOULD WE CONSIDER?
    - TENSION PNEUMOTHORAX
    PULMO CASE DISCUSSION
    During the procedure, the patent complains
    of sudden chest pain and dyspnea. She
    becomes diaphoretc and pulses are weak.
    WHAT SHOULD WE CONSIDER?
    - TENSION PNEUMOTHORAX

    WHAT SHOULD WE DO?


    PULMO CASE DISCUSSION
    During the procedure, the patent complains
    of sudden chest pain and dyspnea. She
    becomes diaphoretc and pulses are weak.
    WHAT SHOULD WE CONSIDER?
    - TENSION PNEUMOTHORAX

    WHAT SHOULD WE DO?


    - Needle aspiraton
    PULMO CASE DISCUSSION

    WHAT SHOULD WE CONSIDER?


    PULMO CASE DISCUSSION

    WHAT SHOULD WE CONSIDER?


    COMPLICATED PARAPNEUMONIC
    EFFUSION
    PULMO CASE DISCUSSION

    WHAT SHOULD WE CONSIDER?


    COMPLICATED PARAPNEUMONIC
    EFFUSION
    - Loculatons
    - pH < 7.2
    - (+) G stain/ culture
    - Gross pus (empyema)
    DRAINAGE OF FLUID
    PULMO CASE DISCUSSION

    HOW DO WE MONITOR
    RESPONSE TO TREATMENT?

    - Clinical improvement within


    3-5 days
    - Lower level of fuid by PE
    PULMO CASE DISCUSSION

    DISCHAGE DIAGNOSIS?
    PULMO CASE DISCUSSION

    DISCHAGE DIAGNOSIS?
    CAP MR
    Parapneumonic efusion, L
    s/p thoracentesis
    DM, poorly controlled
    PULMO CASE DISCUSSION

    TAKE HOME MEDICATIONS?


    PULMO CASE DISCUSSION

    TAKE HOME MEDICATIONS?


    - B lactam + Macrolide to
    complete 7 days
    - DM medicatons
    PULMO CASE DISCUSSION

    Discharge advice?
    - DM control!
    - Repeat chest x ray
    afer 6 weeks
    PULMO CASE DISCUSSION

    Asynchronous learning
    - ATMLL
    - CONCEPT MAP

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